Thyroid : official journal of the American Thyroid Association
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Comparative Study
Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules: comparison in efficacy according to nodule size.
The objective of this study was to compare the efficacy and procedure time of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules, according to the nodule size. ⋯ US-FNAB of thyroid nodules smaller than 5 mm in maximum diameter was less successful, and the sensitivity was lower than those of nodules larger than 5 mm. We considered, however, that the sampling adequacy and efficacy of US-FNAB of thyroid nodules less than 5 mm in maximum diameter was satisfactory in our series and should be similar in other centers with similar characteristics to ours.
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Clinical repercussions, progression to overt hypothyroidism, and treatment benefits have been well established in patients with subclinical hypothyroidism (SCH) and TSH >10 mIU/L. In contrast, these aspects of the disease are poorly understood in patients with even milder SCH as defined by TSH < or = 10 mIU/L and normal thyroid hormone levels. Therefore, we sought to evaluate the natural history of this milder form of SCH (TSH < or =10 mIU/L with normal thyroid hormone levels) in adult women patients. ⋯ Most patients with SCH and TSH < or = 10 mIU/L do not progress to overt hypothyroidism. The presence of chronic thyroiditis as demonstrated by US increases the evolution of SH to overt hypothyroidism or more severe SCH and thus the need for L-T4 treatment. US findings are important in determining the prognosis of mild SCH.
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Case Reports
Thyrotoxic periodic paralysis complicated by acute hypercapnic respiratory failure and ventricular tachycardia.
Thyrotoxic hypokalemic periodic paralysis in combination with an acute episode of general flaccid paralysis and hypokalemia is common in young Asian men with hyperthyroidism. We report the very rare complications of involvement of the respiratory muscles and ventricular tachycardia in this disorder. ⋯ Thyrotoxic periodic paralysis usually involves the proximal muscles of the limbs, but on rare occasions it can affect the respiratory muscles with the potential for severe and even fatal complications.
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Randomized Controlled Trial Comparative Study
Postoperative intravenous patient-controlled analgesia in thyroid surgery: comparison of fentanyl and ondansetron regimens with and without the nonsteriodal anti-inflammatory drug ketorolac.
Nonsteroidal anti-inflammatory drugs (NSAIDs), through synergistic action with opioids, can reduce postoperative nausea and vomiting via intravenous patient-controlled analgesia (PCA). We compared the efficacy of three PCA regimens. ⋯ The NSAID ketorolac when combined with lower doses of the opioid fentanyl and the same dose of ondansetron is associated with the same analgesic efficacy but less nausea and vomiting after thyroid surgery. A higher ratio of NSAID to opioid, when used as reported here, is associated with less postoperative dizziness.
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Thyroid hormone suppression therapy is associated with decreased recurrence rates and improved survival in patients with differentiated thyroid cancer. Recently higher baseline thyrotropin (TSH) levels have been found to be associated with a postoperative diagnosis of differentiated thyroid cancer. Our objective was to confirm whether preoperative TSH levels were higher in patients who were diagnosed with differentiated thyroid cancer after undergoing thyroidectomy, compared with patients who were found to have benign disease. We also sought to determine whether thyroid hormone levels were lower in the patients with malignancy. ⋯ These data confirm that higher TSH concentrations, even within the normal range, are associated with a subsequent diagnosis of thyroid cancer in individuals with thyroid abnormalities. This further supports the hypothesis that TSH stimulates the growth or development of thyroid malignancy during its early or preclinical phase. We also show for the first time that patients with thyroid cancer also have lower T(3) levels than patients with benign disease.