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BACKGROUND: The optimal therapeutic choice for Graves' hyperthyroidism in the presence of moderate-severe Graves' orbitopathy (GO) remains controversial. OBJECTIVES: We aimed to compare GO course in patients with moderate-severe GO treated with early total thyroidectomy (TTx) versus antithyroid drug (ATD) regimens, in a prospective, randomized manner. METHODS: Forty-two patients with moderate-severe GO were enrolled. A total of 4.5 g of pulse corticosteroids were given intravenously to all patients before randomization. Patients in the first group were given TTx, whereas patients in the second group were treated with ATDs. TSH was kept between 0.4 and 1 mIU/l. The clinical course of GO was evaluated with proptosis, lid aperture, clinical activity score (CAS), and diplopia. RESULTS: Eighteen and 24 patients were randomized to the TTx and ATD groups, respectively. Thyroid autoantibodies decreased significantly, and there were significant improvements in proptosis, lid aperture, and CAS in the TTx group. While in the ATD group the decrement in thyroid autoantibodies was not significant, there were significant improvements in proptosis and CAS. When the TTx group was compared with the ATD group, anti-TPO, anti-Tg, and TSH-receptor antibodies were significantly decreased in the TTx group (p < 0.01), but there was no significant difference with respect to proptosis, lid aperture, CAS, and diplopia between the two groups during a median (min.-max.) follow-up period of 60 months (36-72). CONCLUSION: Although no definitive conclusions could be drawn from the study, mainly due to limited power, early TTx and the ATD treatment regimens, followed by intravenous pulse corticosteroid therapy, seemed to be equally effective on the course of GO in this relatively small group of patients with moderate-severe GO during a median (min.-max.) follow-up period of 60 months (36-72).
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INTRODUCTION: The current medical literature has conflicting results about factors related to hypothyroidism and nodular recurrences during follow-up of hemithyroidectomized patients. We aimed to evaluate factors that may have a role in new nodule formation, hypothyroidism, increase in thyroid lobe and increase in nodule volumes in these patients with and without Hashimoto's thyroiditis (HT), and with and without levothyroxine (LT4) use. MATERIAL AND METHODS: We enrolled 140 patients from five different hospitals in Ankara and evaluated their thyroid tests, autoantibody titre results and ultrasonographic findings longitudinally between two visits with a minimum 6-month interval. RESULTS: In patients with HT there was no significant difference between the two visits but in patients without HT, thyroid stimulating hormone (TSH) levels and nodule volume were higher, and free T4 levels were lower in the second visit. Similarly, in patients with LT4 treatment there was no difference in TSH, free T4 levels, or lobe or nodule size between the two visits, but the patients without LT4 had free T4 levels lower in the second visit. Regression analysis revealed a relationship between first visit TSH levels and hypothyroidism during follow-up. CONCLUSIONS: Patients who have undergone hemithyroidectomy without LT4 treatment and without HT diagnosis should be followed up more carefully for thyroid tests, new nodule formation and increase in nodule size. The TSH levels at the beginning of the follow-up may be helpful to estimate hypothyroidism in hemithyroidectomized patients.
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PURPOSE: To compare 21 and 27 gauge (G) needles used for fine-needle aspiration (FNA) of thyroid nodules to obtain better specimens for adequacy and cytological diagnosis. MATERIALS AND METHODS: One hundred patients with thyroid nodules (100 nodules) were included in this study. Each nodule was aspirated with both 27 G and 21 G needles. The obtained aspirates were classified as adequate and inadequate by two separate cytopathologists. The results were analyzed by appropriate statistical methods. RESULTS: There was no statistically significant difference between 21 G and 27 G needles in terms of adequacy, according to each pathologist (P > 0.05). After pathological evaluation with consensus, the adequacy prevalence was the same (84%) for both needle types in all study populations (P > 0.05). According to the ultrasound characteristics of nodules, the prevalence of inadequate samples in patients with hypoechoic or heterogeneous nodules was significantly higher compared with the prevalence of inadequate samples in patients with isoechoic or hyperechoic nodules for both types of needles (P < 0.05). However, according to the size of the needles, there was no significant difference between hypoechoic and heterogeneous nodules or between isoechoic and hyperechoic nodules with regard to the ability to yield adequate samples (P > 0.05). CONCLUSION: The results of our study showed that FNA with 27 G needles can aspirate adequate material for cytopathological diagnosis. The probability of inadequate sample aspiration of hypoechoic and heterogeneous nodules is higher than that for other nodule types.