Day 2 :
Keynote Forum
A Martin Gerdes
New York Institute of Technology- College of Osteopathic Medicine, USA
Keynote: Treatment of thyroid dysfunction in heart failure: Are we paralyzed by fear?
Time : 10:00-10:40
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.
Keynote Forum
Mahir Khalil Ibrahim Jallo
Gulf Medical University, UAE
Keynote: Title: A Triad of Vitamin D Deficiency, Thyroid Disorders and Type 2 Diabetes: Where is the link ?
Time : 10:40-11:20
Biography:
Dr. Jallo, an Associate Professor of Medicine & Senior Consultant Endocrinologist. He granted his MB, ChB from Mosul University College of Medicine in IRAQrn1981, his postgraduate Arab Board Certification in Internal Medicine CABM in1992, Fellowship of The American College of Endocrinology FACE in 2015 andrncertified with Diploma in Dyslipidemia from Boston University School of Medicine, USA in 2014.rnHe is the Coordinator for MBBS Endocrinology Module in GMU, Editorial Board for many international journals and active Principle Investigator in many national &rninternational clinical studies, Member of AACE, EASD, ESE, ISPAD and many professional societies. To his credit many awards of honor & publications in medicalrnperiodicals and conference abstracts.
Abstract:
- Session: Thyroid Disorders: In Children, Teens and Adolescents
Session: Thyroid Surgery & Care
Session: Thyroid Challenges & Improvements
Session Introduction
Artur Bossowski
Medical University of Bialystok, Poland
Title: Analysis of chosen polymorphisms rs2476601 A/G - PTPN22, rs1990760 C/T - IFIH1, rs179247 A/G - TSHR in pathogenesis of autoimmune thyroid diseases in children
Time : 11:40-12:10
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: Autoimmune thyroid diseases are multi-factorial diseases with a genetic susceptibility and environmental factors. A potential role of the protein tyrosine phosphatase non-receptor type 22(PTPN22) gene, the interferon induced helicase domain 1 (IFIH1) gene, the thyroid-stimulating hormone receptor (TSH-R) gene polymorphisms on autoimmune thyroid diseases(AITDs) in children has not been established equivocally yet. Aim: To estimate the association of polymorphisms of protein tyrosine phosphatase non-receptor type 22 genes, the interferon induced helicase domain 1 gene, thyroid-stimulating hormone receptor gene with the predisposition to Graves’ disease (GD) and Hashimoto’s thyroiditis (HT) in children. Methods: The study was performed in 142 patients with GD, 57 with HT and 160 healthy volunteers. The three single nucleotide polymorphisms (SNPs): rs2476601 - PTPN22 in the protein tyrosine phosphatase non-receptor type 22 gene, rs1990760 - IFIH1 in the interferon induced helicase domain 1 gene, rs179247 - TSHR in the thyroid-stimulating hormone receptor gene were genotyped by Taq-Man SNP genotyping assay using the real-time PCR. Furthermore, the interaction between rs1990760, rs2476601, rs179247 polymorphisms and the status of thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb) and TSH receptor antibody (TRAb) were analyzed. Results: rs2476601: Our study revealed that rs2476601-A alleles were more frequent (18% in men and 20% in women) in GD patients in comparison to healthy subjects (11% in men and 10% in women). P-value=0.009 with OR=2.13 and 95% confidence interval for OR: 1.2–4.0, what means that risk for development of GD is over two times higher for A allele in comparison to G allele. Moreover rs2476601 A alleles were more frequent (25% in men and 21% in women) in HT patients in comparison to healthy subjects (11% in men and 10% in women). P-value=0.008 with OR=2.48 and 95% confidence interval for OR: 1.3–5.0, what means that risk for development of HT is two and a half times higher for A allele in comparison to G allele. rs1990760: Rs1990760 T alleles were more frequent in GD male patients in comparison to healthy males (69% vs. 42%). P-value=0.003 with OR=3.00 and 95% confidence interval for OR: 1.5–6.2, what means that risk for development of GD is three times higher for T allele in comparison to C allele, when considering male group. In case of HT patients rs1990760 T alleles were also more frequent in males compared to healthy subjects (65% vs. 42%). P-value=0.086 with OR=2.47 and 95% confidence interval for OR: 0.9–7.5, what means that risk for development of HT is nearly two and a half times higher for T allele in comparison to C allele. Results for female group were non-significant from the statistical point of view, hence are not discussed here. rs179247: Our study revealed that rs179247 A alleles were more frequent (47% both in men and women) in GD patients in comparison to healthy subjects (37% in men and 38% in women). P-value=0.039 with OR=1.51 and 95% confidence interval for OR: 1.0–2.3, what means that risk for development of GD is over two times higher for A allele in comparison to G allele. Conclusions: Rs2476601: A/G polymorphism in protein tyrosine phosphatase non-receptor type 22 gene could contribute to development of AITDs in children and A allele is the main risk factor. Rs1990760: C/T polymorphism in the interferon induced helicase domain 1 gene could contribute to development of AITDs in children and T allele is the main risk factor. Rs179247: A/G polymorphism in thyroid-stimulating hormone receptor gene could contribute to development of AITDs in children and A allele is the main risk factor.
Roopal N Panchani
The Endocrine Clinic, Vadodara, Gujarat, India
Title: Role of peak systolic velocity of inferior thyroid artery in the differential diagnosis of thyrotoxicosis
Time : 12:10-12:40
Biography:
Roopal N Panchani completed her MD in Internal Medicine from Baroda Medical College, Maharaja Sayajirao University, Gujarat and her super specialization in Endocrinology (DNB Endocrinology) from Sir Ganga Ram Hospital, New Delhi; a premier academic institution of India. She has delivered talks as an invited speaker in 13 conferences, organized about 15 patient education workshops on various topics and served as chairperson and panelist in many conferences. She has 14 publications, 24 poster presentations and 5 oral presentations to her merit. She has a bag full of awards to her merit including the Best Resident Doctor of Sir Ganga Ram Hospital.
Abstract:
Radioactive iodine uptake scan (RAIU) is the investigation of choice in differential diagnosis of thyrotoxicosis. Our study evaluated the diagnostic utility of peak systolic velocity (PSV) of inferior thyroid artery (ITA) on color Doppler ultrasound (CDU) in patients with thyrotoxicosis by comparing with RAIU scan and also determined a specific cut off for PSV of ITA to discriminate accurately between Graves’ disease and (painless and sub-acute) thyroiditis. Over 15 months, 143 patients were selected out of 231 patients with thyrotoxicosis. CDU of thyroid and RAIU scan was performed in 98 patients. RAIU diagnosed thyroiditis in 52 patients and 46 had Graves’ disease. Mean TSH, FT3 and FT4 in Graves’ disease was 0.0214+0.028 µIU/ml, 9.682+6.04 pg/ml and 4.186+1.60 ng/dl respectively. Mean TSH, FT3 and FT4 in thyroiditis was 0.0433+0.040 µIU/ml, 3.602+3.34 pg/ml and 4.027+1.91ng/dl respectively. Mean 2hr and 24hr uptake was 33.07% and 62.38% in Graves’ disease and in thyroiditis it was 6.41% and 11.46% (P<0.01). Patients with Graves’ disease had higher PSV of ITA (63.19+22.85 cm/s) than patients with thyroiditis (16.90+6.54cm/s); P<0.01. PSV>36 cm/s differentiated all patients with Graves’ disease from thyroiditis. Thus CDU of thyroid is a cost effective diagnostic tool and is comparable to RAIU scan for the diagnosis of Graves’ disease or destructive thyroiditis. The unique aspect of study was exclusion of patients with obvious clinical features like neck pain and fever in thyroiditis and infiltrative orbitopathy in Graves’ disease which enabled us to study the role of CDU when it is required the most.
Nargis Khowaja
Nurse Manager, Internal Medicine, Endocrinology & Infectious diseases, Pakistan
Title: Evidence based nursing care guidelines of adult patients with hypothyroidism
Time : 12:40-13:10
Biography:
Nargis Khowaja is currently working as Nurse Manager of Endocrinology, Internal Medicine, Rapid Response Team, and infectious diseases and Working as Co-Chair of CPR Committee in The Aga Khan university hospital Karachi Pakistan, JCIA Certified. Since 17 years she also has worked in various capacities that is; worked as Nurse Administrator Of All Critical Care Areas Moreover, worked as Head Nurse of Coronary Care Unit, Senior Critical Care Nurse in Coronary Care unit(CCU), Intensive Care Unit(ICU) and Cardio thoracic intensive Care Unit(CICU) In the Aga Khan University hospital Pakistan. Also worked as Staff Nurse in Pediatric ICU in Harley Street Hospital and Adult Intensive care unit (ITU) in Gloustershaire Royal Hospital NHS Trust, London. She has completed her BSc in Nursing from New Life collage of Nursing in 2015.
Abstract:
Objective: Hypothyroidism is an endocrine disorder. In hypothyroidism patient has an underactive thyroid ("hypo-" means "under" or "below normal"). In patients with hypothyroidism, the thyroid does not make enough thyroid hormone to keep the body maintain its normal balance. Common causes of hypothyroidism are autoimmune disease, surgical removal of the thyroid, and radiation treatment. The objective of this literature review is to present the evidence based nursing practice for patients with hypothyroidism. Methodology: The literature review was done from the period of January to November 2015 from various online databases such as PUBMED, CINAHL and Allied Health Literature. Key words used: ‘Hypothyroidism’, ‘adults’, and ‘Nursing Care’ using Boolean (AND, OR) words. The final reference list consists of 20 relevant articles ranging from 2010 to 2015, which include qualitative and quantitative researches, literature reviews, peer reviews, and index articles. Results: The evidence based nursing suggests that nurses should monitor vital signs of patients with hypothyroidism because fluctuations in metabolic rate are exhibited by changes in blood pressure, heart rate, and body temperature. Also, nurses should watch for the reduction in symptoms related to hypothyroidism such as fatigue, constipation, cold intolerance, lethargy, depression, and menstrual irregularities, it demonstrate that patient is getting therapeutic effect from drug. Nursing intervention should also include watching for the symptoms of hyperthyroidism such as nervousness, insomnia, tachycardia, dysarrhythmias, heat intolerance, chest pain, and diarrhea as these symptoms may indicate that the drug is at a toxic level. Moreover, evidence based nursing care recommends to monitor T3, T4, and TSH levels as these levels help determine the effectiveness of pharmacotherapy. Monitoring of blood glucose levels, especially in individuals with diabetes mellitus is important as hormone can increases metabolic rate, and glucose utilization may be altered. Most importantly, nurses should provide supportive nursing care to cope with symptoms of hypothyroidism such as constipation, cold intolerance, and fatigue until drug has achieved therapeutic effects as it will decrease the client’s anxiety, which will promote healing and compliance. Nursing intervention also includes monitor weight once a week as weight loss is expected because of increased metabolic rate as these changes help determine the effectiveness of drug therapy. Furthermore, nurses should monitor patients for signs of decreased compliance with therapeutic regimen as it may require early intervention and education about the medical regimen and the disease process. Conclusion: Evaluation of the effectiveness of drug therapy is an important task for nurses in order to confirm that patient goals and expected outcomes have been met. These outcomes include the patient’s thyroid hormone levels are normal, the patient demonstrates decreased symptoms of hypothyroidism, the patient is free from significant adverse effects from drug therapy. And the patient demonstrates an understanding of the drug’s action by accurately describing drug side effects and precautions.
Memon Zahid Ali
Assistant Professor, Civil Hospital, Karachi, Pakistan
Title: Postoperative use of drain in thyroid lobectomy– A randomized clinical trial conducted at Civil Hospital, Karachi, Pakistan
Time : 14:00-14:30
Biography:
Zahid Ali Memon (MBBS, FCPS and MRCS) is a London consultant and a Laparoscopic Surgeon. He is an Assistant Professor at Dow University of Health Science and Civil Hospital Karachi.
Abstract:
Background: Thyroidectomy is a common surgical procedure, after which drains are placed routinely. This study aims to assess the benefits of placing postoperative drains, its complications and affects on postoperative stay, in thyroid lobectomy. Methodology: Randomized Clinical Trial of 60 goitre patients undergoing lobectomy was conducted at Civil Hospital Karachi, during July’11-December’11. Patients were randomly assigned into drain and non drain groups. Patient demographics, labs and complications were noted. Ultrasound of neck was performed on both groups. For drain group, the amount of fluid present in the surgical bed and redivac drain was added to calculate fluid collection while in non drain group it was calculated by ultrasound of neck on first and second post-op days. Data was entered and analyzed on SPSS v16 using Independent T tests. Result: The mean total drain output for 2 days in non-drain group was significantly lower 10.67 (±9.072) ml while in drain group was 30.97 (±42.812) ml (p=0.014). The mean postoperative stay of drain group (79.2±15.63 hours) was significantly higher, as compared to mean postoperative stay of non drain group (50.4±7.32 hours). Mean Visual Analogue Score (VAS) for pain day 1 (6.2±0.997) and day 2 (4.17±0.95) in drain group were significantly higher compared to day 1 (2.6±1.163) and day 2 (1.3±0.877) of non drain group. From drain group, 2 patients complained of stridor, dyspnea on Day 1 which subsided by Day 2 and 1 case of voice change, with no such complains in non drain group. No patients from both groups developed seroma, wound infection or hematoma. Conclusion: In uncomplicated surgeries especially for lobectomy, use of drain can be omitted.
Shenila Anwarali
Aga Khan University, Pakistan
Title: Evidence based nursing in management of hypo and hyper thyroidism during pregnancy
Time : 14:30-15:00
Biography:
Shenila Anwarali is currently working as Clinical Nurse Coordinator of Mind and Brain, Majorly Neurology at The Aga Khan University Hospital Karachi, Pakistan. Since past 5 years she has worked as a registered nurse, special care nurse and a team leader for the same service The Aga Khan University Hospital, Karachi, Pakistan. She has completed her Post RN BScN from Aga Khan University in 2013, diploma in Nursing in 2009 and is currently enrolled in Masters in Hospital Management from College of Business Management, Karachi, Pakistan.
Abstract:
Objective: Thyroid is a ductless gland located in the neck which secretes growth regulating hormones and controls development through metabolism. Alteration in the release of this hormone can result in hypo (decreased) or hyper (increased) secretion resulting in various disorders. Thyroid hormone plays a perilous role throughout pregnancy for both; in the development of a healthy baby and in sustaining the well-being of the mother. During pregnancy the release of 2 hormones HCG and estrogen results an increase in thyroid hormone in blood. Early diagnosis is essential for successful management. The objective of this literature review is to present the evidence based nursing practice for mother with thyroid dysfunction during pregnancy. Methodology: The literature review was done from the period of January to November 2015 from various online databases such as PubMed, CINAHL and Allied Health Literature. Key words used: ‘Hypothyroidism’, ‘Hyperthyroidism’, ‘Pregnancy’ and ‘Nursing care’ using Boolean (AND, OR) words. The final reference list consists of 20 relevant articles ranging from 2010 to 2015, which include qualitative and quantitative researches, literature reviews, peer reviews, and index articles. Results: Literature review depicted that altered regulation of thyroid hormone during pregnancy can be life threatening to both the mother and the baby and can lead to serious complications such as congestive heart failure, preeclampsia- a dangerous rise in blood pressure in late pregnancy, thyroid storm- a sudden and severe worsening of symptoms, miscarriage, premature birth, low birth weight and impaired neurophysiological development of the brain. For mother who has already been diagnosed with thyroid dysfunction need to be vigilantly evaluated at all antenatal visit for signs of complication. Furthermore, nurses and midwives should be aware of the signs and symptoms of hypothyroidism such as appetite change (decrease or increase), difficulty in sleeping (insomnia), fatigue, frequent bowel movement perhaps diarrhea, heart palpitations, heat intolerance, increased sweating, irritability, light menstrual periods perhaps even missed periods, mental disturbances, muscle weakness, nervousness, problems with fertility, shortness of breath, sudden paralysis, tremor/shakiness, vision changes, weight loss-but perhaps, weight gain, dizziness, thinning of hair, itching and hives, possible increase in blood sugar and hyperthyroidism in which fatigue, weakness, weight gain or increased difficulty losing weight, coarse, dry hair, dry, rough pale skin, hair loss, cold intolerance (you can't tolerate cold temperatures like those around you), muscle cramps and frequent muscle aches, constipation, depression, irritability, memory loss, abnormal menstrual cycles, decreased libido in order for timely diagnosis and treatment. Moreover, evidence based nursing care recommends to monitor T3, T4, and TSH levels as these levels help to determine the diagnosis and effectiveness of drugs. Ultrasonography of the fetal thyroid gland by an experienced ultra-sonographer is an excellent diagnostic tool. Health care team members should also provide psychological support to the client and ensure that treatment options are available. Nursing intervention also includes monitoring of vital signs, signs and symptoms and educating clients regarding the disease process. Nurses also need to perform fetal examination and identify emergency signs and opt for help as soon as possible. Conclusion: Hence it is essential to rule out thyroid alteration because it can lead to deleterious outcomes affecting mother and the baby. It can result in irreversible damage to the offspring’s brain causing disrupted neurodevelopment. It is suggested that for those mother who have been diagnosed with the altered thyroid activity need to be frequently re-evaluated of the maternal and fetal complication whereas, for those who show classical signs and symptoms need to be investigated for a proper diagnosis. Awareness sessions need to be held and clients should be accurately educated about the treatment modalities.
Biography:
Surbhi Rana is currently pursuing her PhD from Punjab Technical University, Jalandhar, Punjab India. She has published many papers in reputed journals.
Abstract:
Thyroid gland is located at the front of neck and secretes 2 types of thyroid hormones: T4 (Thyroxine) and T3 (Triiodothyronine). Thyroid hormones regulate many functions in our body, such as the way of energy and oxygen consumption. Thyroid hormones are involved in the regulation of basal metabolic state and in oxidative metabolism. They can cause many changes in the number and activity of mitochondrial respiratory chain components. This may result in the increased generation of reactive oxygen species (ROS). ROS are highly reactive, therefore can lead to oxidative damage. Thyroid disorders occur when thyroid gland releases excess or diminished hormones. An overactive or underactive thyroid can lead to a wide range of health problems. Hyperthyroidism is associated with increase in free radical production and lipid peroxide levels whereas hypothyroidism, a decrease in free radical production because of the metabolic suppression by the decrease in thyroid hormone levels. Mitochondria is also one of the major reactive oxygen species (ROS) producer. Mitochondrial dysfunction is associated with an increase in the generation of reactive oxygen species. Mitochondrial dysfunction and increased ROS contributes to number of diseases including neurodegenerative diseases and cancer. Mitochondria use metabolic intermediates generated during the tricarboxylic acid (TCA) cycle to generate adenosine triphosphate (ATP) during oxidative phosphorylation. It has been reported that mitochondria also serve to regulate cytosolic calcium and iron concentration. Mitochondrial dysfunction is associated with an increase in the generation of reactive oxygen intermediates and release of free radicals derived from oxygen and nitrogen. Both the radical species generated via interaction with free radicals, and referred as reactive oxygen or nitrogen species (RONS). Thyroid hormones are associated with oxidative stress and antioxidant status due to their capacity to change respiratory rate in mitochondria. It has been suggested that changes in thyroid hormone levels may be one of the main modulators of oxidative stress. Thyroid dysfunction is the most frequent endocrine abnormality in population. It has been reported that oxidative stress in both hypothyroidism and hyperthyroidism condition are controversial. In hypothyroidism, a low free radical generation is expected because of the metabolic suppression by decrease in thyroid level. However, in some studies an increased oxidative stress is found in hyperthyroidism as well as in hypothyroidism. However, many aspects that are crucial for the health and well-being of people with this condition remain to be elucidated and require further research.
Zaina Adnan
Zvulon Medical Center at Clalit Medical Services, Israel
Title: Simultaneous occurrence of medullary and papillary thyroid micro-carcinomas
Biography:
Zaina Adnan has completed his MD from Carol Davila faculty of Medicine and Pharmacy, Bucaresti Romania. He is a specialist in Internal Medicine, Endocrinology, Diabetes and Bone Metabolism. He is a Director of the Endocrinology and Bone Metabolism Department at Zvulon Medical Center at Clalit Medical Services – Haifa. He is a Lecturer and instructor of medical students at the faculty of Medicine in the Galilee/Bar-Ilan University. He has published papers in medical journals and has been serving a reviewer for different articles in Endocrinology and Diabetes.
Abstract:
Papillary thyroid micro carcinoma has been demonstrated to present in association with medullary thyroid carcinoma, however, the coexistence of medullary thyroid carcinoma and papillary thyroid carcinoma represent a very rare entity. In recent years, this rarity has been increasingly observed. The pathogenesis is still controversial. Genetic analysis of RET proto-oncogenes in cases of simultaneous papillary thyroid carcinoma and medullary thyroid carcinoma has so far provided conflicting results. Our presentation describes rare cases of simultaneous medullary thyroid carcinoma and papillary thyroid micro carcinoma. These cases were presented in our clinic with unique features and with different ethnicities. Database and literature review will be presented. Our data supports the coexistence of papillary thyroid micro-carcinoma and medullary thyroid carcinoma. Endocrinologists and pathologists should be aware of this entity. Small thyroid nodules should be evaluated preoperatively especially if they are located in the contra lateral thyroid lobe. The pathologist can play a pivotal role in identifying papillary thyroid micro carcinoma in concurrent existence with medullary thyroid carcinoma.
Aslan Ahmadi
Iran University of Medical Science, Iran
Title: Our experience in treatment of recurrent laryngeal nerve paralysis after thyroidectomy
Biography:
Aslan Ahmadi has done with Otorhinolaryngology and head and neck surgery from 2008 to 2012 in Iran University Medical Science and with Board certified with the best degree in Iran at 2012. He has also done Fellowship in Laryngology in 2015. He has an experience as Assistant Professor of otorhinolaryngology at IUMS in Rasule Akram Hospital from 2013 (site of excellent in otorhinolaryngology in Iran), as Chairman of clinic at Rasule Akram Hospital, Director of resident program at department of otorhinolaryngology, Rasule Akram Hospital. Some of the publications are the effect of IMOD in recurrent respiratory papillomatosis of larynx, Iranian Red Crescent Journal 2015
Abstract:
Recurrent laryngeal nerve paralysis is a common complication after thyroidectomy depends on the kind of thyroidectomy, unilateral or bilateral paralysis may occur. Anterior branch of RLN is in the posterior aspect of cricothyroid joint so it can simply injured in blind dissection of this area. After unilateral RLN injury, we have true vocal cord paralysis at the same side. In this category the patients have swallowing problem with voice disorder. Depends on the severity and the type of injury in the operation we can do some procedures with different approach. TVC medicalization with Cortex, cadaveric fascia, fascia late is the procedures of choice in selected patients in our experience. Especially we create a window in lower most border of thyroid cartilage about 6-10 mm posterior to the anterior commissure. Injection of VOX under general anesthesia in paraglotic space with the special injector is the simplest procedure with good outcome. Neuromuscular pedicle transfer, reinnervation with nerve graft is the other procedure that we can do in this situation. Anyway the best result is in the primary surgery at the time of thyroidectomy, that the surgeon should carefully dissect the nerve and prevent to damage the recurrent laryngeal nerve.
Fualal Jane Odubu
Mulago National Referral and Teaching Hospital, Uganda
Title: Challenges impacting giant goiter surgery at a tertiary Sub-Saharan Hospital
Biography:
Senior Consultant Surgeon, Head Breast and Endocrine Surgical Unit at Mulago National Referral Hospital, Past president Association of Surgeons of Uganda, Current Uganda Country Representative College of Surgeons of East Central and Southern Africa [COSECSA]. Hon. Lecturer, Department of Surgery, College of Health Sciences, Makerere University with passion in training and Mentoring of undergraduate and graduate medical students and Fellows/Residents. Pioneer Endocrine Surgeon in Uganda with enormous experience in surgery of the Thyroids, Adrenals and the Breast and Member of the International Association of Endocrine Surgeons [IAES]. Was an International guest speaker at Department of Continuing Education on “Surgery of the Thyroid and Parathyroids”, Harvard Medical School Boston Massachusetts USA. Has 12 publications and several presentations at International scientific meetings and numerous citations. Awarded Model of Excellence by FAWE-U, and Community Service by Rotary Club of Luzira Kampala.
Abstract:
Thyroid disease is prevalent in Africa. Regional governments’ and NGO’s effort to establish tertiary institutions and facilitate surgical outreaches have yielded little. Globally, health funding faces scarcity. Third world countries have been identified with neglected thyroid disease like big goiters causing disfigurements, upper airway and gastrointestinal tract obstruction or neck vasculature engorgement. Longstanding cases may undergo malignant transformation or extend retrosternally. This was a prospective cohort selected from a pool of operated thyroid patients at Breast and Endocrine Unit of Mulago National Referral and Teaching Hospital, Kampala Uganda. Averagely, six (6) thyroidectomies are done every week. Two (2) out of these qualified for the study as having giant goiter. Surgery necessitated the team’s lobbying for ICU space, meticulous peri-operative involvement of anesthesiology residents and undertaking thorough investigations. Age range of patients was 15 – 70 years with majority in the 40-60 year age bracket; a female preponderance of 8:1. Average operative time was 4hours with about half utilized by anesthesia. Challenges encountered included team building, scarce surgical instruments, managing difficult airway, extracting impacted retrosternal goitre, encountering the markedly engorged neck vessels and ICU space. Loss to follow up after discharge was about 30%. Despite innumerable challenges, the result shows that 95% of our patients get successful surgery; 4% develop transient complications like hoarseness and hypocalcaemia. One patient required tracheostomy. Giant thyroid is fairly common at Mulago. Its surgery is challenging. With organized team, competence, overall surgical results are comparable to those in well facilitated centers even amidst scarce resources.
Biography:
Elamin Abdelgadir is a Senior specialist endocrinologist at Dubai Hospital. He is graduated from Sudan in 2004 and obtained his membership at the Royal College of Physicians in 2010. He pursued his endocrinology career in 2010. He got his Post-graduate degree in Endocrinology in 2014. He was appointed as Vice-Head of Medical Education Institute in International University of Africa 2009. He is interested in clinical research and has published 20 papers and abstracts so far.
Abstract:
Data from LEAD trials showed that liraglutide was associated with significant reduction in weight HbA1c and blood pressure values. Unfortunately there are no enough data on Arab population. We aimed to assess the changes in blood pressure, lipids profile, and liver function test upon starting liraglutide and after 6 months of therapy in Arab patients with type2 diabetes as primary objective. 365 agreed to sign an informed consent. 29% of the studied population was males (n=106) compared to 71% females (n=259). There was no significant change in systolic blood pressure, however average diastolic blood pressure improved significantly (74.4±10 to 72±9 mmHg at 6 months P<0.001). Significantly lower average diastolic BP was seen in Insulin users at both start and the end of the study (73+4 vs. 76+4 P=0.05 and (71+ 5 vs. 73+4.6) p=0.02, respectively). Mean AST and ALT was within normal range at baseline and despite that there was a highly significant reduction between baseline and end of study 29+18 to 25.7+13 and 25.1+20 to 22.2+16 for ALT and AST, respectively. Both of them showed highly significant P value (0.0000). There was a significant reduction in weight and HbA1c at 6 months. However the change in weight was more significant in insulin users compared to those who did not use insulin (96+3 to 93+5 vs. 93+5 to 98+3.5, P-value at the end of the study was 0.02). The HbA1c reduction was significant irrespective of weight loss. Liraglutide showed remarkable improvement in weight, HbA1c, liver enzymes and diastolic blood pressure. Patients who used insulin at base line had better results in weight and lipids reduction.
Aslan Ahmadi
Iran University of Medical Science, Iran
Title: Thyroid surgery-Pre and postoperative care address
Biography:
Aslan Ahmadi has done with Otorhinolaryngology and head and neck surgery from 2008 to 2012 in Iran University Medical Science and with Board certified with the best degree in Iran at 2012. He has also done Fellowship in Laryngology in 2015. He has an experience as Assistant Professor of otorhinolaryngology at IUMS in Rasule Akram Hospital from 2013 (site of excellent in otorhinolaryngology in Iran), as Chairman of clinic at Rasule Akram Hospital, Director of resident program at department of otorhinolaryngology, Rasule Akram Hospital. Some of the publications are the effect of IMOD in recurrent respiratory papillomatosis of larynx, Iranian Red Crescent Journal 2015
Abstract:
Iatrogenic injury to recurrent laryngeal nerve in thyroid surgery is an important complication. In thyroid cancer surgery this complication is much more common. When it occurs, at the time of surgery what should we do and at the end of operation what should we in exudation period? When we receive TVC paralysis with the history of thyroid surgery and breathiness after that, we do direct laryngoscopy with evaluation of vocal fold movement. If we found unilateral paralysis with complain of breathiness or aspiration we do medicalization thyroplasty when the patients are sedated or augmentation of vocal cord under general anesthesia directly in the TVC.We have many images or video from this procedure with outcome of such intervention.
Mafalda Gomes
University of Porto, Portugal
Title: Risks to the fetus from diagnostic imaging during pregnancy: Review and proposal of a clinical protocol
Biography:
Mafalda Gomes has completed her Degree in Basic Health Sciences in the Faculty of Medicine of the University of Porto, the best Medical School in Portugal, in 2012. She is engaged in one of the biggest Hospitals in the country and gained clinical experience in Hospital S. João, with internships in Hospital Pedro Hispano and Póvoa de Varzim-Vila do Conde Hospital Center. In 2015, she finished her Master Degree in Medicine in the same Faculty of Medicine. Her thesis was recently published in an international journal with an impact factor of 1.6.
Abstract:
Every day, medical practitioners face the dilemma of exposing pregnant or possibly pregnant patients to radiation from diagnostic examinations. Both doctors and patients often have questions about the risks of radiation. The most vulnerable period is between the 8th and 15th weeks of gestation. Deterministic effects like pregnancy loss, congenital malformations, growth retardation and neurobehavioral abnormalities have threshold doses above 100–200 mGy. The risk is considered negligible at 50 mGy and in reality no diagnostic examination exceeds this limit. The risk of carcinogenesis is slightly higher than in the general population. Intravenous iodinated contrast is discouraged, except in highly selected patients. Considering all the possible noxious effects of radiation exposure, measures to diminish radiation are essential and affect the fetal outcome. Non-ionizing procedures should be considered whenever possible and every radiology center should have its own data analysis on fetal radiation exposure. In this review, we analyze existing literature on fetal risks due to radiation exposure, producing a clinical protocol to guide safe radiation use in a clinical setting.
Biography:
Hussein Abdul Raheem Hussein Alkoofee is Professor in Molecular Pathology, Director of Post-graduate Teaching & Learning and Director of Medical Ethics at the School of Medicine, Trinity College Dublin. He has a PhD in Molecular Pathology from TCD and an MA in Medical Law and Ethics from KCL. The underlying theme of his research is to understand the causes and molecular basis of the development of disease and to apply this knowledge to improving disease prevention, detection, diagnosis and treatment. He has particular interest in developing novel molecular diagnostics. Translational research is the common theme throughout his research, linking identification of disease processes with targets for early disease detection or classification.
Abstract:
Background: Fine needle aspiration cytology (FNAC) with its minimal invasiveness has been a well accepted procedure in the initial diagnosis of various swellings. With time and experience, high sensitivity and specificity of FNAC over conventional open biopsy has lead to the wide acceptance of this procedure. Objective: We decided to compare the accuracy of this method with open biopsy & see if this technique reduces the need for more invasive and costly procedures and to evaluate the utility of aspirate cytology as a first line diagnostic tool in palpable neck masses & even non-palpable masses under U/S or CT guide. Patients & Methods: A hospital based prospective for (100) patients with various swellings at Neck regions in the Department of General surgery, AL-Yarmouk Hospital between Jan. 2014 to Jan. 2015. FNAC were done from the palpable masses of neck regions and were compared with biopsy findings of the same lesions. The sensitivity, specificity and accuracy rates were calculated. Results: A total 100 patients were subjected to both FNAC and histo-pathological examination (HPE). Total (41%) were females and (59%) were males. The age group ranged from 21-30 years. Eighty seven percent of patients were in the age group below 50 years. The highest number of cases included thyroid 52(52%), followed by lymph nodes 29(29%), salivary glands 11 & 8 miscellaneous. The overall sensitivity and specificity of FNAC were (72%) and (87%) respectively in determining the various pathologies. The overall accuracy of FNAC in present study was (79%). Conclusion: FNAC is a minimally invasive first line investigation with a high sensitivity and specificity for the diagnosis of various head and neck masses and it’s highly recommended for diagnosis of cervical swellings.
- Track 8: Thyroid Surgery & Care
Track 9: Thyroid Challenges & Improvements
Track 10: Thyroid Therapy: Medications & Remedies
Session Introduction
Gyan Chand
Sanjay Gandhi Post Graduate Institute of Medical Sciences, India
Title: Follicular variant of papillary thyroid carcinoma: A distinct clinical entity in endemic area
Biography:
After completing MS General Surgery in 2000 from KGMC Lucknow and Endocrine Surgery Training from SGPGIMS Lucknow, He serves as Lecturer BRD medical College Gorakhpur till 2006, Assistant professor GSVM Medical College Kanpur till 2007, Assistant Professor till 2010 & Associate Professor till now at Department of Endocrine Surgery, SGPGIMS Lucknow. He received UICC fellowship, and other awards, visited various national and international institutions, Author of research publications in various peer reviewed journals and book chapters. Presented scientific research papers in various national & international conferences. Has been invited as guest lecture and chair sessions in various scientific conferences. Member of various professional organizations. Have actively participated in resident teaching and guided four research projects. And various thesis. Active in research and running two project. His area of research interest is thyroid cancer. Attended many scientific conferences and workshops. And was in the team of organizers of various scientific conferences. And also done various public camps and delivered various public lectures.
Abstract:
Introduction: Follicular variant of papillary thyroid carcinoma (FVPTC) is being increasingly diagnosed in recent years, however little is known about its histopathological and clinical behavior. Aim: The purpose of this study is to determine clinical characteristics of FVPTC and to compare it with classical papillary thyroid carcinoma (cPTC). Methods: We prospectively analyzed the retrospectively collected data of 182 PTC patients treated between 2009 and 2012. Two pathologists, who were blinded of the clinical and previous histopathology report, individually reviewed the slides. Statistical analysis was done using SPSS version 17.0 and non parametric tests were used to compare FVPTC and cPTC. Results: There were 35 cases of follicular variant of PTC (FVPTC) and 147 cases of classic PTC (cPTC). On comparison, FVPTC presented more commonly in males and as multinodular goiters and cPTC had more incidence of LN metastasis. Compared to cPTC, FVPTC had histopathologically higher incidence of capsular invasion and extrathyroidal extension and distant metastasis (p<0.001). FVPTC patients had bone as the more common site of metastasis, whereas cPTC patients had pulmonary as the site of metastasis. Conclusions: FVPTC is a common variant of PTC and has unique clinical behavior. Inspite of there being variations in clinical behavior between FVPTC and cPTC, the long term outcome of FVPTC patients remains similar to that of cPTC.
Orla Sheils
The University of Dublin, Ireland
Title: Next generation sequencing of thyroid neoplasms to determine mutational status
Biography:
Orla Sheils is Professor in Molecular Pathology, Director of PostgraduateTeaching & Learning and Director of Medical Ethics at the School of Medicine, Trinity College Dublin. She has a PhD in Molecular Pathology from TCD and a MA in Medical Law and Ethics from KCL. The underlying theme of her research is to understand the causes and molecular basis of the development of disease and to apply this knowledge to improving disease prevention, detection, diagnosis and treatment. She has particular interest in developing novel molecular diagnostics. Translational research is the common theme throughout her research, linking identification of disease processes with targets for early disease detection or classification.
Abstract:
The prognosis for patients with thyroid carcinoma is generally dependent on age and tumour stage at time of diagnosis. Nonetheless, the biological aggressiveness of individual tumours cannot always be predicted from the initial clinical features, making it difficult consistently to identify patients who will die from their disease. Moreover, the occurrence of non-specific lymphocytic thyroiditis of varying severity adjacent to thyroid tumours is frequently observed. Risk factors for the development of thyroid cancer include radiation exposure, somatic and germline genetic mutations. Common mutations that precede the development of thyroid carcinoma target the mitogen-activated protein kinase (MAPK pathway) and include BRAF, RET/PTC and RAS. We employed a NGS sequencing approach for parallel interrogation of the presence of somatic mutations in samples from 82 patients. We hypothesised this approach might have utility as an adjunct diagnostic in tissue and FNA analyses and in understanding the molecular patho-biological processes in carcinogenic progression. Adopting a null hypothesis approach, we used the oncomine comprehensive assay and Ion PGMâ„¢ semi-conductor sequencing technology to analyze hundreds of the most referenced oncology biomarkers including hotspot mutations, CNVs, gene fusions and indels. The method involved multiplex PCR requiring 10 ng of input DNA. The most commonly detected mutations involved: DDR2, NRAS, PI3KCA, MET, ERBB2, FGFR3, MET, STK11, EGFR, BRAF and TP53. The number of somatic variants per sample was higher among FTC (mean=28.2, Median=9) than PTC (mean =9.9, median = 6). In addition, we detected the SQSTM1-NTRK1 fusion transcript in RNA from 2 PTC samples. The number of predictive biomarkers that are assessed in clinical practice is rapidly increasing with the availability of drugs that target specific molecular alterations. NGS has the advantage of providing information on known and novel molecular alterations and multiple genes can be sequenced simultaneously in the clinical laboratory setting. This study identified significant pathological mutations among PTC and FTC DNA and RNA samples that may have potential diagnostic and therapeutic implications.
Biography:
Uma Garg has done MBBS in 1985 & MS (ENT) in 1989 from Medical College in Maharashtra India. Currently she is working as Professor & Head Dept. of ENT BPS Govt. Medical College, India. She has published more than 40 papers in national and international journals of repute and has attended various state & national conferences as faculty & delivered lectures. She is a life member of Indian Association of ENT surgeons in addition to Indian Medical Association.
Abstract:
Thyroid gland being an important structure in neck is a vascular organ strategically located& bearing very close association with trachea, larynx, esophagus, carotid arteries & between the two important nerve recurrent laryngeal nerves. Swellings of thyroid per se can affect these structures. Thyroid also houses parathyroid glands which play an important part in calcium metabolism. Primarily thyroid enlargements are a common finding in females the incidence of this being almost 50% & this is referred to as incidentaloma’’. Owing to its central midline position it is easily noticed by others & felt or palpated by the patient. Symptoms of pressure on the anatomically close relations appear late & they are ominous in the sense that they warrant investigations to rule out true nature of thyroid swelling. Investigations are required in this subset of patients to know whether thyroid is involved primarily or secondarily. Decision on when & how to treat a thyroid swelling depends on a few basic investigations which will guide to true nature of thyroid involvement. Most of thyroid swellings are benign, cancers being very rare. Physiologically thyroid dysfunctions are seen but are treated medically rarely needing surgical intervention. For a judicious stratification of thyroid patient for investigations & treatment a thorough understanding of anatomy of this gland is essential. Therefore a brief review into the anatomy of thyroid gland is being presented here.
Mohinder Kumar Garg
BPS Govt. Medical College, India
Title: Management of solitary thyroid nodule-Current concepts
Biography:
M K Garg has done his MBBS in 1985 & MS in General Surgery from Govt. Medical College, Haryana India in 1989. Currently he is working as Professor and Head of Dept. of surgery BPS Govt. Medical College, Haryana India. He has published more than 35 papers in national and international journals of repute and has attended various state & national conferences as faculty & delivered lectures. He is a life member of Indian Association of Endocrine surgeons in addition to association of Surgeons of India (ASI), IMA and SELSI. He has been invited as panelist and delivered lectures on thyroid being his area of special interest.
Abstract:
Thyroid disorders are commonly presenting in outdoor of surgery department. As these are located anatomically at a place, where it can easily be noticed by the patient; patients present quite early. As with any swelling, needless anxiety is created in the mind of the patient and the clinician to exclude malignancy, which is not very commonly encountered pathology. In the present era of modern diagnostic modalities surgeon can reach correct diagnosis in many cases. However at times surgeon is in a dilemma whether to keep the nodule under observation or to treat specially in benign disorder. FNAC though useful cannot differentiate between follicular adenoma & follicular carcinoma; in addition, it is operator dependent also. Differentiated thyroid carcinoma on the other hand has an indolent course and has got excellent prognosis depending on some parameters. Other investigations which are not available at many places particularly in developing countries like India are required only for special circumstances and should be used judiciously to make it cost effective. An in-depth knowledge of pathology is required for ideal management of solitary thyroid nodule as many cases do not require any treatment except observation, for which surgeon should by all means exclude malignancy. Cosmetic indication of surgery requires second thought as thyroid surgery leaves scar in the neck. The current topic will highlight an insight into investigation & treatment of solitary thyroid nodule
Purushottam Kand
Tata Memorial Hospital, India
Title: Challenges in the management of patients with differentiated thyroid carcinoma and renal metastasis: Case series with follow up
Biography:
Purushottam Kand is a qualified Nuclear Medicine Physician presently offering services to patients as Consultant, PET-CT and Nuclear Medicine at the Sir H. N. Reliance Foundation Hospital & Research Centre. Previously he worked as Consultant, PET-CT and Nuclear Medicine at the P.D. Hinduja National Hospital & Medical Research Centre and Associate Professor at the Radiation Medicine Centre, Tata Memorial Hospital, the premier Institute for the teaching, training and practice of Nuclear Medicine in India. He has independently conducted and administered over 5000 radionuclide therapies with expertise in Radionuclide management of metastatic Differentiated Thyroid Carcinoma and Peptide Receptor Radionuclide Therapy in Somatostatin Receptor expressing tumors. He has successfully managed one of the Thyroid Clinics at the Radiation Medicine Centre - the largest Thyroid Clinic facility in India with more than 15000 beneficiary patients per year.
Abstract:
Background: Renal metastasis has relatively less occurrence in patients with differentiated thyroid carcinoma. Methods: The various clinical, imaging, diagnostic and therapeutic parameters of a series of patients with differentiated thyroid carcinoma and renal metastasis were assessed, together with follow-up data. Results & Conclusion: 4 male patients over the age of 45 years with extensive disease at the primary site formed part of the series. Retro-sternal extension of the large goitre was observed in three of the four patients. The primary tumour was 4 cm or larger in all patients (range, 4–14 cm), and three patients had associated lymph node metastasis. None had any genito-urinary symptoms at presentation. Two patients had isolated renal metastases with no other distant metastases, while the others had extensive multi-organ involvement. The bilateral occurrence of lesions was a hallmark, being observed in all cases. The criticality of establishing the diagnosis of renal metastasis had important therapeutic implications. Ultrasound-guided fine needle aspiration cytology and 131I scintigraphy played a significant role in confirming the diagnosis. The optimization of the high dose radioiodine therapy aimed at stabilization of disease with serial meticulous monitoring of renal function facilitated the administration of cumulative average therapy dose of 21.83 GBq (range, 9.176 – 37.666 GBq) 131I in 3 to 4 divided doses. A meticulous and focused approach to establish an accurate diagnosis, ensuring a well maintained renal function without any further compromise due to the therapy or the disease per se and eventually optimization of the high dose radioiodine therapy helped to achieve a stable disease status at a minimum follow- up period of four years after diagnosis in three patients. One patient had expired due to a poorly differentiated lung carcinoma, which developed subsequently.
- 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
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.
Magid Althbety
Security Forces Hospital
Saudi Arabia
Title: Outcomes of trans-cervical surgical management for massive substernal thyroid goiters; a community hospital experience
Time : 12:05-12:35
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
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
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.
Cannataro Giovanni
Azienda Ospedaliera SS. Annunziata
Italy
Title: Strain elastosonography of thyroid nodules: A new tool for malignancy prediction? Overview of literature
Time : 15:25-15:50
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.
Mohsen Ghadami
Tehran University of Medical Sciences, Iran
Title: Molecular analysis of RET proto-oncogene in patients with medullary thyroid carcinoma
Time : 15:50-16:20
Biography:
Mohsen Ghadami completed his MD at Tehran University of Medical Sciences in Iran and his PhD in Medical Genetics at Nagasaki Univerisity in Japan. He obtained his Post-doctoral studies in the field of Gene therapy and Stem Cell Therapy at Baylor College of Medicine in Houston, TX and Texas University of Medical Branch, in Galveston, TX, USA. He is Director of Plenary Genetic Center at Tehran University of Medical Sciences and published more than 20 papers.
Abstract:
Introduction: Medullary Thyroid Carcinoma (MTC) accounts for 5-10% of thyroid cancers and derives from the para-follicular C cells of the thyroid gland. MTC has worse prognosis compare to the most common form of thyroid cancer, papillary thyroid carcinoma (PTC) which accounts for 60-80% of thyroid carcinomas and derives from follicular cells. There are 2 forms of sporadic and hereditary MTC, accounts for 75% and 25% of the cases, respectively. The inherited form is transmitted as autosomal dominant manner and presents either as isolated familial MTC (FMTC) or as a part of syndromic cancer: multiple endocrine neoplasia type 2 (MEN2). Methods: A total of 42 MTC patients from 35 independent families participated in this study. All of the patients were clinically and pathologically diagnosed as MTC. Four families had more than one affected and characterized as FMTC or MEN2 and 31 of cases were sporadic. Genomic DNA was extracted from PBMC. PCR amplification followed by direct DNA sequencing of the RETgene hot spots (exons 10, 11, 13, 14, 15 and 16) was done in all affected. Offspring’s of affected were subjected to RET analysis, if the affected parent had pathogenic mutation in RET gene. Results & Conclusions: We identified RET germ line mutation in 14 families (4 familial and 10 apparently sporadic cases), out of 35 families. Interestingly, 16 asymptomatic family members were carried pathogenic RET germ line mutations that directed to total thyroidectomy. The highest prevalence of mutations was found in exon 11 (9 out of 14/ about 64% of mutations).
Shota Janjgava
Tbilisi State University
Georgia
Title: Screening study of iodine deficiency status and thyroid diseases in Caucasian children
Time : 10:00-10:40
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?
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.
Igor Branovan
Chief of Ear, Nose and Throat Institute
USA
Title: Morphological and clinical presentation of papillary thyroid carcinoma in children and adolescents of Belarus: The influence of radiation exposure and the source of irradiation
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.
Kepal N. Patel
chief, NYU Langone Medical Centre
USA
Title: Clinical and genetic heterogeneity in papillary thyroid carcinoma
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.
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.
Biography:
Izabella Wentz received the Pharm D degree from Midwestern University College of Pharmacy. She is a 2013 recipient of the Excellence in Innovation Award (Illinois Pharmacists Association), Fellow of the American Society of Consultant Pharmacists and holds certifications in Medication Therapy Management and Advanced Diabetes Care. She is the author of the New York Times bestselling patient guide: Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, and co-founder of the Hashimoto’s Institute. She is a trustee for Thyroid Change and Hashimoto’s Awareness and frequently speaks on the subject of lifestyle and complementary treatments for Hashimoto’s.
Abstract:
Various studies have established a connection between Celiac disease and Hashimoto’s. The incidence rate of Celiac disease in Hashimoto’s patients has been reported to be between 1.2% and 15%. Researchers have reported that patients diagnosed with both conditions, who were started on the gluten-free diet, had improved outcomes in both Celiac disease and Hashimoto’s. Anecdotal evidence suggests that the gluten-free (GF) diet may also be helpful for Hashimoto’s patients without Celiac disease. This presentation will focus on summarizing current published research on nutritional interventions for Hashimoto’s, including the well described interventions of the gluten-free diet, Vitamin D and Selenium, as well as anecdotal results on the most helpful self-reported interventions from a survey of 2232 patients with Hashimoto’s that took place in May 2015 (publication pending). Overall, 88% of survey respondents with Hashimoto’s who attempted a GF diet felt better, with 86% reporting an improvement in digestive symptoms. Improvements in mood, energy levels and weight reduction were reported in 60%, 67%, and 52% of people with Hashimoto’s who undertook a GF diet, respectively. Notably, only 3.5% of survey respondents reported being diagnosed with celiac disease, suggesting that a person with Hashimoto’s does not have to have celiac disease to benefit from a gluten-free diet. Large scale randomized clinical trials on lifestyle interventions for Hashimoto’s thyroiditis are still in their infancy, however this presentation will share the most helpful interventions from a large scale patient survey which was guided by this author’s clinical experience, that can be utilized in clinical practice.
Biography:
Amalan Karthigeyan obtained his MD from the University of Debrecen in Hungary in 2012. He is currently working as a Junior Doctor in UK. He has worked in various specialties including Cardiology, Psychiatry and Orthopedics.
Abstract:
Radioactive iodine is widely used in the treatment of thyroid cancer. However like any treatment it does have side effects. It has demonstrated effects on the hematopoietic system by an increase in early apoptosis and hence decreases the levels of peripheral blood lymphocytes. The erythroid lineage is also affected but to a lesser extent. Studies have also shown an increased incidence of salivary gland damage from radioactive iodine therapy by mild narrowing of the Stensen’s duct demonstrated by sialography. CT imaging also demonstrated mild hyper-density of the parotid gland but this was not diagnostic of permanent damage. As well as effects on the salivary glands, another study demonstrated nasolacrimal duct obstruction. One publication in 2007 stated that there was an increased incidence of dental caries in patients who received radioactive iodine. There has also been an increase in cases of severe hyponatraemia in patients who received radioactive iodine.
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.
Patricia de Gortari
National Institute of Psychiatry Ramon de la Fuente
Mexico
Title: Zinc-deficiency decreases adenohypophyseal TRH-degrading enzyme (pyroglutamyl-aminopeptidase II) and increases TSH serum levels in pre or post-weaned adult rats
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.
Monika Lamba
Saini Universite Catholique de Louvain
Belgium
Title: Expression of mitogen-activated protein kinases in papillary thyroid carcinoma
Biography:
Monika Lamba Saini, MD (Pathology), DNB, currently works at the Department of Anatomie Pathologie, Cliniques Saint Luc, Université catholique de Louvain, Brussels, Belgium. After receiving her undergraduate medical training (MBBS) and Masters degree (MD) in Pathology from India, she worked as an Assistant Professor in the department of pathology at the Kempegowda Institute of Medical Sciences, Bangalore, India. In 2009, she joined a molecular pathology fellowship at the Université catholique de Louvain, Brussels, where she is working on a PhD based on molecular profiling of different types of thyroid carcinoma. She is a member of professional organizations like ASCO, EORTC Head and Neck Group and ESMO. She is also the author, co-author and peer reviewer of many national and international scientific publications. She is also the recipent of 'National fund for scientific research, Belgium' fellowship for her PhD.
Abstract:
Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy, accounting for 85–90% of all thyroid cancers. PTC also frequently carries several alterations in genes coding for proteins that activate the Mitogen-activated protein kinases (MAPK) signalling pathway, which plays a key role in the regulation of cell growth and differentiation. This study aims to investigate the mitogen-activated protein kinase (MAPK) signaling pathway, [extracellular-regulated kinase (ERK), Jun N-terminal Kinase (JNK) and p38] involved in tumorigenesis of PTC. 20 samples of PTC were selected for immunohistochemical and Western blot analysis of total and phosphorylated ERK, JNK and p38. Effect of MAPK inhibitors U0126 (ERK inhibitor), SP 600125 (JNK inhibitor) and SB 203580 (p38 inhibitor) were analyzed on BC-PAP, TPC-1, and WR082-W-1 cell lines by MTT assay and Western blots. Phosphorylated p38 was seen as abundant nuclear and cytoplasmic immunolabelling in 11/20 cases, while ERK and JNK phosphorylation were seen in one and four cases respectively (p<0.01). By Western blotting, phosphorytated p38, phosphorylated ERK and JNK were detected in 17, 7 and 10 cases respectively. MTT assay showed a decrease in the number of viable cells in all the cell lines after culturing with the p38 and ERK inhibitor. Western blot analysis revealed decreased phosphorylation of p38 and ERK after treating with inhibitors. These data suggest that p38 is activated in a larger proportion of PTC than ERK or JNK. The molecular profiling of PTC could reveal the altered biological pathways involved in the genesis of this common endocrine malignancy.
Zaki Antonio Taissoun Aslan
Medellin Cancer Institute
Colombia
Title: Anaplastic thyroid cancer: Multimodal treatment results
Biography:
Zaki Antonio Taissoun Aslan is a Medical Doctor and Deputy Head of Service, Head and Neck in Medellin Cancer Institute. He is a Specialist in General Surgery at University of Zulia; in Surgical Oncology at the National Cancer Institute, Mexico City and in Oncology Head and Neck Surgery at the National Cancer Institute, Mexico-DF. He is an active member of the Mexican Society of Oncology, Medical Society of the National Cancer Institute, Mexico DF, The Latin American Thyroid Society and the Venezuelan Society of Surgery.
Abstract:
Introduction: Anaplastic thyroid cancer is a rare and lethal disease. It accounts for 1-2% of thyroid malignancies, but specific mortality is higher than 90%. It is an aggressive loco-regional disease with a high metastatic capacity. There is no agreement concerning the best treatment. We analyzed the results of treatment in a Mestizo population treated in the National Cancer Institute (Mexico). Methods: 1,581 files of thyroid carcinomas were reviewed; of these, 29(1.83%) had anaplastic thyroid carcinoma. We analyzed Demographic variables, clinical manifestations, tumor characteristics and treatments. Results: The median age was 64.5±13.2 years. Females were more affected (female/male ratio: 2.6:1); 21 cases occurred in women (72.4%), and 8 in males (27.6%). The most common manifestations were neck enlargement (93.10%) and hoarseness (71.31%). The median tumor size was 8 cm (range: 4-20 cm). The percentage of cases, which presented in clinical stage IV-A was 10.3%, with 62.1% presenting in clinical stage IV-b and 27.6% presenting in clinical stage VI-c. Complete resection (R0) (p=0.05), radiation doses of higher than 33.1 Gy (p=0.04), and multimodal therapy were associated with better survival. Surgery plus radiotherapy with or without systemic treatment (p=0.006). The median overall survival was 119 days (IC 95%, 36.3-201.6). Six-month, one-year and two-year survival was 37.9%, 21% and 13%, respectively. Conclusion: Complete surgical resection is associated with better survival but is very difficult to achieve due to aggressive biological behavior. Multimodal therapy is associated with better survival and a better quality of life. There is a need for more effective systemic treatments as extensive surgical resections have little overall benefit in highly invasive and metastatic disease
- Poster Presentation
Session Introduction
Kurren Gill
Thomas Jefferson University Hospital, USA
Title: Thyroid cancer metabolism: A review
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.
- Only for Young Researchers Forum
Session Introduction
Matteo Bianchi
PhD student, Uppsala University, Sweden
Title: Genetics of hypothyroidism in dog as a model organism
Biography:
Matteo Bianchi studied basic and applied biology at University of Perugia, Italy. Matteo is now a PhD student in Comparative Genetics and Genomics, at Uppsala University, Sweden. His work focuses on trying to uncover the genetic factors associated with the development of complex autoimmune diseases in dogs and humans. Matteo has always been interested in animal and disease genetics, which made him work with different species in various working environments. Although he spent a lot of time in the lab in the past, he is currently moving towards the bioinformatics world, analyzing high-throughput genotyping and sequencing data.
Abstract:
The domestic dog is not only man’s best friend and accompanying animal in our daily life, but also in the long-term challenge of unraveling the genetics behind complex diseases. Besides living in the same environment as we do, dogs may spontaneously develop several diseases that are analogous to those affecting humans. In addition to these peculiar features, dogs’ unique genome structure and the respective availability of valuable genomic and molecular tools for its analysis overall facilitate the identification of disease-causing genes. We have studied a common endocrine disease affecting both humans and dogs– hypothyroidism, which in the latter has in most cases an autoimmune etiology. Here we present a multi-breed analysis of genetic risk factors predisposing to hypothyroidism in dogs belonging to three high-risk breeds - the Gordon Setter, Hovawart and the Rhodesian Ridgeback. Using an integrated genome-wide association and meta-analysis strategy, we identified the presence of a major hypothyroidism risk locus shared by these breeds on chromosome 12 (p=2.1x10-11). Additional characterization of the candidate region revealed a shared ~167 kb risk haplotype being significantly enriched across the affected dogs (p<0.001). The identified haplotype harbors three genes that have not previously been associated with hypothyroidism, thus representing interesting targets for the discovery of novel disease pathways and mechanisms. This study is of utmost importance for the improvement of hypothyroid dogs’ health and it may also help to enlarge our knowledge regarding the genetics of the human counterpart of this disease and searching for its missing heritability.