No abstract

Context: Establishing the etiology of thyrotoxicosis is of utmost importance to plan the appropriate line of therapy. However, certain scenarios such as absence of pathognomonic clinical features of Graves’ disease in some patients, or non-availability of radionuclide scanning and newer generation TRAb assays especially in resource-poor settings, necessitates utilization of other, simple and effective measures to differentiate between the two common causes of thyrotoxicosis, Graves’ disease (GD) and Destructive thyroiditis (DT). Aims: The aim of this work was to study the role of FT3/FT4 ratio, T3/T4 ratio and color flow Doppler ultrasound in treatment-naïve patients with thyrotoxicosis, in comparison to Tc-99m pertechnetate thyroid scanning in the differentiation of thyrotoxicosis due to GD and DT. Materials and Methods: Clinical data was collected from all study subjects. Thyroid function tests including FT3, FT4, T3, T4 and TSH, TSH Receptor Antibody (TRAb), Technetium Tc 99m pertechnetate scan and the mean peak systolic velocity in inferior thyroid artery (mean PSV-ITA) by color Doppler ultrasonography of thyroid gland was done in all patients. Results: A total of 83 treatment-naïve patients with thyrotoxicosis (61 with GD and 22 with DT) were studied. Mean PSV-ITA, T3/T4 ratio and FT3/FT4 ratio showed a sensitivity of 85.2%, 73.8%, and 77.04%, and a specificity of 90.9%, 72.7%, and 59.09%, respectively. The three parameters in combination yielded a positive predictive value of 100% in the diagnosis of Graves’ disease. Conclusion: Results of this study show that inferior thyroid artery blood flow, T3/T4 ratio and FT3/FT4 ratio are useful parameters in the differentiation between GD and DT.

BACKGROUND Amenorrhea refers to the absence of menstrual periods and may result from a number of different conditions. The normal menstrual cycle involves complex interactions between the hypothalamic pituitary axis, the ovaries and the outflow tract, thus disruption at any level can result in abnormal menstruation and amenorrhea. Amenorrhea is broadly classified into primary or secondary. Amenorrhea is classified as primary if menstrual bleeding has never occurred in the absence of hormonal treatment. The clinical significance of lack of regular menstrual cycles extends beyond reproductive concerns and include implications on bone and cardiovascular health. The aim of this study was to evaluate the clinical profile and etiology, mean age of presentation of common etiologies, common age group of presentation, variation of gonadotropin levels, of patients of primary amenorrhea presenting to Endocrine OPD of a tertiary care hospital.

Context: Adult studies have shown the association of subclinical hypothyroid (SCH) with various cardiovascular dysfunction, which indicates SCH may be a potentially modifiable risk factor of CV disease and mortality. However, there is still controversy about the association of cardiovascular dysfunction in children with SCH. Epicardial fat thickness (EFT) is a reliable and sensitive marker of cardiovascular risk and has become an emerging modality to predict CV risks. Aims: To measure the EFT in children with subclinical hypothyroidism and compare with healthy children. To find its correlation with subclinical atherosclerosis. To compare EFT between TPO positive and TPO negative subclinical hypothyroid patients. Materials and Methods: Children of subclinical hypothyroidism (TSH >5 mIU/ml with normal FT3, FT4, and age and sex matched control were included as per inclusion and exclusion criteria. Clinical data was collected from all study subjects. Thyroid function tests including FT3, FT4 and TSH, TPO antibody, fasting insulin, hsCRP, Lp(a), USG neck for carotid intima media thickness (CIMT), USG brachial artery for flow mediated dilation (FMD) and echocardiography for epicardial fat thickness (EFT) were done in all patients. Results: A total 42 number of SCH and 50 age and sex matched controls were recruited and screened for various parameters of subclinical atherosclerosis. EFT was significantly higher in the cases than in the controls (6.27 mm vs 4.54 mm) with P value < 0.001. Brachial FMD was significantly lower in cases than the cohort (4.5% vs 8.93%, P < 0.001). Difference in CIMT was not significant amongst the cases and controls. EFT failed to correlate with the level of TSH though it had significant positive correlation with hsCRP. The patients who were TPO positive, had higher fasting insulin, HOMAIR, hsCRP, Lp(a) than those who were TPO negative. Conclusion: Results of this study show the presence of subclinical atherosclerosis in children with SCH regardless of the aetiologies. The patients of Hashimoto thyroiditis had significantly high insulin resistance and inflammation than the SCH patients of other aetiologies.

Turner syndrome occurs in one out of every 2500-3000 live female births and the diagnosis is usually based on the clinical presentation. It is a genetic condition in which a female does not have the usual pair of two X chromosomes. Deletions of proportions of the X chromosome result in various Turner variants who have varied spectrum of clinical presentation. We report on a rare variant of deletion on long arm of X chromosome in a 35-year-old female with short stature, lack of secondary sexual characters, primary amenorrhea, average intelligence and diabetes mellitus. Chromosomal analysis using GTG-banding showed 46, X, del (X), (q13) in all cell lines. Hence, suspicion of rare variants of Turner syndrome in females must be done who present at a later age with atypical features. A 35-year-old female presented to us for evaluation of primary amenorrhea. She was diagnosed with T2DM two years ago with poor compliance to OAD. She also was detected with primary hypothyroidism 3 months before presenting to us and had been on levothyroxine supplementation since then. She is a first order child born of a nonconsanguineous marriage at 40 wks. of gestation, delivered at term in hospital by normal vaginal delivery. Her fathers and mothers age during her delivery was 28yearsand 22years, respectively. Clinical examination revealed height 130.8cm (<3 rd centile ht. SDS-4.6), weight 31kg (<3 rd centile, wt. SDS-1.94).Pubertal status was A1B1P2, arm span 136cmwith US:LS ratio of 0.85.General examination revealed normal placement of posterior hairline, neck length to height ratio of 1:11, right and left carrying angle of 11 degrees and 14 degrees, respectively (Figure 1a, 1b). She was hypertensive with all peripheral pulses being well palpable. Systemic examination were within normal limits. Routine haemogram revealed microcytic anaemia. Biochemical parameters revealed elevated FPG and PPPG and elevated S.urea and creatinine level. Urine ACR was 5000mg/gm. Fundoscopy revealed modNPDR.2D echo (transthoracic) was normal.