BackgroundDiagnostic re-evaluation is important for all patients with congenital hypothyroidism (CH) for determining the etiology and identifying transient CH cases. Our study is a first thyroxine therapy withdrawal study conducted in Macedonian CH patients for a diagnostic re-evaluation. We aimed to evaluate the etiology of CH, the prevalence of transient CH and identify predictive factors for distinguishing between permanent (PCH) and transient CH (TCH).Materials and methodsPatients with CH aged >3 years underwent a trial of treatment withdrawal for 4 weeks period. Thyroid function testing (TFT), ultrasound and Technetium-99m pertechnetate thyroid scan were performed thereafter. TCH was defined when TFT remained within normal limits for at least 6-month follow-up. PCH was diagnosed when TFT was abnormal and classified according the imaging findings.Results42 (55%) patients had PCH and 34 (45.0%) patients had TCH. Thyroid agenesia was the most prevalent form in the PCH group. Patients with TCH had lower initial thyroid-stimulating hormone (TSH) values (P < 0.0001); higher serum thyroxine levels (P = 0.0023) and lower mean doses of levothyroxine during treatment period (P < 0.0001) than patients with PCH. Initial TSH level <30.5 IU/mL and levothyroxine dose at 3 years of age <2.6 mg/kg/day were a significant predictive factors for TCH; sensitivity 92% and 100%, specificity 75.6% and 76%, respectively.ConclusionTCH presents a significant portion of patients with CH. Initial TSH value and levothyroxine dose during treatment period has a predictive role in differentiating TCH from PCH. Earlier re-evaluation, between 2 and 3 years age might be considered in some patients requiring low doses of levothyroxine.

Objective:Thyroid ectopy is a rare condition resulting from abnormal embryologic development and migration of the gland. Sublingual is the most common thyroid ectopy; all other ectopic thyroid locations occur very rare. There are no reports in the literature that describe the clinical course of patients with congenital hypothyroidism due to thyroid ectopy.Methods and Results:We present a child with congenital hypothyroidism detected on neonatal screening which had a subclinical course during follow-up. Scintigraphy revealed submental thyroid ectopy, a rare ectopic location and no orthotopic thyroid gland.Conclusion:Our case is unique because of the rare ectopic thyroid location but also of the unexpected clinical course; however, further thyroid monitoring is required for the therapy adjustment and detection of any changes in the ectopic tissue.

Background: We wanted to evaluate the presense of myocardial ischaemia in asymptomatic patients with high cardiovascular risk, the influencing clinical and laboratory factors and the impact of ischaemia on final management decision.Material and methods: We evaluated 60 asymptomatic patients with high CV risk, who underwent SPECT myo-cardial perfusion imaging (MPI) for detection of suspected CAD. We used the 17 segment model for quantitative and semiquantitative scan perfusion and function analysis using perfusion scores. All patients had full blood laboratory analyses including lipid values, presence of albuminuria, rest and stress ECG. Logistic regression analysis was used to assess the impact of clinical and laboratory parameters on myocardial ischaemia prevalence.Results: Stress-inducible ischaemia was found in 19 pts (33%), fixed defects were found in 13% and mixed defects in 9% of cases. The average ischaemia amount was 10%. Mild ischaemia was found in 12 patients (64%) - summed stress score (SDS) < 4, moderate ischaemia in 5 patients (26%) - SDS 5-7 and severely abnormal scans in 2 patients (10%) - SDS > 7. Severe ischaemia was only related to the duration of diabetes. Six pts with severe ischaemia had ST depression > 2 mm on stress study, and a higher wall motion index and LVEF fall > 5% during stress study (p < 0.01). Stepwise logistic regression analysis for prediction of stress-induced ischaemia showed OR 2.4 (95% CI 1.7?3.6) for stress-induced ECG changes and OR 3.9 for presence of DM over 10y (95% CI 2.3?6.6). Seven patients with ischaemia > 10%, were referred for coronary angiography.Conclusions: MPI is a valuable method for preclinical assessment of myocardial ischaemia in patients with high CV risk, which can improve prognosis and guide treatment decision.

We wanted to assess prevalence, predictors and gender difference of coronary calcium score (CCS) and myocardial ischemia in diabetes type 2 patients.We have evaluated 145 patients (58 male and 87 females, age 63+/-9), who underwent singlephoton emission computed tomography myocardial perfusion imaging computer tomography (SPECT/CT) for assessment of myocardial ischemia and coronary atherosclerosis burden. Forward logistic regression analysis was used to assess predictive parameters for myocardial ischemia and increased CAC.Gender differences between myocardial perfusion and CCS findings were analyzed. SPECT results were normal in 102 patients (70%). Mild ischemia was noted in 16 patients (37%), moderate ischemia in 9 patients (20%), severe ischemia in 10 patients (23%), and fixed defects in 8 patients (18%). CCS >0 Agatston Units (AU) was found in 69 patients (62.7%), with average CAC 198+/-45 in male and 98+/33AU in female patients. 24 patients (34%) had moderate CCS (100-399 AU) and 19 patients (27.5%) had severe CCS (401-1000 AU). Multivariate regression analysis showed independent predictors for CCS (>0AU) age (⩾65 years) (odds ratio (OR): 1.074, p = 0.028), smoking (OR: 1.81, p = 0.048) and male gender (OR: 1.43, p = 0.051).We found stress-induced ECG changes, CCS>400AU and diabetes type 2 over 10 years to be independent predictors of myocardial ischemia in the model that included CCS. CCS was increased predominantly in male and myocardial ischemia was more prevalent in female patients. SPECT/CT imaging enable assessment of anatomic and functional aspects of CAD and optimize treatment in diabetes type 2 patients.

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