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Deucalione iodine is an essential mineral vital for the optimal function of the thyroid gland in human beings. Apart from being found in a variety of foods, it is a component of various medications, amiodarone and expectorants, iodine-based swabs used for skin cleaning before interventional and surgical procedures, and iodinated contrast media in medical settings. Jod-Basedow Phenomenon, also known as Jod-Basedow Syndrome or iodine-induced thyrotoxicosis, is a rare cause of thyrotoxicosis that characteristically refers to a paradoxical phenomenon in which large loads of exogenous iodine can cause hyperthyroidism. This phenomenon is mainly seen in populations already at risk for thyroid diseases, such as autoimmune thyroid diseases, prior thyroid surgical history, latent Graves' disease, and prior non-toxic diffuse or nodular goiter formation, or those with underlying kidney disease, such as chronic kidney disease and end-stage renal disorders, which can impact iodine excretion. Typically, it is recognized in those with the administration of a large iodine load, dietary supplement, iodinated contrast media used in conjunction with computed tomography scans, angiography, and various other imaging studies, iodinated antiseptic solutions and oral supplements, or a medication, mainly amiodarone, class III antiarrhythmic drug used in the treatment of recurrent severe ventricular arrhythmias, paroxysmal atrial tachycardia, atrial fibrillation and maintenance of sinus rhythm after cardioversion of atrial fibrillation. Prophylactic medical management of the phenomenon may include antithyroid drugs, methimazole, or perchlorate, to be considered for patients at risk for developing iodine-induced thyrotoxicosis that is scheduled for radio imaging modalities by using iodinated contrast media. Moreover, the preliminary management modality comprises cessation of iodine administration, avoiding further exposure, administration of beta-adrenergic antagonists, thionamides, corticosteroids, and rarely lithium. Prognosis is usually favorable, although a small percentage of cases could suffer permanent sequelae from iodine-induced thyrotoxicosis. Nevertheless, complications are remarkable including thyroid storm, permanent hyperthyroidism, atrial fibrillation, and fetal hypothyroidism with goiter development, in terms of ordering iodinated contrast media in pregnants. Jod-Basedow Phenomenon should not be overlooked and should be managed by an interprofessional healthcare team serving and officiating not only to treat it but also to concern themselves, actively in the relevant prophylaxis.

May 25, World Thyroid Day, WTD, was officially accepted at the Annual General Meeting of the European Thyroid Association (ETA) before the September 2007 Congress in Leipzig, Germany. Although the date also refers to the establishment day of ETA in 1965, the aim is to create awareness about thyroid diseases on this day. After World Thyroid Day was first celebrated by ETA, in 2010, the American Thyroid Association (ATA) declared its support for this day. In addition, on May 25-31, International Thyroid Awareness Week, ITAW, is celebrated worldwide with the mentorship of Thyroid Federation International. The "thyroid gland", commonly used terminology simply "thyroid", is an important endocrine organ localized in front of the neck, extending laterally on both sides. This butterfly-shaped and delicate (1) vital organ is responsible for many metabolic activities that are critical for the organism through the secretion of thyroid hormones. Therefore, "thyroid health" becomes extremely important. As such, thyroid gland disorders continue to affect all age groups globally and possess a wide spectrum of signs and symptoms. Among these, hypothyroidism, thyrotoxicosis with or without hyperthyroidism, goiter, congenital thyroid diseases, thyroiditis, retro/substernal goiter, follicular nodular thyroid disease with primary and secondary thyroid carcinomas are noteworthy. Family history, genetic and familial predisposition, radiation exposure to the head & neck and thorax region during the first two decades particularly in children and women (0-20 years of age), iodine deficiency, and some drugs such as amiodarone are known as the leading factors to the thyroid gland disorders. Nevertheless, the Public Health Update reported that more than 200 million people worldwide are facing thyroid disorders, and over 50% of them remain undiagnosed. To achieve an accurate diagnosis for disorders and also carcinomas with their metastasis and recurrences before histopathology and during postoperative follow-up of this small, delicate, and papillon vital organ that can affect the whole organism: (i) biochemical essays (fT3, fT4, tT3, tT4, TSH, Tg, antiTg, antiTPO, calcitonin, TSI/TRAb, US-guided-Tg/calcitonin washout); (ii) imaging modalities (sonography, strain, and shear wave elastography, SWE, scintigraphy and CT, MRI, 18-FDG PET/CT, and 131I-WBS, when necessary) and (iii) cytopathologic examinations have been utilized. However, thyroid and neck US and cytopathological examination, in particular, still maintain their importance today. Indeterminate cytology (Category III, IV, V, The Bethesda System for Reporting Thyroid Cytopathology, TBSRTC, 1st and 2nd ed.s) (2,3) in cytopathology and follicular nodular thyroid disease, in general, is one of the controversial topics which remains to be a significant topic in Thyroidology (4,5). The latest ATA guidelines, 2015 ATA Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer (6), recommended repeat FNA cytology, molecular tests with further surveillance or diagnostic surgery, considering worrisome sonographic and clinical features with patient preference, as novel approaches in Endocrine Surgery, Endocrine Pathology, and Thyroidology to resolve the challenging issue, Category III, TBSRTC (AUS/FLUS, atypia of undetermined/follicular lesion of undetermined significance), which is at the center of the aforementioned controversion (Recommendation 15A, Weak recommendation, Moderate-quality evidence; 15B, Strong recommendation, Low-quality evidence). Of note, some authors and authorities have advocated the potential need for separation in TBSRTC in terms of Category III, AUS/FLUS (7,8,9). We very recently also postulated the so-called subdivision concept in Category III, TBSRTC, id est, (i) Category IIIA: AUS/FLUS without nuclear atypia (AUS/FLUS wo NA), and (ii) Category IIIB: AUS/FLUS with nuclear atypia (AUS/FLUS w NA) within the possible forthcoming 3rd ed., the 202X TBSRTC (10,11). Mater artium necessitas. Therefore, a novel risk of malignancy, ROM, for each diagnostic category of possible forthcoming TBSRTC would selectively enrich the different management proposals in Thyroidology. As a matter of fact that this issue merits further investigation. Bene diagnoscitur bene curatur.. Dum vivimus servimus.

Background:The goal is to evaluate the association between the topo-sonographic polarity of the thyroid nodules and the thyroid malignancy by analyzing its effect on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), score of Strain Elastography (SE) for thyroid as Tsukuba Elasticity Score (TES), and histopathologic assessment. Material and Methods: A preliminary single-center retrospective study was carried out by including the documents of 641 consecutive eligible patients, possessing 770 thyroid nodules which undergone neck ultrasonography (US), Doppler US, SE, and US-guided-fine needle aspiration (FNA) during April 2011 to April 2017. The stiffness had been measured by TES of SE. The ability of the prediction of the malignancy by the polarity of 770 thyroid nodules considering the association between; i) TBSRTC and histopathology and ii) TES and histopathology had been evaluated. Results: Of the 770 thyroid nodules evaluated, 408 (53.0%) were located at the superior pole (Pol 1) while 362 (47.0%) were at the inferior pole (Pol 0) with 0.9046 AUC and 0.8171 AUC for the association between TBSRTC and histopathology and 0.9280 AUC and 0.7888 AUC for the association between TES and histopathology, respectively. However, those difference were not significant for Pol 1, topographically. Conclusion: The topograghic and sonographic polarity of the thyroid nodules may not be useful for estimating the thyroid malignancy by using the association between TBSRTC and histopathology with TES and histopathology. However, the association with Pol 1, the superior thyroid pole, was stronger though the difference was not significant.

Thyroidology has yet to declare the optimal needle size for thyroid fine-needle aspiration (FNA) cytology. In this respect, the researches on this issue remain restricted in English-language literature. Currently, Saraph and colleagues (1) evaluated dissimilarity between 23- and 25-gauge needles in terms of nondiagnostic/unsatisfactory rates of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) after FNA applications. The authors had worked with a sum of 141 23- and 157 25-gauge needles and reported their nondiagnostic/unsatisfactory rates as 31.09% and 35.07%, respectively, with no statistical difference. However, Dong et al. (2) reported working with 240 consecutive nodules, had undergone US-guided FNA (US-FNA), and obtained the highest scores of sample quality with 25-gauge needles in thyroid FNA cytology, comparing with 22- and 23-gauge needles, very recently. The authors declared the nondiagnostic scores of 15.42%, 19.58%, and 14.17% for US-FNA with 22-, 23-, and 25-gauge needles, respectively (2). In addition, recently, Shumrick et al. (3) reported 148 thyroid nodules in 107 cases, had undergone US-FNA, revealing significantly less non-diagnostic cytology with 27-gauged needles, 11.3%, comparing 25-gauge needles, 24.7%. We recently have studied the possible impact of size cutoff of 10- and 15-mm for the thyroid nodules on three diagnostic tools; i) strain elastography (SE), ii) sonography-guided FNA cytology, and iii) histopathology. A sum of 425 cases with 500 thyroid nodules had undergone US-guided FNA (USFNA) with 27-gauge finest-needle by a single surgeon (I.S.), surgeon-performed US (SUS), with a local anesthetic agent (1-3 mL of 1% lidocaine with 1:100,000 epinephrine) based on American Thyroid Association (ATA) management guidelines for patients with thyroid nodules and differentiated thyroid cancer [i.e. low, intermediate, and high suspicion nodules]; 2015 ATA management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer] for three years and two months. TBSRTC 1st ed. had been used for this period, for the mentioned considerable and novel ‘SUS based’ US-FNA terminology with the specific and also ‘ well-accepted and crucial’ size cut offs of 10- and 15- mm in Thyroidology revealing the FNA cytology outcomes with27-gauge fine needles, for Category I, per se, TBSRTC, 1st ed. were revealed as 9.0% (4). Moss et al.(5) notified that regular and coordinated thyroid FNA should be performed with smaller needle gauges, 24-27-gauges, without aspiration, routinely, in a systematic review and meta-analysis. Saraph et al. (1) specified the utilization of a 25-gauge needle did not produce a lower nondiagnostic rate, comparing the 23-gauge one. In addition, they pointed out that larger nodules might increase diagnostic rates, while the older and cystic nodules are prone to inadequate samples. We agree with Saraph and colleagues’(1) opinion about the limitations of nodule location, such as a posterior, more difficult to reach nodules, and sonography of composition (mixed and solid) and echogenicity which may be crucial parameters for this issue. Nonetheless, we postulate that the so-called needle gauge concept selectively enriches with finer needles. Additionally, we currently introduced the proposal of a novel terminology, “minimally invasive FNA (MIFNA)” and “minimally invasive thyroid FNA; Thyroid MIFNA (Thy MIFNA)”, including 27-gauge fine-needle with pre-procedural topical and local anesthetic agents administration, hope to contribute in Thyroidology (6). Of note, we might recommend opting for a 27-gauge finest needle in terms of US-FNA for a butterfly gland, the thyroid, with reasonable low rates of non-diagnostic/unsatisfactory cytology, TBSRTC, 1st and 2nd ed. and low severity of pain, as a matter of course. To this end, we also recommend: “think twice with larger needles for thyroid US-FNA”. This issue merits further investigation.

Objective: Microscopically, the thyroid gland is composed of spherical follicles and thyroid parenchyma includes two major cell types, the thyrocytes releasing thyroid hormones and C cells secreting mature calcitonin. Hypothyroidism has been known as being associated with the various abnormalities of the coagulation system. In the present study, it had been purposed to inverstigate the relationship between inflammatory hematological parameters, RBC, Hb, Htc, RDW, WBC, neutrophil, lymhocyte, N/L, Plt, MPV, PCT, PDW and hypothyroid hormonal status in the cases possessing the benign thyroid nodules. Material and Methods: A total of 313 cases, 202 with hypothyroidism, 111 with euthyroidism possesing the benign thyroid nodules, that was verified with the cytological evaluation after one-endocrine surgeon performed ultrasonography (US) guided fine needle aspiration (FNA) (US-g-FNA), at the Division of Endocrine Surgery, Department of General Surgery, Giresun University Faculty of Medicine, Giresun, Turkey, in conformity with the criteria, were enrolled into the study during the period, from April 2010 to April 2015. The documents that were used to follow consisted of laboratory tests of the cases including both the thyroid hormones, freeT3, FreeT4, and TSH, and the inflammatory hematological parameters were reviewed and scanned retrospectively. The upper limit of the normal Thyrotropin (TSH) reference range was determined as 4 mU/L in the present study. Results: No statistically significant difference was found between the inflammatory hematological parameters, RBC, Hb, Htc, RDW, WBC, neutrophil, lymhocyte, N/L, Plt, MPV, PCT, PDW, and hypothyroidism (p>0.05). Conclusion: Inflammatory hematological parameters may not be useful for estimating the hormonal status of the thyroid gland in the cases with the benign thyroid nodules verified with the cytological evaluation, TBSRTC.

Objective: Neutrophil lymphocyte ratio (N/L) and mean platelet (Plt) volume (MPV), the markers of systemic inflammatory response, has been investigated in many cancers, but data for head and neck cancers and thyroid carcinoma are limited. It had been purposed to study N/L, MPV, and Plt levels in papillary thyroid carcinoma (PTC) as a diagnostic marker. Material and Methods: A total of 104 patients, had undergone ultrasonography (US) guided fine needle aspiration (FNA) and thyroidectomy, for indicated cases, between April 2010 and August 2013, were enrolled in the study and the laboratory tests, regarding N/L, MPV, and Plt, of the cases had been collected retrospectively. Results: No any difference was stated between PTC and benign nodular thyroid diseases (BNTD) in terms of age, gender, size of the nodule, N/L, MPV, and Plt (p>0.05). Conclusion: The preoperative inflammatory hematological parameters, in terms of N/L, MPV, and Plt, may not be useful as a predictive diagnostic marker of the thyroid malignancy, PTC.

To the Editor, A 34-year-old Turkish woman presented with a left-sided cervical accessory thyroid gland. Her B-Mode thyroid ultrasonography exhibited an accessory thyroid parenchyma adjacent to the inferolateral border of left lobe of the thyroid gland (Figure 1a). fine-needle aspiration (FNA) cytology (FNAC) is a frequently used primary diagnostic procedure worldwide due to its preciseness, easiness, non-invasiveness, possessing very little complications and low cost [1, 2]. The thyroid gland ectopia and accessory thyroid tissue are two patterns of the abnormal thyroid gland migration. Ectopic thyroid gland is rare phenomenon and described as a functioning thyroid tissue in an aberrant area along the embryological descending line of the thyroid gland. Its most common form is known as lingual thyroid, accounting for 90 %. Aproximately 70 % of patients will exposed to the hormonal status of sub-clinical hypothyroidism [3]. These phenomenon may later undergo a malignant transformation [4]. An accessory thyroid gland is determined as a permanence of the thyroidal parenchyma anywhere from the base of the tongue to the thyroid isthmus, with the majority of the functional thyroid in its normal pre-tracheal area. The incidence of accessory thyroid gland is unknown [3]. Of 58 cadavers just one (1/58) was detected as the accessory thyroid gland on the thyroid cartilage by Braun et al [3]. Radkowski et al [5] performed thyroid US on 230 cases of the throglossal duct cyst and detected four cases (4/230) with the accessory thyroid tissue and three (3/230) with the ectopic thyroid gland. Therefore, they propunded the possibility of their equality in the incidence. The accessory thyroid glands are classified into five groups, based on their anatomical location: (1) cranial, (2) caudal, (3) lateral, (4) ventral, and (5) dorsal glands. They usually are founded along the former course of the thyroglossal duct and emigrate laterally [6]. Pyramidal lobes, superior accessory thyroids, retrotracheal, inferior/lateral extensions or extrusions are involved in the reasons of the recurrent thyroid diseases as the anomalies of the gland. Richards et al [3] asserted both thyroid gland ectopia and accessory thyroid tissue being vulnerable to the same potential diseases as a normally-situated thyroid gland. An accessory thyroid gland do not lead to clinical complication except in cases of the pathologic conditions such as goitre, malignancy, and the others. A thyroid FNA were planned, performed and its cytopathological evaluation with Haematoxylin and Eosin revealed a huge cellular cluster including the benign thyrocytes (Figure 1b). Therefore, a clinical follow-up was suggested for the present case, after a benign FNAC. Conclusively, education, training, and cognition of the thyroid anatomy and its associated variations and anomalies are very much essential for these kinds of the cases and it will lead to increasing the level of awareness.