Alterations of sleep quality and circadian rhythm genes expression in elderly thyroid nodule patients and risks associated with thyroid malignancy

To study the alterations of sleep quality and circadian rhythm genes expressions upon elderly thyroid nodule patients, the risk factors associated with thyroid malignancies, and the potential relationship involved. The elderly people enrolled in our study were divided into three groups according to the thyroid histopathology: malignant nodule group, benign nodule group, and normal group, and the clinical data and sleep quality were collected. Among the patients of surgery, 56 fresh thyroid tissues were collected for real-time PCR, immunohistochemistry and western blotting analysis of CLOCK, BMAL1, CRYs and PERs. Poor sleep quality, sleep latency and daytime dysfunction were the independent risk factors of malignant nodule after adjusted by other impacts. The expression levels of CLOCK, BMAL1 and PER2 in thyroid malignant group were significantly higher than benign and normal groups, while CRY2 was decreased, p < 0.05. In addition, CLOCK and BMAL1 protein levels were positively correlated with PSQI of corresponding patients and CRY2 was negatively correlated. Circadian rhythm genes mainly altered in malignant nodules, and sleep disorders may be involved in the occurrence of elderly thyroid malignancy through the high expressions of CLOCK and BMAL1, and low expression of CRY2.

Characterization of Thyroid Nodule by Sonographic Features

Introduction: The thyroid is an endocrine gland situated in the infrahyoid compartment of neck in a space outlined by muscle, trachea, esophagus, carotid arteries and jugular veins. Though nodular thyroid disease is relatively common, thyroid cancer is rare and accounts for less than 1% of all malignancies indicating that overwhelming majority of thyroid nodules are benign. The purpose of this study was to assess the sonographic characteristics in a solitary thyroid nodule and predict risk of malignancy.Methods: This prospective study was conducted in a tertiary care hospital in Kathmandu.62 patients with palpable thyroid nodule were evaluated for sonographic characteristics .USG guided FNA for cytopathological examination was then performed.Results: Out of 66 patients, four were subsequently excluded because they didn’t fulfill the inclusion criteria. Of the 62 patients, 47 (75.8%) were females and 15 (24.2%) were males. Among 56 benign nodules, 45 (80.4%) were in females and 11(19.6) were in male. Among 6 malignant nodules, 4(66.7%) were in males and 2 (33.3%) were in females. Result shows 5 malignant nodules (83.3%) were solid where as 1 malignant nodule (16.7%) was complex with solid predominance. All 4 cystic nodules (7.1%) were benign. All complex nodules with predomint cystic components were also benign. One malignant nodule (16.7%) had snow storm type of microcalcification. None of the benign nodules had microcalcification. Nodule having microcalcification was malignant. Findings showed that all malignant nodules (100%) had increased internal vascularity whereas benign nodules were variable in internal vascularity.Conclusion: This study has shown that colloid goiter is the commonest benign diagnosis whereas papillary carcinoma is the commonest malignancy. Malignant nodules are solid or predominantly solid whereas cystic and predominantly cystic nodules are likely to be benign. Macrocalcification and internal vascularity are not reliable to differentiate benign from malignant nodule. However, snowstorm calcification makes a nodule likely to be malignant whereas egg shell calcification is characteristic for benign nodule.

Solitary nodule thyroid: diagnosis and management

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Solitary nodule can be a true solitary nodule or a dominant nodule of multinodular goitre or ectopic thyroid or unilateral agenesis. Solitary nodule can be benign or malignant. Purpose of evaluation is to differentiate between the two. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A prospective study of solitary nodule thyroid (STN) patients presenting to ENT outpatient department, for a period of 3 years from September 2012 to 2015. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Out of 67 patients<strong> </strong>enrolled into study, 53 patients had benign true STN, 9 patients had multinodular goiter (MNG) presenting as solitary nodule and 5 had malignant nodule (7.46%). Among the benign nodules, 25 patients had small solitary nodule (&lt;4 cm size). They were treated medically and followed-up for a period of 1 year. 28 patients with large benign solitary nodules (&gt;4 cm size) were taken up for surgery directly. Hemithyroidectomy was done in benign STN patients (39 patients) and total thyroidectomy was done in malignant nodule and MNG patients and followed-up by lifelong L-T₄therapy. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Small benign solitary nodules regress with medical therapy alone. In large solitary nodules, and in those nodules not regressing with medical therapy, hemithyroidectomy is adequate. In MNG and malignant nodules, total thyroidectomy is advocated. Hemithyroidectomy and total thyroidectomy patients were followed - up with suppression and supplementation therapy respectively.</span><span lang="EN-IN">This area being fluorotic belt, there is an increased prevalence of goiter. This study gives a concise guideline in evaluation and management of STN for goiter endemic areas.</span></p><p class="abstract"> </p>