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Thyroid volume was found to be a determinant of serum calcitonin levels in animal models and in thyroid-healthy subjects, as recently reported. This study aims to evaluate if this finding is confirmed in patients undergoing ultrasonographyguided fine-needle aspiration cytology of suspicious thyroid nodules. A dataset of 561 patients including basal serum FT4, FT3, TSH, calcitonin, thyroid volume, anti-thyroperoxidase antibodies (TPOAb), and cytology report, was retrospectively analysed. The median thyroid volume was 20.5 ml (14.5-26.8) in males and 12.0 ml (9.3-17.0) in females (p < 0.001). The overall median serum calcitonin value was 2.00 pg/ml (2.00-3.10). A Spearman's correlation was performed between serum calcitonin levels and thyroid volume, showing a weak direct relationship (rs = 0.173, p < 0.001). This relationship is confirmed both in the smokers group (rs = 0.337, p = 0.003) and in non-smokers group (rs = 0.115, p = 0.012), and both in the TPOAb-positive patients (rs = 0.419, p < 0.001) and negative ones (rs = 0.107, p = 0.025). There is no correlation between serum TSH and calcitonin levels. In patients grouped according to morphologic diagnosis, calcitonin levels are slightly higher in the high-volume groups: the interquartile range was 2.00-2.00 pg/ml in the atrophy, 2.00-2.82 pg/ml in the normal volume, and 2.00-3.85 pg/ml in the goiter group (p = 0.02). When males and females are computed separately, the statistical significance is lost. In conclusion, thyroid volume can mildly influence calcitonin levels. Gender acts as a "surrogate marker" of thyroid volume and the application of a gender-specific cut-off can probably overcome this issue in clinical practice. [ABSTRACT FROM AUTHOR]

Ultrasonography is the main imaging method for the workup of thyroid nodules. However, interobserver agreement reported for echogenicity and echotexture is quite low. The aim of this study was to perform quantitative measurements of the degree of echogenicity and heterogeneity of thyroid nodules, to develop an objective and reproducible method to stratify these features to predict malignancy.A retrospective study of patients undergoing ultrasonography-guided fine-needle aspiration was performed in an University hospital thyroid center. From January 2010 to October 2012, 839 consecutive patients (908 nodules) underwent US-guided fine-needle aspiration. In a single ultrasound image, 3 regions of interest (ROIs) were drawn: the first including the nodule; the second including a portion of the adjacent thyroid parenchyma; the third, the strap muscle. Histogram analysis was performed, expressing the median, mean, and SD of the gray levels of the pixels comprising each region. Echogenicity was expressed as a ratio: the nodule/parenchyma, the nodule/muscle, and parenchyma/muscle median gray ratios were calculated. The heterogeneity index (HI) was calculated as the coefficient of variation of gray histogram for each of the 3 ROIs. Cytology and histology reports were recorded.Nodule/parenchyma median gray ratio was significantly lower (more hypoechoic) in nodules found to be malignant (0.45 vs 0.61; P = 0.002) and can be used as a continuous measure of hypoechogenicity (odds ratio [OR] 0.12; 95% confidence interval [CI] 0.03-0.49). Using a cutoff derived from ROC curve analysis (<0.46), it showed a substantial inter-rater agreement (k = 0.74), sensitivity of 56.7% (95% CI 37.4-74.5%), specificity of 72.0% (67.8-75.9%), positive likelihood ratio (LR) of 2.023 (1.434-2.852), and negative LR of 0.602 (0.398-0.910) in predicting malignancy (diagnostic odds ratio 3.36; 1.59-7.10). Parenchymal HI was associated with anti-thyroperoxidase positivity (OR 19.69; 3.69-105.23). The nodule HI was significantly higher in malignant nodules (0.73 vs 0.63; P = 0.03) and, if above the 0.60 cutoff, showed sensitivity of 76.7% (57.7-90.1%), specificity of 46.8% (42.3-51.4%), positive LR of 1.442 (1.164-1.786), and negative LR of 0.498 (0.259-0.960).Evaluation of nodule echogenicity and echotexture according to a numerical estimate (nodule/parenchyma median gray ratio and nodule HI) allows for an objective stratification of nodule echogenicity and internal structure.

The heterogeneity of diagnostic criteria of Hashimoto's thyroiditis leads to overdiagnosis and prevents strong conclusions from being drawn in clinical studies. The aim of this study is to propose a comprehensive scoring system. A case-control study compared a set of presurgical features of patients with lymphocytic infiltration of the thyroid (Hashimoto's thyroiditis) and controls, in order to design a multi-criteria scoring system. Given a dichotomous outcome (lymphocytic infiltration of the thyroid), a set of covariates was analyzed in 180 patients after total thyroidectomy. A different validation cohort of 1,171 patients was reviewed and classified according to the score. Variables associated with the diagnosis of Hashimoto's thyroiditis were first assessed by univariate analysis. Analysis showed that TPOAb (area under the ROC curve (AUC), 0.67; 95 % CI 0.57-0.77) and TgAb (0.63; 95 % CI 0.54-0.74) were univariate predictors of the diagnosis of HT, which is largely recognized. Combined covariates were then tested using stepwise logistic regression analysis. The final regression model included TPOAb, TgAb, and thyroid vascularity (AUC 0.72; 95 % CI 0.62-0.81). A scoring system was developed, which has a sensitivity of 45.5 % and a specificity of 89.0 %, with a cutoff of 1.7. The likelihood of incident hypothyroidism was higher (OR 2.30; p = 0.004) in the positive (≥1.7) score group. A scoring system has a better performance than any single predictor and is able to identify the subgroup of individuals at higher risk to develop subsequent hypothyroidism.

Background: Whether the risk of cancer is increased in patients with chronic autoimmune thyroiditis is a controversial issue., Methods: Between May 2005 and October 2012, 3777 fine-needle aspiration cytologies (FNACs) were performed on 2562 patients. Serum FT4, thyroid-stimulating hormone (TSH), anti-thyroglobulin antibody (TgAb), and anti-thyroperoxidase antibody (TPOAb) were determined., Results: Patients with suspicious cytology were younger and presented smaller maximum lesion diameter. In patients with TgAb positivity, suspicious cytology was detected more frequently (9.4%) than patients without TgAb (5.7%; p = .04). No significant difference was recorded between benign and suspicious cytology in the positive TPOAb rate. Risk factors for suspicious cytology were younger age (odds ratio [OR], 0.94), smaller maximum diameter (0.95), single lesion (1.85), microcalcifications (3.45), and TgAb (1.74). Mixed solid/fluid content resulted as being a protective factor (0.34). According to multivariate logistic regression analysis, age, mixed content, and microcalcification confirmed significance., Conclusion: Thyroid nodule malignancy in patients with Hashimoto thyroiditis is not more frequent than in patients without thyroiditis., (© 2014 Wiley Periodicals, Inc.)

Problem: Thyroid disease is one of the most common endocrine conditions affecting women during reproductive age. A link between thyroid and assisted reproduction outcome is debated., Method of Study: Serum TSH levels, number and scoring of oocytes and embryos, and number of clinical pregnancies were retrospectively recorded in 164 women undergoing assisted reproduction technologies (ART) at an University-based fertility center, to evaluate the outcome of the first steps of assisted reproduction (ovarian stimulation, oocyte pickup and fertilization, embryo transfer and implantation) in relation to thyroid function and autoimmunity., Results: No significant relationship was found between TSH and all parameters, except clinical pregnancy rate (22.3% in TSH ≤ 2.5 group versus 8.9% in TSH > 2.5 mUI/L group; P = 0.045). No pregnancy occurred in women with anti-thyroperoxidase autoantibodies, while pregnancy occurred in 23.9% of cycles without autoimmunity (P = 0.02)., Conclusion: Further studies must be conducted in order to shed light on the link between infertility and thyroid dysfunction., (© 2013 John Wiley & Sons Ltd.)

During space missions, radiation represents a major hazard for human health and involves all body organs and tissues. Regarding thyroid function, it has been shown that ultraviolet radiation (UVC) has dose-dependent apoptotic effects on FRTL-5 cells, a normal strain of rat thyrocytes. We examined the effects of a sublethal dose of UVC on FRTL-5 cell growth and gene expression. Cells exposed to 10 J/m(2) UVC showed no differences in viability compared to control cells after 24 h, but the BrdU incorporation was reduced, indicating a cytostatic effect. Quantitative RT-PCR carried out at 24 and 48 h after irradiation demonstrated that the mRNA levels of thyroglobulin (Tg), thyroperoxidase (Tpo), and sodium/iodide symporter (Nis) were transiently decreased at 24 h in treated cells, while the mRNAs of the thyroid transcription factors TTF1, Foxe1, and Pax8 were not affected. In cells cultured with TSH-free medium, the basal transcription of Tg, Tpo, and Nis genes was equally impaired by radiation and no longer stimulated by TSH. Overall, the results demonstrate that a sub-apoptotic dose of UVC compromises not only thyrocyte proliferation but also the expression of genes involved in thyroid hormone production. These findings might contribute to explaining the histological, biochemical, and clinical features of hypothyroidism observed in both animals and humans during spaceflight, and suggest that free thyroxine levels of astronauts during prolonged space missions should be monitored.

Objective: To evaluate intrinsic nodule features predictive of an inadequate report in fine-needle aspiration cytology (FNAC)., Design: Single-centre cross-sectional study., Methods: Between May 2005 and April 2011, 3279 ultrasonography-assisted FNACs were carried out and features of nodules recorded prospectively. Univariate logistic regression analyses were performed to estimate the association between nondiagnostic cytology and variables such as age, gender, single nodule, maximum nodule diameter and estimated volume., Results: Inadequate or nondiagnostic samples were reported in 1195 FNACs. All diameters were found to be predictors of nondiagnostic cytology; estimated nodule volume, on the other hand, was not. Nodules with a diameter <10 mm were more frequently nondiagnostic (OR 1.65, 95% CI 1.40-1.94, P < 0.001). Neither micro- nor macrocalcification increased the risk of inadequacy. On the contrary, mixed lesions were more frequently diagnostic (OR 0.68, 95% CI 0.85-0.80, P < 0.001). Solid nodule aspiration was performed more easily on isoechogenic nodules (OR 0.64, 95% CI 0.54-0.77, P < 0.001); the same procedure was more cumbersome on hypoechogenic lesions (OR 1.87, 95% CI 1.62-2.16, P < 0.001). Increased vascularization did not cause a significant increase in the nondiagnostic results. Blurred margins increased the inadequacy rate (OR 1.45, 95% CI 1.24-1.69, P < 0.001), while presence of a hypoechogenic halo decreased it (OR 0.67, 95% CI 0.54-0.82, P < 0.001)., Conclusions: Some ultrasonographic features suggestive of malignancy may be predictive of inadequate cytology. Patients must be notified that the FNA report may be nondiagnostic and that this represents a limitation of the technique related to the structure of lesions., (© 2012 Blackwell Publishing Ltd.)

Aim: Several studies have been undertaken to investigate a possible link between breast cancer and thyroid diseases, notably thyroid carcinoma and autoimmune thyroid diseases, but the issue remains unresolved. The aim of this study is to evaluate, in thyropathic women with and without breast cancer, the following effects: the distribution of different thyroid diseases, the breast-cancer-related prevalence of anti-thyroperoxidase and anti-thyroglobulin antibodies and the role in thyroid pathology of breast-cancer post-surgery therapy with tamoxifene., Materials and Methods: One-hundred-ninety thyropathic women with breast cancer (BC group) were recruited, and compared with a control group (C group) of one-hundred-ninety thyropathic women without breast cancer., Results: Nodular disease is the most frequent pathology in both groups. The difference in the incidence of thyroid carcinoma is also not statistically significant. The biochemical increase in the positivity of autoantibodies in BC-group patients is confirmed, but there is no statistically significant difference in the rate of clinical autoimmune diseases between the two groups. No difference in the frequency of any particular thyroid disease is found between those patients who underwent post-operative tamoxifene therapy and those who did not., Conclusion: It can be concluded, on the basis of these results, that it is advisable to reduce the clinical weight of the issue. A routine thyroid screening is recommended in women with BC for the management of chronic comorbidities, as would be for women in the general population having the same age and coming from the same iodine-intake area.

Calcitonin (CT) is an important clinical marker for the diagnosis and follow-up of medullary thyroid carcinoma, although it is not absolutely specific. Some authors have reported C-cell hyperplasia in a number of thyroid specimens affected by Hashimoto's thyroiditis. The association between thyroiditis and hypercalcitoninemia is still controversial because some authors have reported low CT levels. The aim of this study is to evaluate the basal CT values in patients with and without thyroid autoimmunity. From May 2005 to February 2010, 1073 patients underwent ultrasonography-guided fine-needle aspiration cytology at the Thyroid Center of Sapienza University of Rome, with evaluation of basal serum FT4, FT3, TSH, and antithyroid peroxidase (anti-TPO) antibodies as well as CT levels. Forty-one patients presented a basal CT level above the reference upper limit. The mean serum CT was significantly lower in women than in men (4.28 ± 6.63 vs 7.50 ± 25.50  pg/ml; P<0.01). Basal serum CT was not significantly higher in patients showing anti-TPO Ab positivity (4.71 ± 6.46 vs 4.84 ± 13.11  pg/ml; P>0.05). Importantly, the rate of 'suspicious' CT values (above the 10  pg/ml cutoff) was not significantly different between patients with or without thyroid autoimmunity (3.9 vs 3.0%). Patients with hypercalcitoninemia suffering from chronic autoimmune thyroiditis should undergo the same clinical evaluation procedure as patients do without thyroid autoimmunity.

Objectives: On December 1905 Darling, resident histopathologist on the Panama Channel area, observed a parasite in the large mononuclear cells of different organs. Negroni in 1914 described the first Argentinean case. Lung, oral, nasal, and laryngeal involvement are common. On the other hand, genital involvement is uncommon. The objective of this war is to communicate the case of a patient with genital histoplasmosis., Methods/results: A 60-year-old Argentinian male started two years before with penile lesions and pruritus. Two partial penile resections had been performed in 1999, but pathology reports were not available. The lesions evolved towards ulceration and bleeding. Surgical toilette was carried out. A partial penectomy and glanuloplasty with an original technique were performed. Pathology revealed intracellular and extracellular spherical microorganisms. Morphologically it was histoplasma capsulatum. The histoplasmosis is an endemic mycosis. The infection takes place when inhaling the microconidiae of the fungus filamentous phase. Only a small number of people develop the disease after infection. Diagnosis is made by discovering of 2-3 micron yeasts with Giemsa stain., Conclusions: If a patient from the histoplasmosis endemic area has a granular lesion, a mycotic disease should be considered.

We report a case of acute left main coronary artery subocclusion treated by stenting. The patient had a severe ostial left main coronary artery stenosis and after diagnostic coronary angiography developed subocclusion of the left main coronary artery, with TIMI 1 flow and life-threatening hemodynamic consequences. After two balloon dilatations had failed, a half Palmaz-Schatz stent (7 mm) was successfully deployed at the site of the lesion with immediate improvement of the angiographic and clinical picture. We claim that the placement of a half Palmaz-Schatz stent, hand-crimped on a high-pressure and non-compliance balloon, could provide a means for restoring adequate blood flow in patients who develop an important ischemia after diagnostic coronary angiography of a short, calcified left main coronary artery with severe ostial stenosis. Despite the satisfactory angiographic and clinical findings in these patients, the risk of restenosis and the presence of other multivessel diseases press us towards a more definitive surgical treatment.

We describe the case of a patient with angiographic evidence in the right sinus of Valsalva of anomalous origin of LCx and common origin of LAD and RCA. This anomaly, which has not been reported previously, represents a further anatomic variation of the rare anomalous origins of all coronary arteries from right sinus of Valsalva. The symptoms in our patients were related exclusively to the atherosclerotic lesions in LCx and RCA and not to the anatomic anomalies. The patient underwent a bypass graft to LCx and RCA.

Small vessel coronary disease is not commonly found in endomyocardial biopsies (EMB) of nondiabetic patients with clinical evidence of ischemic heart disease, congestive heart failure, or ventricular arrhythmia (VA). In 166 patients studied by heart catheterization and multiple right ventricle EMB, we identified 4 patients with histologic evidence of small vessel disease and normal coronary arteriograms. Two patients were suffering from VA without an obvious cardiac cause. Of the other two, one initially showed frequent ventricular tachycardia attacks followed by congestive heart failure alone. In both patients, the cardiac chambers were dilated and the left ventricular function seriously impaired. In all four patients, the histologic examination of right EMB revealed a wall thickening of the precapillary arterioles and capillary vessels. At ultrastructural examination, an increased thickening (four or five times normal) of the subendothelial lamina and of the basement membrane of capillary pericytes was found. Degenerative changes of cardiac myocells were found in all cases.

A case of severe effort angina treated with Percutaneous Transluminal Coronary Angioplasty (PTCA) is described. The critical coronary lesion involved the left anterior descending coronary artery and the origin of a first diagonal branch. The "kissing balloon" technique was used. After a year, the immediate positive angiographic results remained unchanged.