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ABSTRACT: The diagnosis of Hashimoto thyroiditis (HT), especially in a nodular goiter, can be challenging. This study was performed to determine the accuracy of cytologic interpretation in the diagnosis of the disease. HT was suggested in fine needle aspiration biopsies (FNA), obtained from 109 patients. These features were correlated with the results of serologic and thyroid function tests, and with sonographic data. Repeated FNA was performed in 42 patients. Hypothyroidism was diagnosed in 54 (49.5%) and hyperthyroidism in 7 patients (6.4%). Thyroid autoantibodies-thyroid peroxidase >100 were detected in 49 (45%) and antithyroglobulin antibodies >400 in 20 patients (18%). Chronic thyroiditis was suggested by ultrasonography in 4 patients (4.2%). In 109 aspirates, HT was diagnosed in 56 (51.3%) based on elevated titer of thyroid peroxidase and/or antithyroglobulin autoantibodies. We conclude that the cytodiagnosis of HT, especially when a single thyroid nodule is present, is difficult. FNA is unwarranted if the diagnosis can be made on clinical and serological grounds.
The Endocrinologist 02/2009; 19(2):55-57. · 0.09 Impact Factor
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ABSTRACT: Primary hyperparathyroidism is usually an asymptomatic disease characterized by mild hypercalcemia and elevated parathormone (PTH) levels. Recently, a normocalcemic group of individuals with increased PTH levels has been identified. The purpose of this study was to investigate whether these normocalcemic patients have abnormal parathyroid glands as imaged by high-resolution ultrasonography.
Fourteen patients with normocalcemic primary hyperparathyroidism (NPHP) were studied. Secondary causes of hyperparathyroidism such as vitamin D deficiency and renal dysfunction were excluded. High-resolution ultrasonography was performed on all 14 subjects.
All patients had high PTH levels (112 ± 33 pg/mL), normal corrected serum calcium (9.6 ± 0.3 mg/dL) and 25 hydroxyvitamin D (27.5 ± 5.3 ng/mL) levels. All patients had a normal creatinine clearance (97 ± 19 mL/mn). The ultrasound examination revealed a parathyroid adenoma, either single or double, in 10 of 14 patients (71%).
The high prevalence of parathyroid adenomas on sonography indicates that NPHP is characterized by the same morphologic derangement as the hypercalcemic form of the disease. Thus, NPHP is probably an early manifestation of primary hyperparathyroidism.
The Endocrinologist 04/2008; 18(3):130-133. · 0.09 Impact Factor
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ABSTRACT: Although renal vein thrombosis (RVT) is a complication of various renal and medical conditions, nephrotic syndrome is known as the most frequent one. RVT in patients suffering from nephrotic syndrome is rarely present with flank pain. Most patients are asymptomatic and recover spontaneously. The treatment of RVT consists of handling the primary condition and treating the thrombosis itself by anticoagulation. In severe cases with grave prognosis thrombolytic therapy is needed. This is a case study of a 38 year old male who presented with severe renal colic which subsequently diagnosed as RVT complication of the nephrotic syndrome. The article also reviews the literature regarding the frequency, etiological factors, pathophysiology, radiological diagnosis and disease treatment.
Harefuah 09/2006; 145(8):597-600, 629.
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ABSTRACT: In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis (APN) is a challenge, particularly during infancy. In an attempt to differentiate APN from lower urinary tract infection (UTI), we evaluated the ability of power Doppler ultrasonography (PDU) to predict renal parenchymal involvement, as assessed by dimercaptosuccinic acid ((99m )Tc-DMSA) scintigraphy. The study comprised 62 patients, 46 girls and 16 boys, aged 2 weeks to 5 years, admitted to the pediatric department with febrile UTI. All children were examined by PDU and DMSA scintigraphy within the first 3 days of admission. In the group of 31 patients with one or more DMSA scan abnormalities, the PDU showed a matching perfusion defect in 27 (87%). Of 26 children with normal DMSA scintigraphy, the PDU evaluation was also normal in 24. The sensitivity and specificity of PDU for the detection of affected kidneys were 87% and 92.3%, and the positive predictive value and negative predictive value were 93.1% and 85.7%, respectively. These data indicate the PDU has a high sensitivity and specificity for differentiating APN from lower UTI and may be a useful and practical tool for the diagnosis of APN in infants and children.
Pediatric Nephrology 10/2004; 19(9):987-91. · 2.52 Impact Factor
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ABSTRACT: PURPOSE This study assessed the role of renal power Doppler ultrasonography (PDU) to identify acute pyelonephritis (APN) and to determine whether PDU can replace Tc-99m DMSA renal scintigraphy in the diagnosis of APN in children. METHODS A prospective study was conducted in 40 infants and young children (78 kidneys were evaluated) with a mean age of 25.9 months (range, 1 to 68 months) who were hospitalized with a first episode of high fever and bacteruria, possibly APN. All children were examined by PDU and Tc-99m DMSA within the first 3 days after admission. Patients with congenital abnormalities, hydronephrosis, and urinary reflux were excluded. RESULTS Twenty-seven of the 78 kidneys appeared abnormal on Tc-99m DMSA, and 20 of them were abnormal on PDU. Fifty-one of 78 kidneys were normal on Tc-99m DMSA, and 3 of 51 appeared diseased on PDU. The accuracy of PDU was 87%, sensitivity was 74%, and specificity was 94%. The positive predictive and negative predictive values were both 87%. When considering the numbers of lesions in 27 kidneys with positive Tc-99m DMSA studies (38 lesions), PDU did not disclose 16 lesions (false-negative results). Thus, the sensitivity of PDU for diagnosing lesions of APN decreased to 58%. CONCLUSIONS A positive PDU finding should obviate the use of Tc-99m DMSA in patients thought to have possible APN. However, because of a large number of false-negative results (26%) and underestimation of the number of pyelonephritic lesions (low sensitivity of 58%), PDU cannot replace Tc-99m DMSA in the diagnosis of APN in children.
Clinical Nuclear Medicine 04/2003; 28(3):198-203. · 3.67 Impact Factor
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ABSTRACT: To assess the value of color-flow Doppler sonography (CFDS) in evaluating intrathyroidal blood flow and velocity in patients with subclinical thyroid dysfunction.
In this prospective study, patients with subclinical hypothyroidism, patients with subclinical hyperthyroidism, and euthyroid patients without known thyroid autoimmune disease who served as controls were included. Subclinical thyroid dysfunction was defined as normal se-rum free thyroxine (FT4) and free triiodothyronine (FT3) in the presence of high (subclinical hypothyroidism), or low-suppressed (subclinical hyperthyroidism) serum thyrotropin (TSH) levels. Serum FT4, FT3, TSH, and antibodies to thyroid peroxidase and thyroglobulin were measured in all participants. In addition, TSH receptor antibody levels were determined in patients with subclinical hyperthyroid-ism. All participants underwent conventional sonography and CFDS. Mean peak systolic velocity (PSV) and resistive index were obtained from multiple extranodular thyroid parenchyma samplings and inferior thyroid artery measurements.
The study population included 27 patients with subclinical hypothyroidism, 15 patients with subclinical hyperthyroidism, and 20 euthyroid patients. Patients with subclinical hypothyroidism had significantly higher mean intrathyroidal PSV values than control patients (19.9 +/- 5.6 cm/s vs 15.7 +/- 4.4 cm/s; P = .008), whereas patients with subclinical hyperthyroidism had significantly higher mean PSV values than control patients at the inferior thyroid artery level (29.7 +/- 10.7 cm/s vs 21.9 +/- 6.8 cm/s; P = .014). Compared with control patients, a greater proportion of patients with subclinical hypothyroidism and patients with subclinical hyperthyroidism had marked CFDS patterns (78% vs 15% [P<.001] and 53% vs 15%; [P<.001], respectively). A significant association was found between positivity for thyroid autoantibodies and intense CFDS patterns. No correlation was found between TSH or thyroid hormone levels and CFDS pattern or blood flow velocity.
We have demonstrated that significantly increased thyroid blood flow velocity and vascularity are already present in patients with mild thyroid dysfunction.
Endocrine Practice 16(3):376-81. · 2.49 Impact Factor
