Table Of Content

Thyroid Disease Challenges and Debates Mahmoud F. Sakr 123 Thyroid Disease Mahmoud F. Sakr Thyroid Disease Challenges and Debates Mahmoud F. Sakr Department of Surgery University of Alexandria Alexandria Egypt ISBN 978-3-030-48774-4 ISBN 978-3-030-48775-1 (eBook) https://doi.org/10.1007/978-3-030-48775-1 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To my students and colleagues Preface In this single-author book, we aim at emphasizing established concepts, displaying the ongoing arguments, controversies, challenges, and debates on thyroid disease with a view to clarifying some uncertainties, and making suggestions, which may contribute to further resolving others. This book, with 210 images, will provide a valuable source of knowledge and reference for all specialists and trainees entrusted with the care of patients suffering from thyroid disease. It includes ten chapters, namely, thyroid disease during preg- nancy, Hashimoto's disease, Hurthle cell lesions, solitary thyroid nodule, retroster- nal goiter, thyroid cancer, recurrent thyroid disease, thyroidectomy techniques, post-thyroidectomy hypocalcemia, and thyroid auto-transplantation. It is my collec- tive hope that head and neck surgeons, endocrinologists, and clinicians of other specialties will find this book to be a useful and indispensable resource. Alexandria, Egypt Mahmoud F. Sakr vii Acknowledgments I would like to thank all those who helped and encouraged me during the writing, editing, and revision of this book. I would like to express my appreciation and grati- tude to my wife and children for their continuous support and unconditioned love. ix Contents 1 Thyroid Disease During Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Physiological Changes During Pregnancy . . . . . . . . . . . . . . . . . . . . . 2 1.3 Thyroid Function Tests in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 3 1.3.1 How Do Thyroid Function Tests Change During Pregnancy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.3.2 What Is the Normal Range for TSH in Each Trimester? . . . . 5 1.3.3 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.4 Screening for Maternal Thyroid Dysfunction . . . . . . . . . . . . . . . . . . 7 1.4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.4.2 Screening for Thyroid Dysfunction . . . . . . . . . . . . . . . . . . . . 7 1.4.3 Efficacy of Case Finding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.4.4 Thyroid Screening in Pregnancy: Current Practice and Cost- Effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.4.5 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1.4.6 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.5 Iodine Deficiency During Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.5.1 Requirement of Iodine During Pregnancy and Lactation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.5.2 Requirement of Iodine in Neonates . . . . . . . . . . . . . . . . . . . . 13 1.5.3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1.5.4 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1.6 Hyperthyroidism in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1.6.1 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1.6.2 Causes of Thyrotoxicosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1.6.3 Diagnosis of Hyperthyroidism in Pregnancy . . . . . . . . . . . . . 16 1.6.4 Risks of Hyperthyroidism During Pregnancy on Fetal and Maternal Health . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.6.5 Treatment of Hyperthyroidism During Pregnancy . . . . . . . . 18 1.6.6 Treatment of Hyperthyroidism During the Post-partum Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 1.6.7 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 xi xii Contents 1.7 Hypothyroidism in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 1.7.1 Iodine Deprivation and Goiter Formation . . . . . . . . . . . . . . . 24 1.7.2 Overt or Subclinical Hypothyroidism? . . . . . . . . . . . . . . . . . 25 1.7.3 Isolated Hypothyroxinemia . . . . . . . . . . . . . . . . . . . . . . . . . . 25 1.7.4 Incidence of Hypothyroidism During Pregnancy . . . . . . . . . 25 1.7.5 Risks of Hypothyroidism on Fetal and Maternal Health . . . . 26 1.7.6 Treatment of Hypothyroidism During Pregnancy . . . . . . . . . 30 1.7.7 Treatment of Hypothyroidism During the Post-partum Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 1.7.8 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 1.8 Autoimmune Thyroiditis in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . 35 1.8.1 Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 1.8.2 Risks on Fetal and Maternal Health . . . . . . . . . . . . . . . . . . . . 35 1.8.3 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 1.8.4 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 1.9 Infertility and Miscarriage: Impact of Thyroid Dysfunction . . . . . . . 38 1.9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 1.9.2 Autoimmunity and Reproductive Failure. . . . . . . . . . . . . . . . 39 1.9.3 Impact of TAI on Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . 40 1.9.4 Impact of TAI on Miscarriage . . . . . . . . . . . . . . . . . . . . . . . . 42 1.9.5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 1.10 Post-partum Thyroiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 1.10.1 Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 1.10.2 Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 1.10.3 Clinical Evaluation and Treatment . . . . . . . . . . . . . . . . . . . . . 48 1.10.4 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 1.11 Thyroid Nodules and Thyroid Cancer During Pregnancy . . . . . . . . . 49 1.11.1 Pregnancy and the Risk of Thyroid Cancer . . . . . . . . . . . . . . 49 1.11.2 Diagnostic Strategy for Thyroid Nodules Detected During Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . 50 1.11.3 Impact of Pregnancy on the Prognosis of Thyroid Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 1.11.4 Management of Benign Thyroid Nodules During Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 1.11.5 Management of Thyroid Cancer During Pregnancy . . . . . . . 52 1.11.6 Pregnancy After Treatment of DTC . . . . . . . . . . . . . . . . . . . . 54 1.11.7 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 1.11.8 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 2 Hashimoto’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 2.1 Historical Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 2.2 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 2.2.1 Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 2.2.2 Prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Contents xiii 2.3 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 2.3.1 Gross Appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 2.3.2 Microscopic Picture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 2.4 Etiology and Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 2.4.1 Genetic Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 2.4.2 Nongenetic Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 2.5 Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 2.6 Clinical Course . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 2.6.1 Goiter (Neck Swelling) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 2.6.2 Pain/Tenderness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 2.6.3 Hypothyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 2.6.4 Associated “Unusual” Syndromes . . . . . . . . . . . . . . . . . . . . . 89 2.6.5 Neoplastic Transformation . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 2.6.6 Remission of Hashimoto’s Thyroiditis: Pregnancy . . . . . . . . 91 2.6.7 Painless (Silent) and Post-partum Thyroiditis (PPT) . . . . . . . 92 2.6.8 Hashimoto’s Encephalopathy. . . . . . . . . . . . . . . . . . . . . . . . . 93 2.6.9 Hashimoto’s Ophthalmopathy . . . . . . . . . . . . . . . . . . . . . . . . 94 2.6.10 Summary of Various Presentations of Hashimoto’s Thyroiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 2.7 Hashimoto’s Encephalopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 2.7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 2.7.2 Definition and Synonyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 2.7.3 History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 2.7.4 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 2.7.5 Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 2.7.6 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 2.7.7 Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 2.7.8 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 2.7.9 Differential Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 2.7.10 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 2.7.11 Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 2.8 Iodine Metabolism and Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 2.9 Diagnosis and Differential Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . 100 2.9.1 Clinical Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 2.9.2 Laboratory Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 2.9.3 Histology/Cytology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 2.9.4 Isotope Scanning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 2.9.5 Ultrasound Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 2.9.6 Evaluating Variations in Presentation of Hashimoto’s Thyroiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 2.9.7 Evaluating Complications of Hypothyroidism . . . . . . . . . . . 105 2.9.8 Differential Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 2.10 Association with Papillary Thyroid Carcinoma . . . . . . . . . . . . . . . . . 107 2.10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 2.10.2 Meta-analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

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