Scientific Program

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Day 1 :

Keynote Forum

Shota Janjgava

Tbilisi State University
Georgia

Keynote: Screening study of iodine deficiency status and thyroid diseases in Caucasian children

Time : 10:00-10:40

OMICS International Thyroid 2016 International Conference Keynote Speaker Shota Janjgava photo
Biography:

Shota Janjgava, MD, PhD is the Head of Andrology department in National Institute of Endocrinology, Vice-President of the “Georgian young Association for the Study Diabetes and Metabolic Disorders”. He is a Board Member of “Georgian Association for the Study Obesity” and member of “European Association for the Study Obesity”, “Young European Association for the Study Obesity”, “Study group for the Insulin Resistance” and “European Association for the Study of Diabetes”. He is the participating and presenting author in several international conferences and congresses. He is the author of more than 15 publications. He is giving lectures in Endocrinology and Andrology and is giving scientific lectures for students, residence and doctors.

Abstract:

Background & Aims: Thyroid disorders are the second commonly encountered disorders in endocrine clinics and are significant causes of medical morbidity and mortality. The relationship between Thyroid disorders and childhood are one of the longest running controversies in endocrinology. Currently all iodized salt in Georgia for both human and animal consumption is imported, and regulations mandate iodization at 40±15ppm, in line with the World Health Organization criteria of 20-40ppm. The objective of the study was screening thyroid diseases in republic of Georgia as a iodine deficiency region in school age child.rnrnMaterials & Methods: 52,328 children with age range 6-16 years were included in the study. Children were screened by Palpation and ultra-sonography of the thyroid gland, after that, with children who have had changes were made: TSH and Anti-TPO. According to the laboratory and clinical condition we divided children into five groups: 1) without changes, 2) with hypothyroidism, 3) with hyperthyroidism, 4) with nodular goiter, 5) with autoimmune thyroiditis.rnrnResults: The children were distributed in the following way: 1) without changes endemic goiter: 4 403, 2) with hypothyroidism 303, 3) with hyperthyroidism 18, 4) with nodular goiter 27 and 5) with autoimmune thyroiditis 675. The appropriate treatment according to the laboratory and clinical condition was prescribed to all patients.rnrnConclusion: Thyroid gland diseases are an important medical and epidemiologic entity, as its deleterious effects on patients is firmly established. As our study demonstrated thyroid gland diseases in Georgian children is one of the major problems. A supplementation program which was done by government improves iodine-deficiency status, but it is not enough to stop IDD. rn

  • Session: Thyroid Physiology
    Session: Thyroid: Diagnosis and Clinical Evaluation
    Track 3: Thyroid: Clinical Studies Cases Reports
    Session: Thyroid Cancer: Therapy & Treatment

Session Introduction

Artur Bossowski

Medical University in Bialystok, Poland

Title: Chosen immunological aspects in autoimmune thyroid diseases in developmental age

Time : 11:35-12:05

Speaker
Biography:

Artur Tadeusz Bossowski, completed the doctorate in June 2001 and have already presented preliminary findings at various local and international meetings. Also started to performed investigation of lymphocyte subpopulations and co-stimulatory molecules and integrins in peripheral blood and in thyroid tissues of patient with Graves’ disease and non-toxic nodular goiter.

Abstract:

Introduction: Up till now, altered balance of Th1 and Th2 immune cells has been postulated to play an important role in the pathogenesis of autoimmune thyroid diseases (AITD). However, recent studies on thyroid diseases suggest a new role for Th17 (T helper 17) cells that have been classified as a new lineage, distinct from Th1, Th2 and T-reg cells. Despite wide interest, the role of Th17 cells in the pathogenesis of inflammatory and autoimmune diseases is still being debated. Th17 cells are involved in immune responses against extracellular pathogens and have the ability to secrete cytokines: IL-17, IL-17F, IL-21 and IL-23. Th17 cells can be characterized by several surface markers, i.e. CCR6 (CD196), IL-23R, IL-12Rbeta2 and CD161. Aim of the Study: To estimate the proportions of circulating CD4+CD161+CD196+ and CD4+IL-17+ Th17 cells and serum concentrations of IL-17 & IL-23 in patients with Graves' disease (GD, n=42, mean age ± SEM 14.2 ± 4 years), Hashimoto's thyroiditis (HT, n=67, mean age ± SEM 14.8±2 yrs) and in healthy controls (C, n=45, mean age ± SEM 15.1 ± 3 yrs). Material & Methods: Polychromatic flow cytometry and several fluorochrome-conjugated monoclonal antibodies were applied to delineate Th17 cells with CD4+CD161+CD196+ or CD4+IL-17+ phenotype using apparatus FACS Calibur (BD Biosciences). The expression of IL-17 and IL-23 were analyzed by Bio-Tek ELx800 ELISA reader. Results: In untreated HT children we observed an increased percentage of CD4+CD161+CD196+ (p<0.04) and CD4+IL-17+ (p<0.01) Th17 lymphocytes in comparison to the healthy controls. In GD children we did not reveal such abnormalities in the population of these cells. In cases with HT, a positive correlation between the percentage of CD4+IL-17+ and CD4+CD161+CD196+ T cells and serum level of anti-TPO antibodies (r=0.48; p<0.025; r=0.65; p<0.01; respectively) was detected. In untreated patients with AITD we observed anincreased levels of IL-23 in comparison to control group (GD: p=0.004, HT: p=0.046). Methimazole treatment in GD led to decrease in these cytokine levels in a period of 6-12 months. However, during 6-24 months of L-thyroxine therapy in HT there wasn’t any reduction of IL-23 concentration compared with HC. IL-17 was elevated only in HT patients in comparison to the controls (p=0.021), which normalized during therapy. Conclusions: We conclude that the increased percentage of Th17 cells and elevated level of IL-17 and IL-23 cytokines in children with HT can suggest their role in initiation and development of immune and inflammatory processes in this endocrinopathy.

Speaker
Biography:

Magid Althbety has completed his Residency in Otolaryngology and Head and Neck Surgery in Riyadh and then continued his Fellowship in University of California, Irvine, USA as Head & Neck and Reconstruction surgery 2011-2012 then another year from 2012-2013 in Kaiser-Permanent Hospital as Clinical Head & Neck and Skull base Surgery. He is currently working as Otolaryngologist and Head and Neck Surgeon and Skull base Surgeon in Security Forces Hospital in Riyadh, KSA. He published more than 4 papers in different journals and has been serving as Acting Head of ENT Division in the same Hospital and member of many of ENT society internally and internationally and member of Head and Society in USA.

Abstract:

Background: Massive substernal goiters are frequently noted in developing countries, but are not as frequently treated in developed countries. Management of massive thyroid goiters is frequently referred to tertiary university hospitals. In the following study, we present our recent community hospital based experience managing such cases using a trans-cervical approach. Objective: To assess a community hospital based experience managing massive substernal thyroid goiters. To assess our clinical outcomes using a trans-cervical or a collar neck incision for accessing and surgically removing such massive tumors. Setting: Southern California Permanente Medical Group, community hospital setting. Method: Retrospective review over the past 6 years (2006-2011) of all cases of massive substernal thyroid goiters surgically treated. Chart review was performed and identified were age, sex, diagnosis, extent of goiter, treatment, disease status, survival (months), size of thyroid (grams), complications (hypocalcemia, vocal cord injury) and estimated blood lose (ml). A comparison was made between pre- and post-operative function (breathing, speech and swallowing). Results: 9 cases were identified which met study criteria. The average age at diagnosis was 59.1 yrs (43-86 yrs). There were 2 males and 7 females. There were 6 multi-nodular goiters and 3 goiters with papillary thyroid carcinoma present. With regard to extent of goiter – 4 cases extended under the arch of the aorta, 5 cases extended to the mid-arch, and all compressed the trachea to some extent. All surgically underwent total thyroidectomy, mediastinal dissection via trans-cervical approach and neck dissections in 3 cases. All patients are alive and cancer free or disease free at 26.3 months. The average size of the gland was 184 grams (100-353 grams). With regard to complications there were 2 cases of vocal cord paralysis, 2 cases of vocal cord paresis and 6 cases requiring long term calcium supplementation. The average blood lose surgically was 167 ml (50-500 ml). All patients had returned to normal breathing, speech and swallowing function post-operatively. Conclusion: Massive substernal goiters can be surgically removed via a trans-cervical approach, thus avoiding sternotomy. A Thoracic surgeon was available at all times to assist with our cases. Our community hospital based series although not large is a good representation of what potential outcomes might be in a non-tertiary setting. All patients improved post-operatively with regarding to breathing, speech and swallowing. A higher complication rate of recurrent laryngeal nerve was noted in cancer cases due to tumor invasion. Long term follow up of our patients is needed to fully confirm these studies findings.

Madhu Pandey

Metro Polyclinic Pvt. Ltd, Nepal

Title: Case series of thyroid cancer patients coming to endocrine clinic in Nepal

Time : 14:00-14:30

Speaker
Biography:

Madhu Pandey completed her MBBS in 2008 and MD Endocrinology in 2011 from Xian Jiao Tong University, China. She is currently working as a Consultant Endocrinologist at Metro Polyclinic pvt Ltd., Kathmandu. She has ample number of publications. She has received many awards and merit possessions.

Abstract:

We are reporting a case series of thyroid cancer patients seen in a private endocrine clinic in Kathmandu. This is a retrospective review of case series of thyroid cancer patients coming to a private endocrine clinic in Kathmandu from August 2014 to end of August 2015. Total number of patients was 16, aged between 25 to 80 years old. Male were two in number, female were fourteen in number. Total numbers of follicular thyroid cancer were three. Most of the cases were of TNM stage 1 according to AJCC cancer staging. There was one metastatic cancer. Most of the cases were referred in early stage. Advanced stage cancer may have been referred to oncologist and thus is not reflected in our data. Most common cancer reported was papillary thyroid cancer. This is a small case series reporting thyroid cancer in Nepal and further large studies are needed to define the nature and stages of thyroid cancer in Nepal.

Robin Maskey

B P Koirala Institute Of Health Sciences

Title: Spectrum of thyroid disorders in diabetes mellitus in Nepal

Time : 14:30-15:00

Speaker
Biography:

Robin Maskey, Associate Profesoor, has completed his MBBS from Manipal College of Medical Sciences, Pokhara , Nepal and MD in Internal Medicine from B P Koirala Insttiute of Health Sciences, Dharan, Nepal and Fellowship in Endocrinology and Metabolism from Sir Ganga Ram Hospital, Delhi, India. He has published more than 20 papers in reputed journals and has been serving as an Associate Professor in academic Institution in Eastern part of Nepal.

Abstract:

Background & Aim: The coexistence of diabetes mellitus and thyroid disorders is a known clinical observation. The objective of this study was to see the spectrum of thyroid disorders in diabetes mellitus in Nepal. Methods: Two hundred and seventy one known or newly detected cases of diabetes mellitus aged more than 15 years were selected randomly from the patients attending to BPKIHS from September 2012 to September 2013. These patients were subjected to evaluation for thyroid function – clinically and biochemically and other relevant investigations were done. Results: Out of 271 subjects only 23 patients (8.48%) were found to have thyroid disorders. Among 23 patients; 11 had euthyroid, 4 had subclinical hypothyroidism; 7 had clinical hypothyroidism and 1 had subclinical hyperthyroidism. We found majority of patients with female hypothyroidism. We found body mass index, mean triglyceride and cholesterol levels were more in those diabetic patients having coexisting hypothyroidism. So every diabetic patient should be screened for thyroid fucntion test.

Speaker
Biography:

Cannataro Giovanni has completed his PhD from University School of Medicine “G D’Annunzio” of Chieti (Italy). He is Consultant Radiologist at “SS Annunziata Hospital” of Chieti, Italy. He has published two research papers in reputed journals.

Abstract:

Strain elastosonography is a new non invasive technique that employs ultrasounds and manual compression in order to obtain information about tissues’ stiffness. It provides a colored map of tissues’ deformation, visualized in a split-screen mode with a conventional B-mode image and a colored elastosonogram on a screen. It could be used in addiction to conventional US signs in order to differentiate malignant from benignant thyroid nodules. In particular, the hardness of a tumor is considered an indicator of malignancy. In many studies malignant nodules are often associated with a greater elasticity/hardness scoring at elastosonography compared to benign nodules. Elastosonography could also be used as a guide for fine needle aspiration (FNA), which is the most important procedure for the management of thyroid nodules. Limiting conditions for elastosonography are calcified and cystic areas, which could be responsible respectively for false positive and negative results. In these cases, the conventional US plays an important role to define which nodules are suitable for the US elastosonography. Other limiting conditions are follicular carcinoma gross anatomy and cellular pattern that may resemble the elastosonographic pattern of benign follicular adenoma. The histological examination is often necessary to discover capsular or vascular invasion of follicular carcinomatous condition.

Speaker
Biography:

Shota Janjgava, MD, PhD is the Head of Andrology department in National Institute of Endocrinology, Vice-President of the “Georgian young Association for the Study Diabetes and Metabolic Disorders”. He is a Board Member of “Georgian Association for the Study Obesity” and member of “European Association for the Study Obesity”, “Young European Association for the Study Obesity”, “Study group for the Insulin Resistance” and “European Association for the Study of Diabetes”. He is the participating and presenting author in several international conferences and congresses. He is the author of more than 15 publications. He is giving lectures in Endocrinology and Andrology and is giving scientific lectures for students, residence and doctors.

Abstract:

Background & Aims: Thyroid disorders are the second commonly encountered disorders in endocrine clinics and are significant causes of medical morbidity and mortality. The relationship between Thyroid disorders and childhood are one of the longest running controversies in endocrinology. Currently all iodized salt in Georgia for both human and animal consumption is imported, and regulations mandate iodization at 40±15ppm, in line with the World Health Organization criteria of 20-40ppm. The objective of the study was screening thyroid diseases in republic of Georgia as a iodine deficiency region in school age child. Materials & Methods: 52,328 children with age range 6-16 years were included in the study. Children were screened by Palpation and ultra-sonography of the thyroid gland, after that, with children who have had changes were made: TSH and Anti-TPO. According to the laboratory and clinical condition we divided children into five groups: 1) without changes, 2) with hypothyroidism, 3) with hyperthyroidism, 4) with nodular goiter, 5) with autoimmune thyroiditis. Results: The children were distributed in the following way: 1) without changes endemic goiter: 4 403, 2) with hypothyroidism 303, 3) with hyperthyroidism 18, 4) with nodular goiter 27 and 5) with autoimmune thyroiditis 675. The appropriate treatment according to the laboratory and clinical condition was prescribed to all patients. Conclusion: Thyroid gland diseases are an important medical and epidemiologic entity, as its deleterious effects on patients is firmly established. As our study demonstrated thyroid gland diseases in Georgian children is one of the major problems. A supplementation program which was done by government improves iodine-deficiency status, but it is not enough to stop IDD.

A Martin Gerdes

New York Institute of Technology- College of Osteopathic Medicine, USA

Title: Treatment of thyroid dysfunction in heart failure: Are we paralyzed by fear?
Speaker
Biography:

A Martin Gerdes received his PhD from the University of Texas Medical Branch at Galveston in 1978 and was the 2013 Distinguished Alumnus. He is the Chairman of Biomedical Sciences at New York Institute of Technology- College of Osteopathic Medicine in Old Westbury, NY. Previously, he was the Chairman of the Department of Anatomy at the University of South Dakota (USD) and Founding Scientist of Sanford Research-USD. His work focuses mainly on the role of low thyroid function in heart failure. He has obtained over $30M in funding from the NIH as PI and has authored ~120 research articles.

Abstract:

Many studies have shown benefits from thyroid hormone (TH) treatment of cardiovascular diseases such as heart failure (HF). However, several poorly designed clinical studies using toxic doses of TH analogs convinced the medical community that TH treatment of heart diseases was too risky, primarily due to increased risk of inducing arrhythmias. Due to a steady stream of positive new information, however, this issue has not gone away. Over the years, we have learned many things about low TH function and heart diseases. In many studies, low TH function has been linked to increased mortality in patients with various heart diseases. Many short term clinical studies also showed improvement in cardiac patients treated with THs. A key animal study clearly demonstrated that hypothyroidism alone can eventually cause HF with maladaptive myocyte remodeling and impaired coronary blood flow. Cumulatively, animal studies suggest that all types of heart disease lead to low cardiac tissue T3 levels. One has to ask the question, why is there so much opposition to a drug that improves systolic/diastolic function, improves coronary blood flow, inhibits myocardial fibrosis, reverses fetal gene expression, and new data suggest also reduces arrhythmias? There are good reasons to be apprehensive. But, is fear of overtreatment unreasonable? Is there a safe, therapeutic window for TH treatment of heart diseases, including heart failure? Over the past few years, animal research in our lab has focused on answering the critical questions that have blocked progress to translation in this field. These results will be discussed.

Speaker
Biography:

Daniel Igor Branovan, MD, FACS, MHCM is the Founder and President of Project Chernobyl, UN-accredited not-for-profit international organization, based in New York. He is a US trained Head and Neck Surgeon and serves as Director and Chair of the New York Ear, Nose and Throat Institute. He received his Medical training at Stanford University School of Medicine and Harvard University School of Public Health.

Abstract:

Background: The results of international and local ultrasound screening programs aftermath the Chernobyl accident (1990-2005) had shown high variations of thyroid cancer prevalence among children: 0.2%-0.6% in Gomel, 0.3% in Brest, and 0.008% in Mogilev Oblasts of Belarus. Aim: The aim of this study was to evaluate the pathological and clinical characteristics of radiation induced papillary thyroid carcinoma (PTC) in childhood population. Patients & Methods: The pathological and clinical characteristics were investigated in 1078 children and adolescents with PTC who were surgically treated during the years 1990 through 2005. Ultrasonic particularities of thyroid carcinoma in children exposed to radio-nuclides could be characterized as following: presentation into nodular – 95% and diffuse forms - 5%. The tumors mostly are visualized as a hypo-echogenic node - 56% with irregular margins -76%. Cervix lymph nodes were visualized in 42% cases. Results: According to the morphological data pediatric patients had high rates of metastatic PTC at presentation (73.8% - lymph nodes involvement, 11.1% distant spread). The overall survival was 96.9% with a median follow-up of 16.21 years, and 20-year event-free survival and relapse-free survival were 87.8% and 92.3% respectively. Patients had significantly lower probability of both loco-regional (P<0.001) and distant relapses (P<0.005) after total thyroidectomy and radioactive iodine therapy. The prevalence of SPM in this unique cohort was 1%. Conclusion: Our investigation had shown that the incidence rates of pediatric thyroid cancer in Belarus is related to levels of radiation exposure, thyroid cancer screening, iodine deficiency and nitrates concentration in groundwater.

Speaker
Biography:

Kepal N Patel is a surgeon in New York, New York and is affiliated with NYU Lang one Medical Center. He received his medical degree from Rutgers Robert Wood Johnson Medical School and has been in practice for 19 years. He accepts several types of health insurance, listed below. He is one of 49 doctors at NYU Langone Medical Center who specialize in Surgery.

Abstract:

Thyroid cancer is on the rise. Understanding the clinical heterogeneity will allow for better risk group stratification, appreciation of pathology and exploiting biology to deliver cost effective treatment, discretion in selection of surgical treatment and discretion in use of adjuvant therapy and follow up strategy. The need for research in the molecular biology will help identify that small group of tumors which may behave poorly and potentially avoid overtreatment.

Brendan C Stack

University of Arkansas for Medical Sciences, USA

Title: Outpatient thyroid surgery
Speaker
Biography:

Brendan C Stack is Professor of Otolaryngology-Head and Neck Surgery at the University of Arkansas for Medical Sciences, Little Rock, AR. He has authored over 200 publications and a textbook on parathyroid surgery. He has presented at over 300 meetings. He has grant funding from the NIH. He has appeared on, or been cited by, media numerous times. He serves on numerous editorial boards and reviewer panels. He is listed in “Best Doctors” of America, “Guide to America’s Top Surgeons”, “Guide to America’s Top Physicians”, Castle and Connolly Top Doctors/Cancer Specialists and “Top Thyroid Doctors”.

Abstract:

Outpatient thyroid surgery has been increasing in frequency over the last decade. Factors driving this transition of a traditional inpatient procedure to the outpatient realm include: costs, surgeon experience, energy instrumentation and agents for hemostasis, laryngeal electromyography and parathyroid hormone assays among others. This presentation will highlight trends and published best practices to safely offer outpatient endocrine surgery of the neck when appropriately indicated. Obstacles to same day surgery will also be presented.

Kurren Gill

Thomas Jefferson University Hospital, USA

Title: Thyroid cancer metabolism: A review
Speaker
Biography:

Kurren Gill completed his BA in Neuroscience from University of Virginia. He is a medical student at The Commonwealth Medical College in Scranton, PA and is currently conducting a year-long research fellowship in Otolaryngology-Head and Neck Surgery at Thomas Jefferson University Hospital.

Abstract:

Metabolic dysregulation within the tumor microenvironment (TME) is critical to the process of tumorigenesis in various cancer types. Thyrocyte metabolism in papillary and anaplastic thyroid cancer, however, remains poorly characterized and studies analyzing the role of multi-compartment metabolism in thyrocyte oncogenesis are sparse. We present a review of the current knowledge on cellular metabolism in non-cancerous and cancerous thyroid tissues, focusing on the monocarboxylate transporters MCT1 and MCT4 and on a transporter of the outer mitochondrial membrane TOMM20. Understanding the metabolic phenotype of tumor cells and associated stromal cells in thyroid cancer can have profound implications on the use of biomarker staining in detecting subclinical cancer, imaging as it relates to expression of various transport proteins and therapeutic interventions that manipulate this dysregulated tumor metabolism to halt tumorigenesis and eradicate the cancer. Future studies are required to confirm the prognostic significance of these biomarkers and their correlation with existing staging schemas such as the AGES, AMES, ATA and MACIS scoring systems.

Speaker
Biography:

Patricia de Gortari completed Master of Science in Biotechnology and PhD degree in Physiology at the National University of Mexico. Since 1999, He has been working at the Laboratory of Molecular Neurophysiology at the Neuroscience Research Division at the National Institute of Psychiatry Ramón de la Fuente in México City. His research line is related to different neuroendocrinological alterations in the hypothalamic-pituitary-thyroid axis in different mood and metabolic alterations, as well as the neuro-modulatory role of TRH as an anorexigenic factor.

Abstract:

Pyroglutamyl aminopeptidase II (PPII), located in adenohypophysis and medial-basal-hypothalamus degrades the hypothalamic peptide thyrotropin-releasing hormone (TRH), which is synthesized in the para-ventricular nucleus and released from the median eminence to the portal blood. TRH acting through its receptor in adenohypophysis induces thyrotropin release to the circulation thus maintaining the serum thyroid hormones concentration. PPII is a Zn-dependent metallopeptidase that may participate in the regulation of the hypothalamus-pituitary-thyroid (HPT) axis function, however, it is unknown whether dietary Zn deficiency down-regulates PPII and whether it would impact TSH release from the adenohypophysis affecting metabolic rate in adult rats. Adult rats fed a Zn-deficient diet (2ppm) throughout their lifespan (DD), prenatally (DC) or after weaning (CD); the CC group ate a control diet (20ppm). We analyzed adenohypophyseal and medial-basal-hypothalamic PPII activity of dams and male offspring when adults; median eminence TRH, serum thyrotropin, leptin and thyroid hormones concentration. Offspring ate the same diet as their dams (CC, DD) or were switched from dietary regime after weaning (CD, DC) and until 2.5 months of age. DD males showed decreased adenohypophyseal and medial-basal-hypothalamic PPII activity, along with high thyrotropin serum concentration. Post-weaning Zn-deficiency (CD) decreased PPII activity only in adenohypophysis and increased thyrotropin circulating levels. Zn-replenishment (DC) normalized PPII activity in both regions and serum thyrotropin concentration. Adenohypophyseal PPII activity decreased and prolactin levels increased in Zn-deficient dams. We concluded that long-term changes in dietary Zn down-regulate PPII activity independently of T3, increasing thyrotropin serum concentration, overall resembling sub-clinical hypothyroidism.