Diagnosis and Management of Hypothyroidism in Gulf Cooperation Council (GCC) Countries.

Hypothyroidism is one of the most common chronic endocrine conditions. However, as symptoms of hypothyroidism are non-specific, up to 60% of those with thyroid dysfunction are unaware of their condition. Left untreated, hypothyroidism may contribute to other chronic health conditions. In the Arabian Gulf States, hypothyroidism is thought to be common, but is underdiagnosed, and management approaches vary. An advisory board of leading Saudi endocrinologists and policy advisers was convened to discuss and formulate recommendations for the diagnosis and management of hypothyroidism in Saudi Arabia based on their clinical expertise. The final document was shared with leading endocrinologists from the other Gulf  Cooperation Council (GCC) and aconsensus report was generated and summerized in this article. While there is no consensus regarding population screening of hypothyroidism, current recommendations suggest screening patients with risk factors, including those with a history of head or neck irradiation, a family history of thyroid disease or pharmacological treatment that may affect thyroid function. Evidence from a cross-sectional study in Saudi Arabia suggests screening the elderly (> 60 years), at least in the primary care setting. In Saudi Arabia, the incidence of congenital hypothyroidism is approximately 1 in every 3450 newborns. Saudi nationwide population prevalence data are lacking, but a single-centre study estimated that the prevalence of subclinical hypothyroidism in the primary care setting was 10%. Prevalence rates were higher in other cross-sectional studies exclusively in women (13-35%). The recommendations included in this  article aim to streamline the diagnosis and clinical management of hypothyroidism in the GCC, especially in the primary care setting, with the intention of improving treatment outcomes. Further study on the incidence, prevalence and risk factors for, and clinical features of, hypothyroidism in the GCC countries is required.

Impact of histopathology of non-neoplastic thyroid tissue on ablation outcome in patients with papillary thyroid cancer.

OBJECTIVE: To assess the impact of histopathology of non-neoplastic thyroid tissue on ablation outcome in patients with papillary thyroid cancer (PTC). METHODS: The study included 124 patients referred for I-131 ablation therapy after total thyroidectomy for unifocal nonmetastatic PTC. All patients received 100 mCi of I-131 ablation dose. Follow-up whole body scan (WBS) and estimation of serum thyroglobulin level were carried out 6-9 months after ablation therapy and results were divided into complete or incomplete ablation. RESULTS: Incomplete ablation was found in 66.6% (12 of 18), 64% (16 of 25), 39.1% (nine of 23), 30% (six of 20), 33% (six of 18), and 20% (four of 20) in patients with PTC in a background of Hashimoto's thyroiditis, lymphocytic thyroiditis, colloid nodular goiter, nodular hyperplasia, multinodular goiter, and normal thyroid tissue, respectively. Patients with Hashimoto's thyroiditis and lymphocytic thyroiditis had statistically significant higher failure rate to achieve complete ablation compared with other groups. This significant difference was lacking between different nonautoimmune histopathologies and normal thyroid tissue. For patients with thyroid disorders of autoimmune origin (Hashimoto's thyroiditis and lymphocytic thyroiditis), incomplete ablation was found in 65.1% (28 of 43) versus 34.4% (21 of 61) for all other nonautoimmune histopathologies collectively; the difference was statistically significant. CONCLUSION: Histopathology of non-neoplastic thyroid tissue has a significant impact on ablation outcome in patients with PTC. Patients with a histopathology of non-neoplastic thyroid tissue of autoimmune origin have a significantly lower incidence of successful complete ablation after a single I-131 ablative dose (100 mCi) compared with those with nonautoimmune histopathology or with normal thyroid tissue.