ITS Textbook of Thyroid Disorders Sarita Bajaj, Rajesh Rajput
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abortion 302
Abundant granular eosinophilic cytoplasm 69f
Actinobacillus actinomycetemcomitans 284b
Actinomyces naeslundii 284b
Acute thyroxine
ingestion 240
overdose 239
Adenomas 155
Adenosine monophosphate 316
Adenovirus 115, 283, 290
Adipocyte 140f
Agenesis 49, 90
Alemtuzumab 116, 267
Alimentary system 117
Aluminum hydroxide 269
American College of Radiology 58, 183
American Joint Committee on Cancer 173, 174, 184
American Thyroid Association 35, 35t, 105, 176, 208, 254
Aminoglutethimide 90, 91, 230
Aminosalicylic acid 230
Amiodarone 20, 27, 62, 90, 91, 115, 119, 267270, 286
effects of 268t
therapy 27
Amitriptyline 267
Amyloid goiter 63
Amyloidosis 64f, 90
Anaplastic carcinoma 59, 77f, 78f
Anaplastic follicular cell-derived thyroid carcinoma 66, 76, 78f
Anaplastic lymphoma kinase 191, 192
Anaplastic thyroid cancer 173, 175, 175t, 180, 188, 190t, 191
management of 189b
treatment of 177
Anaplastic thyroid carcinoma 135, 188, 189, 190t, 193
Ancillary tests 81
Androgens 269
Angioinvasive follicular thyroid carcinoma 71f
Angiotensin-converting enzyme 2 289
Antiepileptics 230
drugs 230
Anti-Müllerian hormone 204
Antineutrophil cytoplasmic antibody 124
Anti-thyroglobulin 24
antibodies 22, 182, 203
Antithyroid drugs 27, 82, 83t, 90, 123126, 130, 212, 213, 230, 236, 237, 237b, 240
adverse effects of 236
therapy, monitoring of 236, 236b
Antithyroid peroxidase 24, 276, 282
antibodies 22
Arcanobacterium haemolyticum 284b
Arnold–Chiari malformations 220
Artificial reproductive techniques 254
Aryl hydrocarbon receptor 317
Assisted reproductive technology 203, 204
Atenolol 124
Atezolizumab 135, 267
Atherosclerotic cardiovascular disease 105, 105f
Athyreosis 30
Atrial fibrillation 26, 100, 117
Attention deficit hyperactivity disorder 131
Auscultation 21
Autoantibodies 140f
Autoimmune thyroid
diseases 207, 260, 276
Autoimmunity 258
Autonomous thyroid
hormone synthesis 119
nodule 247
Avelumab 135
B
Bacteria 284
Basal metabolic rate 93, 251, 257, 259
B-cell chronic lymphocytic leukemia 267
Benign thyroid
disorders 45
nodules 57
Beta-blockers 124, 124t, 237
Bethesda scoring system 163t
cytology diagnostic categories of 174t
Bethesda terminology 60, 61t
Bexarotene 91
Bile acid sequestrants 269
Binding
fraction of 14
inhibitory immunoglobulins 84
Biotin 28, 269, 270
effect 121
Biphasic growth pattern 74f
Bipolar disorder 27
Bisphenol A 316
Blood pressure 103
diastolic 103
systolic 103
Body mass index 93, 208, 258, 259t
Bone 307, 308
loss, accelerated 100
mineral density 308
Borderline follicular tumors 172
Brain 90, 252
Breast cancer 286
British Thyroid Foundation 289
Bronchial asthma 124
Brown adipose tissue 108, 257
Brucella melitensis 284b
C
Café au lait spots 136f
Calcitonin 26, 159, 245
Calcium carbonate 269
Cancer 260
immunotherapy 62
risk of 158
vaccines 62
Candida albicans 284b
Carbamazepine 91, 269, 270
Carbimazole 82, 123, 236, 275
Carcinoembryonic antigen 78, 182
Carcinoma, malignant 172
Cardio-ankle vascular index 252
Cardiovascular disease 252
Cardiovascular dysfunction 273
Cardiovascular system 117, 254
Carotid artery 29
C-cell hyperplasia 64
Cell
higher magnification of 76f
membrane thyroid hormone transporter defect 133
multiple clusters of 76f
Cemiplimab 135
Central compartment lymph node dissection 182
Central neck dissection 246
role of 246
Central nervous system 131, 219, 229, 273
Chemosis 113f, 120f
Chemotherapy 192
Chernobyl disaster 243
Childhood hyperthyroidism 308
etiology of 230b
Childhood papillary thyroid carcinoma 243
Chlordane 270
Cholecystographic agents 269
Cholestatic liver dysfunction 237
Cholesterol ester transport protein 252
Cholestyramine 269
Chronic obstructive pulmonary disease 124
Cirrhosis 98
Clostridium septicum 284b
Coagulative necrosis, foci of 188f
Coccidioides immitis 284b
Colesevelam 269
Colestipol 269
Colloid 59
background of 65f
goiter 59, 60f, 65f
Color Doppler 122, 282, 283
Comparative genomic hybridization 221
Complete blood count 191
Computed tomography 29, 38, 40, 45, 49f, 5155, 135, 153, 159, 177, 183, 191, 285
scan 45f
Congenital hypothyroidism 8, 23, 30f, 31f, 219, 222t, 224fc, 225, 226fc, 308
etiology of 219b
late onset 229, 230
syndromic associations of 221t
Congo red stain 64f
Conjunctival redness 120f, 113f
Conservative management 245
Contrast-enhanced computed tomography 179, 182, 189
Controlled ovarian hyperstimulation 200, 203
Cord blood 241
sample 222
Coronary artery disease 105, 108
Coronavirus disease 2019 (COVID-19) 91, 194, 263, 288291, 294, 296, 297
disease 297
endocrine effects of 288f
infection 263, 283, 288, 289
pandemic 288
symptoms of 292294
vaccine 296
Cough syrups 267
Coxsackievirus 115, 290
Craniopharyngioma 230b
C-reactive protein 115, 123, 252, 291, 294
Cribriform morular thyroid carcinoma 66, 81
Cuboidal cells, benign 66f
Cuboidal epithelial cells 61f
Cushing's syndrome 266
Cystic adenoma 5
Cystic degeneration 59
Cystinosis 90, 230
Cytokine 267
based therapy 116
Cytology 59, 64, 162
benign 165
Cytomegalovirus 290
Cytopathology guidelines 59
D
De Quervain's thyroiditis 91, 283
Decreased libido 197
Deiodinase 14, 219
Dengue 115
Deoxyribonucleic acid 156, 307
Dermopathy 114
Dexamethasone 269
Diabetes mellitus 24, 26, 104, 114, 208, 257
Dichlorodiphenyltrichloroethane 270, 315
Differentiated thyroid
cancer 173, 175, 180, 188f, 189
carcinoma 84, 128, 243
Diffuse thyroid enlargement 57f
Diffuse toxic goiter 65
DiGeorge syndrome 260
Diiodotyrosine 13, 220
Dopamine 90, 230, 266
agonists 266
antagonists 266
Down syndrome 27, 260
Drugs affecting thyroid hormone
activation 269
synthesis 266
Dry eye 143
Dual oxidase maturation factor A2 31
Durvalumab 135
Dysgenesis 219
Dyshormonogenesis 31, 31f, 225
etiology of 31fc
Dyshormonogenetic goiter 64
Dyslipidemia 105, 254
management of 260
Dyspnea 158
Dysthyroid optic neuropathy 140, 142f
E
Echovirus 115, 283
Ectopic adrenocorticotropic hormone 186
Ectopic thymoma 81
Ectopic thyroid 30
gland 49f
Eikenella corrodens 284b
Electrocardiogram 273
Electroencephalography 276
Electrolyte balance 117
Elevated thyroid-stimulating hormone 251
Embryo 197
Embryonal thyroid neoplasms 66, 81
Encephalopathy, steroid responsive 276
Endemic cretinism 225, 302
Endemic goiter 64, 90
Endocrine disruptors 315
impact of 315
Endocrine system 288
Enhanced green fluorescent protein 318
Enteropathy, infiltrative 98
Enzyme linked immunosorbent assay 25, 222
Eosinophilic cytoplasm, moderate 67f
Epithelial origin, differentiated thyroid carcinoma of 84
Epithelial tumors, primary 172
Epithelioid cell granulomas 63f
Eprotirome 101
Epstein–Barr virus 115, 283, 290
Erectile dysfunction 197
Erythema 113f
Erythrocyte sedimentation rate 91, 115, 123, 282, 294
Escherichia coli 284b
Esophagus 29
Ethionamide 90, 91
European Group of Graves’ orbitopathy 20
European Society for Endocrinology 222
European Thyroid Association 254
Euthyroid hyperthyroxinemia 121, 128
causes of 121t
Exogenous thyroid hormone excess 134
Exophthalmos, bilateral severe 120f
External beam radiotherapy 189, 192
Extraocular muscle 138
enlargement of 142f
Extrathyroidal extension 174, 176
Extrathyroidal origin, thyrotoxicosis of 116, 126
Eye 117
disease 145
examination 20
Eyelid
retraction 140f, 238
unilateral 141f
swelling 113f
F
F fluorodeoxyglucose 5, 53
Familial isolated pituitary adenoma 128
Fasciitis 74f
Fatty acids, nonesterified 136
Fatty liver disease, nonalcoholic 106, 107
Female reproductive
health 201f
tract 197t
Female sexual function index 198
Ferrous sulfate 269
Fertility 198, 200, 202, 253
outcomes 260
Fibroblasts 140f
Fibromatosis 74f
Fibrosis 61f
Fibrous thyroiditis 63
Fine-needle aspiration 35, 160, 161t, 162, 174, 183
biopsy 115, 153, 244, 245
cytology 23, 55, 59, 83, 114, 153, 166, 173, 183, 189
Flow cytometry 81
Fluid balance 117
Fluorodeoxyglucose 39, 5255
positron emission tomography 34, 40, 158, 178, 191
Fluorouracil 269
Foamy macrophages 59, 60f
Focal autoimmune thyroiditis 62
Focal lymphocytic thyroiditis 62, 63f
Follicle stimulating hormone 197, 199, 205, 263
Follicular adenoma 65, 66, 67f, 68, 75f, 172
Follicular carcinoma 66
thyroid 55f
Follicular cell 63f
derived carcinomas 66, 75, 81
malignancy 244
tumors of 172
Follicular hyperplasia 66
Follicular neoplasm 65, 67f, 164, 167
Follicular thyroid
cancer 34, 160, 185
carcinoma 58f, 66, 70, 243, 246
Follicular tumor 70
Food Safety and Standards Authority of India 305
Food, fortification of 303
Fractures 100
Free thyroxine 22, 24, 84, 204, 251, 270, 294
Free triiodothyronine 22
Functional metastatic thyroid carcinoma 134
Fungi 284
Furosemide 269
G
Gamma camera planar scanner 44
Gamma scintillation probe 44
Gene sequencing classifier 164
Genetics 172
disease 244
syndromes 260t
testing, role of 221
Germ cells 204
Gestational age 240
Gestational thyrotoxicosis 119, 126, 135, 211, 212
Giant cell collection 65f
Glioma 230
Glomerular filtration rate 206, 273
Glucocorticoids 143, 230, 265, 269
effects of 266t
therapy 273
Goiter 3, 19, 57f, 63, 114, 114f, 147, 149, 150, 155, 254, 302
radioiodine ablation of 153
Goitrogens 90, 155, 230, 300
large quantities of 229
Gomori's silver methenamine stain 285
Gonadotropin releasing hormone 197, 199, 205
Granular amphophilic cytoplasm 80f
Graves’ dermopathy 114f
Graves’ disease 20, 25, 33, 34, 34f, 35f, 47, 47f, 65, 82, 83, 113115, 121, 122f, 128, 138, 157, 159, 202, 211, 212, 235, 236, 237b, 238t, 240, 243, 267, 270, 274, 282, 286, 296, 304, 308
management of 82, 123
medical management of 236
neonatal 25
radioactive iodine treatment of 238
surgical management of 237
ultrasonographic appearance of 33f
Graves’ hyperthyroidism 26, 83t, 125t, 138
Graves’ ophthalmic involvement 113
Graves’ ophthalmopathy 20, 113, 120f, 138, 238
Graves’ orbitopathy 20, 113f, 144fc, 145fc
Growth 251
hormone 129
H
Haemophilus influenza 284b
Hashimoto's disease 273
Hashimoto's encephalopathy 231, 272276
Hashimoto's thyroiditis 24, 25, 31, 32, 33f, 62, 63, 63f, 90, 228, 230, 235, 243, 251, 281, 296
Hashitoxicosis 114, 239
Head
and neck tumors, external irradiation for 230
injury 230
Heart disease 106
cardiovascular 254
coronary 100
ischemic 106, 254
Heart failure 100, 106, 254
chronic 125
congestive 202
pathogenesis of 106f
Helicobacter pylori 99t
Hemangiomas, congenital hepatic 219
Hematopoietic system 117
Hemochromatosis 90, 230
Hemorrhage 59, 230
Heparin 269, 270
releases lipoprotein lipase 270
Hepatic lipase 252
Hepatitis E 115, 290
Heptachlor 270
Heroin 269
Heterophile
antibodies 99
antigens 27
Hexachlorobenzene 315
Hexachlorocyclohexane 316
High serum lactate dehydrogenase 272
High-density lipoprotein-cholesterol 105
Highly active antiretroviral therapy 265, 267
Histoplasma capsulatum 284b
Hodgkin's disease 152
Hodgkin's lymphoma 286
Hormonal alterations 198, 202
Hormone, adrenocorticotropic 263
Horner's syndrome 159, 189
Human antimouse antibodies 27
Human chorionic gonadotropin 115, 126, 128, 135, 197, 205
molecule 135
Human immunodeficiency virus 99, 115, 290
Human leukocyte antigen 84, 290
Human placental lactogen 197
Hürthle cell 52, 59, 60f, 62, 62f, 63f, 68f, 75f, 163, 185
carcinoma 38f, 185
thyroid 55f
neoplasm 62, 173
Hydrocortisone 275
Hydrogen peroxide generation 219
Hydroxymethylglutaryl coenzyme A 105
Hyoid bone 43f
Hypercholesterolemia 272
Hypercoagulation 253
Hyperechoic thyroid gland 33f
Hyperlipidemia 26
Hyperparathyroidism 186
Hyperplasia 64, 157
congenital adrenal 222
Hypertension 103, 125
pregnancy-induced 197, 211
Hyperthyroid 240
disorders 33
Hyperthyroidism 20, 22, 33, 60, 115, 119, 137, 202, 205, 211, 212, 234, 239, 240fc, 241, 252
causes of 33, 211, 234t
clinical features of 235b
diagnosis of 93fc, 212
exogenous 234
familial gestational 119
incidence of 234
iodine induced 304
management of 235
maternal 219
mild 239
neonatal 239, 240
pathological 212
physiological 212, 213
primary 234
signs of 20t
subclinical 239, 308
symptoms of 100
thyrotropin induced 116
Hyperthyrotropinemia 259
Hypocalcemia 237
Hypoechogenicity 58f, 244
Hypoglycemia 272
Hyponatremia 272
Hypophysitis, lymphocytic 90
Hypoplasia 8, 30, 90
Hypotension 273
Hypothalamic disease 90
Hypothalamic disorders 230
Hypothalamic–pituitary–thyroid axis 12, 12f, 15, 43f, 90f, 129, 265, 307, 307fc
Hypothalamic thyrotropin-releasing hormone 89, 311
Hypothalamus 90, 197, 315
Hypothermia 273
Hypothyroid ophthalmopathy 231
Hypothyroidism 19, 20, 20t, 22, 25, 60, 87, 89, 94b, 95, 96b, 103105, 105f, 106, 106f, 107, 107f, 108, 137, 198, 200, 205, 206, 208, 208b, 213, 228, 230f, 232, 257, 258fc, 259f, 260, 263
acquired 90
amiodarone-induced 268
autoimmune 230
central 90, 120, 219, 220, 229, 230, 234, 260
congenital 8, 23, 30, 30f, 31f, 90, 219, 222t, 224fc, 226fc, 229, 308
consumptive 90, 229, 230
drug-induced 91
effects of 199f, 206
etiology of 230
iatrogenic 91
management of 94fc
maternal 198, 206
moderate 106
permanent congenital 220
presentation of 92
prevalence of 96, 105, 257
primary 25, 89, 90, 228, 231f
screening of 95b
secondary 94, 220
severe 106
subclinical 103, 106, 199, 228, 230, 251254, 257, 308
system wise clinical manifestations of 92t
tertiary 94
transient 25, 90, 220
treatment of 203t, 207
I
Imatinib 91
Immune checkpoint inhibitors 91, 229, 230, 266, 267
Immunocytochemistry 59, 81, 188, 191
Immunoglobulins, intravenous 201
Immunometric assay 26
Immunomodulatory drugs 62
In vitro fertilization 200, 203
Indian Society for Pediatric and Adolescent Endocrinology 222
Infections 115, 230
Infectious thyroiditis 61, 284
types of 284b
Infertility 26, 254
Inflammatory bowel disease 98
Influenza viruses 115
Insulin
like growth factor-1 157
resistance 253, 257
Intact parathyroid hormone 186, 246
Intensity modulated radiation therapy 191, 192
Intercellular adhesion molecule-1 140
Interferon 267
alpha 90, 91, 119, 230
Interleukin 91, 123, 140, 267
International Council for Control of Iodine Deficiency Disorders Global Network 303
International Society for Pediatric and Adolescent Diabetes 104
Intracytoplasmic sperm injection 202, 203
Intrauterine insemination 202
Invasive encapsulated follicular variant papillary carcinoma 66, 70
Invasive follicular thyroid carcinoma 71f
Iodide 299
transport 90
Iodine 31, 44, 90, 266, 299, 305
deficiency 90, 155, 182, 229, 230, 243, 251, 300
disorders 299, 301, 303305, 305fc
health consequences of 302t
dietary intake of 299
fortification of 303
insufficiency, risk of 300
isotopes 44
nutrition, assessment of 301t
organification
abnormalities 50
defect 31
pathway 299f
sufficient areas 155, 157
supplementation 153, 303, 303t, 305
benefits of 304
risk of 304
transport defect 31
uptake of 13
Iodotyrosine dehalogenase 31
deficiency 90
Iodotyrosine deiodinase 150, 156
Ipilimumab 91, 267
Irradiation 230
Isolated thyroid-stimulating hormone 229
Isthmus 29
J
Janus kinase 104
Jod–Basedow effect 14
Jod–Basedow phenomenon 266
Joint susceptibility 104
K
Kangra valley study 304f
Klinefelter syndrome 260
Kocher–Debre–Semelaigne syndrome 231
L
Langerhans cell histiocytosis 230
Laryngeal nerve, recurrent 10
Larynx 43f
Laser thermal ablation 166
Lateral neck dissection, role of 246
Lecithin-cholesterol acyltransferase 252
Left ventricular ejection fraction 106
Leptin 258
Lesions, benign 245
Leukemia inhibitory factor 197
Leuprolide 286
Levothyroxine 104, 128, 202, 204, 206, 208, 253, 254, 269
suppression therapy 153, 245
therapy 105
Leydig cells 204
Lid retraction 140
Lindane 270
Liothyronine 104
Lipoprotein lipase 252
Liquid chromatography-mass spectrometry 28
Lithium 27, 62, 90, 91, 230, 267
therapy 251
Live birth rate 200
Liver 197
diseases 98
function test 123
hemangioma 230
presence of 230f
Low birth weight 197, 222
Low molecular weight keratin 59
Low-density lipoprotein 117, 252
cholesterol 105
Lugol's solution 241
Luteinizing hormone 197, 199, 204, 205, 263
Lymph node metastasis 39, 80f, 73f
Lymphadenoid goiter 281
Lymphocytes, background of 62
Lymphomas, malignant 172
M
Magnetic resonance imaging 29, 38, 121, 152, 159, 191, 266, 276, 285
Malabsorption, evaluation of 100fc
Malignancy 183t
risk of 35
suspicious for 167
Malignant follicular neoplasms 156
Marine–Lenhart syndrome 33, 35f
Maturation defects 219
Maximum intensity projection 5, 5355
McCune–Albright syndrome 119, 128, 136, 136f
Measles virus 115
Medullary thyroid
cancer 38f, 39, 173, 175t, 180, 182
treatment of 178
carcinoma 41f, 66, 78, 79f81f, 175, 185, 244, 246
Megabecquerel 44t
Meningioma 230b
Menorrhagia 198
Menstrual disturbances 198
Mental function 302
Mental health 254
Mercury 315
Messenger ribonucleic acid 258, 266, 289
Metabolite 236
Metaplastic cells 65f
Metastasis 182, 230
Metastatic disease 192
Metastatic functioning thyroid carcinoma 126
Metastatic lymph nodes, mapping of 41f
Metastatic medullary thyroid carcinoma, management of 186
Metformin 266
Methadone 269
Methimazole 82, 83t, 123, 124, 213, 236, 275
Methoxyisobutylisonitrile 50
Metoprolol 124
Microcalcification 244
Microfollicles, abundant 67f
Microfollicular growth patterns 79f
Mid-day meal program 305
Minimally invasive follicular thyroid carcinoma 71f
Miscarriage, recurrent 197
Mitogen activated protein kinase pathway 182
Mitotane 266, 269
Mixed medullary-papillary carcinoma 81f
Molecular genetic
role of 245
studies 245
Molecular tests 81, 163
Monocyte chemoattractant protein 140
Monoiodotyrosine 13
Monomorphic nuclei 60f
Mood disturbances 254
Multifocal granulomatous folliculitis 63
Multinodular goiter 48, 65, 66f, 114, 156, 157, 182
management of 84, 167
Multinucleated giant cells 62f64f
Multiple endocrine neoplasia 173, 244
Multiple metastatic cervical lymph nodes 50f
Multiple thyroid follicle 62f
Mumps 115, 290
Muscle 29, 117
cells 140f
hypertrophy 232f
Mycobacterium
avium intracellulare 284b
leprae 284b
tuberculosis 284b
Mycobacteroides chelonae 284b
Myxedema coma 272, 273t, 274
N
Nadolol 124t
National Family Health Survey 257, 300
National Goiter Control Programme 303, 304
National Health and Nutrition Examination Survey 253
National Institute of Nutrition 300
National Iodine Deficiency Disorders Control Programme 304
National Iodine Survey of India 305
National Nutritional Monitoring Bureau 305
Neck, examination of 20
Necrosis, background of 77f
Negative predictive value 164
Neonatal hyperthyroidism 239, 240
clinical features of 240
evaluation of 241
management of 241
Neoplasms, malignant 66, 70
Nephrotic syndrome 98
Nervous system 117, 252
Neuroendocrine C-cell derived thyroid cancer 173
Neurofibromatosis 260
Neuron-specific enolase 78
Neurotrophic tyrosine receptor kinase gene fusion 191, 192
Neutropenia 237
Next-generation sequencing 221
Niacin 269
Nitrates 315
Nitrogen dioxide 270
Nivolumab 91, 135, 267
Nocardia asteroides 284
Nocardia brasiliensis 284
Nodular goiter 57f, 114f, 240
Nodular thyroid
disease 155, 156, 158, 164t, 166fc, 169, 243
goiter 3436, 38
swelling 58f
Nodule 245
growth of 157
sonographic pattern of 35
Nonalcoholic fatty liver disease 106, 107
prevalence of 106
Nonalcoholic steatohepatitis 106
management of 260
Noncommunicable disease control 305
Nonepithelial tumors, primary 172
Non-Hodgkin's lymphoma 62, 286
Noninvasive follicular thyroid neoplasm 66, 69, 69f
Non-necrotizing epithelioid cell granulomas 64f
Nonsteroidal anti-inflammatory drugs 136
Nonthyroidal illness syndrome 25, 120, 262, 263, 290
diagnosis of 263
mechanisms of 263
Nontoxic goiter 149
Noonan syndrome 260
Normal thyroid
function 204
imaging 29, 47
Nortriptyline 267
Nuclear
factor kappa B 140f
pleomorphism, severe 78f
radiation 302
scan 283
thyroid hormone receptor 307
O
Obesity 107, 108, 251, 257, 259f, 260, 260t
management of 260
mechanisms of 258fc
prevalence of 257
Obstructive liver disease 98
Oncocytic adenoma 65, 68, 68f, 69f
Ophthalmopathy 114
thyroid associated 26
Opioids 90
Oral contraceptive pills 269
Oral estrogen 269
Oral tyrosine kinase inhibitors 91
Orbit 140f
computed tomography of 142, 142f
Orbital fibroblasts, activation of 140f
Orbital radiotherapy 144
Orbitopathy, thyroid associated 138, 140, 140f, 141t, 144f, 144fc, 145fc
Organ system 20
Organic anion-transporting polypeptide 133
Organification disorders 90
Organochlorines 270
Orthomyxovirus 115, 290
Osteoporosis 26, 27, 100
Ovaries 197
Overt hyperthyroidism 307, 308
Overt hypothyroidism 198, 228, 251, 308
Oxidation 13
P
P-aminosalicylic acid 91
Papanicolaou stain 68f
Papillary carcinoma 59, 71f75f
nuclear features of 75f
Papillary thyroid
cancer 160, 178, 186
carcinoma 37f, 53f, 66, 70, 81, 156, 160, 182, 184, 246
microcarcinoma 185
Parasites 284
Parathyroid
glands 10
neoplasm 67f
Parenchyma 29f
Parvovirus B19 115, 283
Pediatric thyroid nodules, majority of 247
Pemberton's maneuver 159
Pemberton's sign 20
Pembrolizumab 91, 135, 267
Pendred syndrome 50, 155
Pendrin mutations 90, 219
Perchlorate discharge test 31
Periodic acid–Schiff 70
Peroxidase
antibody 208
deficiency 50
Pesticides 270, 315, 316
Phenobarbital 91, 269
Phenylketonuria 222t
Phenytoin 91, 268270
Pheochromocytoma 186
Phosphatidylinositol-3-kinase 173
Phthalates 315, 316
Pituitary adenoma 90, 230
Pituitary vasoactive intestinal peptide 198
Pizzillo method 152
Placenta 197
Plasma cell free DNA 165
Plasticizers 315, 316
Pneumocystis jiroveci 284b, 285
Polybrominated biphenyls 270
Polybrominated diphenyl ethers 315
Polychlorinated biphenyl 270, 315, 316
Polychlorinated dibenzodioxins 315
Polycystic ovary syndrome 198
Polyethylene glycol 99, 230
Polygonal tumor cells 80f
Polyphosphodiesters 317
Poorly differentiated thyroid carcinoma 66, 76f, 77f, 180
Positive predictive value 164
Positron emission tomography 35, 45, 45f, 5255, 182, 183
Postpartum thyroiditis 91, 115, 126, 197, 208, 209, 281
high-risk for 209b
Postradioactive iodine ablation 251
Post-therapy hypothyroidism 229
Post-thyroidectomy 230
Potassium
iodide, saturated solution of 241
perchlorate test 50
Povidone iodine 267
Prader–Willi syndrome 260
Prednisone 90
Pre-existing thyroid disease 243
Pregnancy 115, 122, 206, 207, 208b, 211, 212, 254, 301, 313
first trimester of 120
nausea of 136
outcomes study 202, 212
toxemia of 136
vomiting of 136
Premature menarche 231f
Premature ovarian failure 200
Primary hypothyroidism 25, 89, 90, 228, 231f
atypical manifestations of 231b
Propaylthiouracil 82
Propranolol 124
high-dose 269
Propylthiouracil 123, 124, 133, 213, 236, 269
Proton pump inhibitors 269
Pruritic rash 237
Psammoma body 72f
Psammomatous calcification 73f
Pseudomonas aeruginosa 284b
Pseudotumor cerebri 231
Pyrexia of unknown origin 281
R
Radiation 180, 192, 315
effects of 317
exposure 243
thyroiditis 63
Radioactive iodine 125, 126, 143, 176178, 182, 237, 238, 240, 247
ablation 176, 246
therapy 123
uptake study 121, 282
Radioimmunoassay 24
Radioiodine 125, 168, 203
therapy 203
treatment 90, 153
whole-body scan 50
Radionucleotides 30
Radionuclide scan 235
Radiopharmaceuticals 43
Rainbow pills 107
Raloxifene 269
Reactive lymphoid follicles 63f
Recombinant human thyroid-stimulating hormone 51
Refractory hypothyroidism 98, 100, 100fc
causes of 98, 98t
management of 101
treatment of 101
Regional lymph node 175
Reproductive health 197, 202
Reproductive system 117, 252
Respiratory system 117
Retinoid 266
X receptor 266, 307, 316
Ribonucleic acid 289, 318
Riedel's struma 63
Riedel's thyroiditis 32, 63, 90, 91, 281, 285, 286
Rifampin 91, 269
Rituximab 144
Roux-en-y duodenal diversion 99
Rubella 290
viruses 115
S
Salicylates 269
Salivary gland 34f, 48f, 66
secretory carcinoma of 66
Salpingo-oophorectomy 135
Salsalate 270
Salt reduction 305
Sarcoidosis 90
Sarcomas 172
Schmidt syndrome 273
Scleroderma 90
Sclerosing mucoepidermoid carcinoma with eosinophilia 66, 81
Sclerosis, multiple 267
Selective estrogen receptor modulators 265, 269
Selective lymph node dissection 182
Selective serotonin reuptake inhibitors 267
Selective thyroid receptor beta agonists 260
Serratia marcescens 284
Sertoli cells 204
Serum antithyroid antibodies 93
Serum binding proteins 14, 121t
Seven-point clinical activity score 20
Severe acute respiratory syndrome coronavirus 2 115, 288
Sex hormone binding globulin 130, 197, 202, 205
Sexual dysfunction 198, 202
Shear wave elastography 162
Sheehan's syndrome 90
Short bowel syndrome 98
Silent thyroiditis 32, 34
Simon's triangle 10
Simple goiter 149, 153
pathogenesis of 150f
Single-photon emission computerized tomography 39, 45f, 49f, 51, 53
Skeletal system 117
Slipped capital femoral epiphyses 231
Small solitary thyroid nodule 151f
Sobetirome 101
Sodium iodide symporter 30, 44, 45, 134, 315
Solitary thyroid nodule 47, 157, 182
Somatostatin receptor scintigraphy 41
Sperm cells 204
Spindle cell morphology 80f
Spindle epithelial tumor 81
Sporadic thyroiditis, painless 282
Staphylococcus aureus 115, 284b
Stavudine 91
Steatohepatitis, nonalcoholic 106
Steroid receptor coactivator 14
Stillbirth 302
Streptococcus pyogenes 284b
Strongyloides stercoralis 284b
Struma ovarii 34t, 127, 128, 135
Subacute granulomatous thyroiditis 63, 63f, 64f, 91, 229
Subclinical hypothyroidism 103, 106, 199, 228, 230, 251254, 257, 308
etiology of 251, 251b
Sucralfate 269
Sulfisoxazole 91
Sulfonamide 90
Sulfur dioxide 270
Sunitinib 91
Superior laryngeal nerve, external branch of 10
Suppression thyroid scintigraphy 49
Suppurative inflammation 59
Surgery 82, 123, 125, 153, 168, 180, 245, 246
complications of 246
Surgical therapy 145
Synaptophysin 78
Syphilis 284
Systemic lupus erythematosus 91, 124
T
Taenia solium 284b
Takayasu arteritis 283
Tamoxifen 269
Technetium-99 scan 122f, 123f
Teprotumumab 144
Tetraiodothyronine 22, 43, 89
Thalassemia 230
Thalidomide 91, 116
Thermoregulatory dysfunction 273, 274
Thiocyanates 315
Thionamides 236
Thygenext 165
Thymic tumors 66, 81
ThyraMIR 165
Thyroblastoma 66, 81
Thyrocyte function 12
Thyrocyte structure 12
Thyroglobulin 25, 26, 78, 122, 150, 177, 178, 182, 190, 191, 198, 219, 220
antibodies 25, 178, 240, 294
elevated negative iodine scintigraphy 13, 5254
levels 26
serum 221
Thyroglossal cyst 61f
Thyroglossal duct 50f
carcinoma 60, 61f
cyst 60, 61f, 65
Thyroid 3, 29, 66, 81, 152, 197, 202, 257, 288, 307
ablation 237
abnormalities, congenital 65
agenesis 30f
antibodies 235
autoimmunity 197, 200, 201, 201f, 202, 203, 203t, 228, 267
autonomy 34f, 157
binding globulin 14, 206, 316
biochemical presentations of 290
blocking antibody 26
bud 8
cancer 40f, 85t, 147, 158, 172, 175t, 178, 180, 181t, 188, 188f, 254, 317
carcinoma 158, 172, 178, 304, 308
management 52
carrier proteins 14, 14t
C-cell derived carcinoma 66, 78
cell 299f
clinical evaluation of 19
cork phenomenon 159
cytopathology 184t
deficiency 95
dermopathy 114
destruction of 119
diseases 289
surgical treatment of 6
disorders 28, 89, 113, 195, 217, 249, 260t, 288, 305
diagnosis of 17
effects of 308t
miscellaneous 279
nuclear imaging in 43
disruption 315
classification of 315
drugs affecting hypothalamic-pituitary control of 265
dysfunction 141f, 200t, 202, 289
effects of 205t
dysgenesis 49, 90, 219, 220
dyshormonogenesis 30, 219, 220
emergencies 272
endocrine abnormalities 60
enlargement 19
examination 20
excess 211
eye disease 138, 289
mild 141f
follicles 61f, 62f, 63f
follicular
carcinoma of 52
cells 59, 60f, 65f, 71f
nodular disease 65
folliculogenesis 8
function 223t, 236, 265, 265t, 266t, 268, 268t, 270
laboratory evaluation of 22
test 22, 22t, 25t, 26, 28, 103, 121, 128, 178, 207, 234, 236, 240, 241, 244, 245, 281, 282, 312
gland 6, 8, 9, 9f, 10, 12, 12f, 13, 29, 33f, 34t, 43, 48f, 49f, 225, 275, 289
abnormal growth of 155
anatomical relation of 43f
anatomy of 8
arterial supply of 9f
congenital anomalies of 8
ectopic sublingual 31f
embryogenesis of 8f
embryology of 8
examination of 21f
increased susceptibility of 302
infections of 115
lymphatic drainage of 10
normal 99mtc scan of 30f
physiology of 12
shape 8
size 8
vascular anatomy of 9
venous drainage of 10f
hormone 13, 14, 46, 34, 90, 90f, 105107, 116, 119121, 128, 129, 131, 197, 202, 251253, 257259, 264, 269, 275, 296f, 307, 310, 311, 312
action 14, 307
alpha 307, 312
beta 107, 229, 312t
drug-induced 115
drugs affecting protein binding of 269
effects of 197t, 204t
excess 111, 113, 117t, 119, 123, 125, 128, 129t, 211
factitious ingestion of 34
homeostasis 268
levels 262
measurement 22
metabolism defect 133
optimal action of 310
physiology of 257
preparations 269
receptor 14, 15, 15t, 197, 230, 310
resistance syndromes, classification of 311
secretion of 90fc
structure 13f
suppression 168, 177
synthesis 13, 13f, 15, 315
transport 219, 315
huge multinodular swelling of 58f
imaging 29, 30, 41
reporting and data system 174, 183
infiltration 90
inflammation of 119
lobectomy 125
malignancy 34, 36, 38, 50
management 289
medullary
cancer 158
carcinoma of 84
metabolism 299
molecular mechanism of 289
mucoepidermoid carcinoma of 66
multinodular swelling of 57f
neoplasm 156
classification of 172, 180fc
nodule 34, 35t, 49f, 57, 147, 158t, 160t, 173, 180, 243, 244, 260
assessment of 57, 173
autonomously functioning 45, 156
classification of 155t
hypoechogenicity of 58f
imaging of 34
liquid biopsy of 153
malignant 57
management of 84
prevalence of 57, 243
principal causes of 155
treatment of 173
ultrasound of 35
nuclear scanning 285
oncocytic
adenoma of 65, 68
carcinoma of 66, 74, 75f
palpation 20
papillary carcinoma of 58f, 71f75f
parenchyma 64f
peroxidase 13, 59, 89, 198, 206, 219, 220, 240
antibody 24, 203, 204, 207, 235, 257, 267
planar scintigraphy 49f
post-radioablation of 230
receptor antibodies 211
scan 45, 244
interpretation, principles of 46
scintigraphy 30, 33, 36, 46, 47f49f, 224fc
specific autoantibodies 24
spindle epithelial tumor 82f
status, management of 204fc
stimulating hormone 6, 12, 2225, 34, 43, 46, 83, 84, 89, 94t, 107, 113, 120, 128, 149, 155, 159, 166, 176, 197, 203, 208, 219, 223, 226, 231, 234, 240, 244, 258, 262, 265, 266, 270, 272, 282, 290, 294, 307, 316
binding inhibitory immunoglobulins 122
concentrations 23t
deficiency 25
dependent hyperthyroidism 25
levels 103, 232
receptor 25, 107, 119, 122, 138, 140f
secreting pituitary adenoma 34
suppressive therapy 247, 308
storm 239, 272, 274, 276
suppression 166
surgery 6
swelling 83fc
transcription factor 1 59, 190
tumors 66, 70, 81, 82t
ultrasonography 159, 235
Thyroidal reference radioactive iodine uptake 47f
Thyroidea ima 9
Thyroidectomy 41f, 85, 184, 237
subtotal 90
Thyroiditis 31, 34f, 47, 48f, 61, 122f, 126, 240, 281, 282
acute 32, 32f, 34, 61, 119, 230
bacterial 285
infectious 115, 126
amiodarone-induced 34
autoimmune 61, 228, 304
chronic
autoimmune 90, 281
lymphocytic 90, 228, 230, 281
cytokine-induced 230
destructive 135
drug-induced 62, 286
invasive 63
lymphocytic 61, 62f, 63f, 65
painful subacute 283
painless 32, 34, 119
palpation 63
radiation-induced 286
sporadic painless 126, 281
subacute 25, 32, 32f, 34, 91, 114, 115, 119, 126, 281, 290, 291, 292t, 294, 296, 296f
treatment of 126t
types of 32, 32t, 126, 281, 281b
Thyromimetics 101, 133
Thyroperoxidase 299
Thyrotoxic crisis, diagnostic criteria of 274t
Thyrotoxicosis 19, 20, 27, 113, 119, 120fc, 126, 134, 135, 152, 202
amiodarone-induced 116, 122, 127, 268, 286
clinical features of 117
diagnosis of 119
differential diagnosis of 121t
etiology of 121
iatrogenic 34, 126
juvenile 308
management of 124t
treatment of 27
typical symptoms of 19
Thyrotrophic receptor 150
Thyrotropin
binding inhibiting immunoglobulin 26
hormone stimulation test 130
receptor
antibody 235, 240, 241
hormone 12, 22, 43, 90, 197199, 229, 258, 263, 266, 307
Thyrotropinoma 121
Thyroxine 12, 22, 23, 25, 89, 94, 251, 258, 272, 289, 299
absorption test, protocol for 100b
binding globulin 25, 130, 201, 211, 257, 266, 269
stimulating hormone 98
supratherapeutic doses of 100
therapy 27
Tissue distribution 15
Toxic adenoma 34, 119, 121, 125, 126
Toxic autonomous nodule 48
Toxic multinodular goiter 34, 48, 114, 119, 121, 123f, 125, 126
development of 157
Toxic thyroid
hyperplasia, hereditary 136
nodule 239, 240
Trachea 29, 43f
Transforming growth factor-beta 140, 157
Transthyretin 14
Trauma 230
Tricyclic antidepressants 265, 267
Triiodothyroacetic acid 101
Triiodothyronine 12, 22, 25, 34, 43, 89, 107, 128, 251, 258, 270, 272, 289, 290, 294, 296, 299, 307
suppression test 130
Trophoblastic disease 34, 119
Trophoblastic tumors 135
Truncal hypotonia 133
Tubercular thyroiditis 32
Tumors 82, 176, 188f, 230
benign 65, 66
cells 73f, 80f
cohesive cluster of 67f
loose clusters of 75f
cuboidal 67f
malignant 155
necrosis factor-alpha 263
node, metastasis 173, 184
secondary 172
Turner's syndrome 27, 260
Tyrosine kinase inhibitors 20, 90, 116, 119, 229, 230, 268
U
Ultrasonography 29, 83, 122, 178, 182, 225, 244, 282, 283
Ultrasound 159
elastography 36, 162
guided fine needle aspiration 57
United Nations International Children's Emergency Fund 303
Urinary iodine concentration 305
Urticaria 237
Uterus 197
V
Van Wyk–Grumbach syndrome 231, 231f
Vasoactive intestinal peptide 199
Vitamin
A deficiency 300
B7 28
W
Wet method 303
White blood cell 123, 282
Whole body
radioiodine scan 50f, 5153
scan 37, 50, 55
scintigraphy 176
Whole exome sequencing 221
Williams syndrome 260
Wolff–Chaikoff effect 13, 266, 268
World Health Organization 188, 300
Classification of Thyroid Neoplasms 65
X
X-chromosome inactivation 150
X-ray neck 183
Y
Yersinia enterocolitica 113
Z
Zuckerkandl tubercle 9
×
Chapter Notes

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ITS Textbook of Thyroid Disorders
ITS Textbook of Thyroid Disorders
Editors Sarita Bajaj MD (Medicine) DM (Endocrinology) FRCP (London, Glasgow and Edinburgh) Consultant Endocrinologist Former Director-Professor and Head Department of Medicine MLN Medical College Prayagraj, Uttar Pradesh, India Rajesh Rajput MD (Medicine) DM (Endocrinology) FRCP (Edinburgh) FACE FICP FIACM FISH FIMSA FRSSDI Head Department of Endocrinology Kainos Superspeciality Hospital Former Senior Professor and Head Department of Endocrinology Postgraduate Institute of Medical Sciences Rohtak, Haryana, India Foreword Susan J Mandel
Jaypee Brothers Medical Publishers (P) Ltd.
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© 2023, Jaypee Brothers Medical Publishers
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ITS Textbook of Thyroid Disorders / Sarita Bajaj, Rajesh Rajput
First Edition: 2023
9789356961142
Printed at
CONTRIBUTORS
EDITOR
SECTION EDITORS
: Introduction
: Diagnosis of Thyroid Disorders
: Hypothyroidism
: Disorders of Thyroid Hormone Excess
: Goiter, Thyroid Nodules and Thyroid Cancer
: Thyroid Disorders in Women
: Thyroid Disorders in Children
: Thyroid Disorders in Special Situations
: Miscellaneous Thyroid Disorders
CONTRIBUTING AUTHORS
FOREWORD
This comprehensive volume, which focuses on thyroidology, is a welcome addition to our medical libraries. It has been developed to provide practitioners with comprehensive and current information about thyroid diseases and the many manifestations of thyroid disorders in patients. The editors, who are members of the Indian Thyroid Society, have assembled these chapters with the primary care physician in mind, and they succeed in providing valuable learnings for the entire spectrum of learners, from specialist endocrinologists to the physicians in training and students at all levels.
Thyroid disorders are common. The organization of the material builds a foundation of knowledge, beginning with the intriguing history of the thyroid gland, and progression through its structural development and physiological function and regulation. To diagnose thyroid disorders, the next chapters then clearly outline the key testing modalities available to clinicians, focusing on evidence based usage.
Subsequent sections guide the learner through the common clinical scenarios of thyroid dysfunction, hypo- and hyperthyroidism, focusing on clinical approach, diagnosis, and treatment. However, thyroid dysfunction can have pleiomorphic manifestations in patients and rarer presentations of common disorders are also presented and discussed. Importantly, there are chapters devoted to hypo- and hyperthyroidism in pregnancy, and recommendations for optimal gestational care—a time when the clinician is actually responsible for two people, the mother and fetus, rather than one patient.
The sections on special situations and miscellaneous topics address clinical scenarios that range from the common (subclinical thyroid disease and thyroid nodules) to the uncommon (resistance to thyroid hormone and anaplastic thyroid cancer). Each topic is presented clearly, with review of recent literature, and a rational, evidence-based approach to the care of patients. Clinicians who are hospital based will find the information on nonthyroidal illness, drugs interference with thyroid function, and thyroid emergencies very relevant to their practices. Our most current knowledge of how COVID-19 affects the thyroid is also included.
The thoughtful, deliberate, and thorough coverage of each topic in this book makes it relevant to all interested learners in clinical practice. I congratulate the editors and the authors and I encourage the readers to explore this text in its fullness.
Susan J Mandel MD MPH
Chief, Division of Endocrinology, Diabetes, and Metabolism
Professor of Medicine, Perelman School of Medicine, University of Pennsylvania
PREFACE
Sarita Bajaj
Rajesh Rajput
Advances in thyroid science and practice continue at a breathtaking rate and it is important to keep up with the progress in this field. The first edition of “ITS Textbook of Thyroid Disorders” retains the fundamental nature to provide a concise but comprehensive and fully updated treatise on thyroidology covering the breadth of thyroid practice, stressing the Indian perspective, highlighting new advances, and their potential to transform the established paradigms of prevention, diagnosis, and treatment.
There are very few books which are truly created with the working primary care physician in mind. Therefore, while this book is written by the leading endocrine and medical specialists we have taken pains to design the book to provide endocrinologists, family practitioners, internists, physicians in training, and students at all levels with what is needed to keep abreast to rapidly changing scientific foundations in clinical research, result, and evidence-based medical practice in thyroid health.
The chapters are written by clinicians and basic scientists from a variety of fields. The book makes abundant use of four-color illustrations, tabular material, and particularly algorithms for evaluating the functions of different systems and the diseases of those systems.
This textbook allows the reader to quickly identify and understand topics of interest which translates into very practical treatment planning. Our authors who are pioneers in the field of endocrinology present relevant pathophysiology with practical protocols for evaluation and treatment. The target audience continues to be any health professional who desires a rapid answer to any challenging question in thyroidology including endocrinologists, diabetologists, endocrine surgeons, general practitioners, and students of medicine.
The book is divided into nine sections arranging closely related subjects into clusters. There are a total of 38 chapters. commences with introduction to thyroid disorders, discusses the diagnostic approaches, highlights all aspects of hypothyroidism, encompasses disorders of thyroid hormone excess, elaborates the entire spectrum of goiter, thyroid nodules and thyroid cancer, focuses on thyroid disorders in women, is exclusively devoted to thyroid disorders in children while and address thyroid disorders in special situations and miscellaneous thyroid topics.
We were extremely fortunate to attract contributors who are renowned as authors and researchers, and who are most importantly consummate physicians. We thank all of them for their diligence, intellectual approach, and clinical acumen without which this volume would not have been possible. We would like to express our gratitude to all the authors and section editors who have balanced their many other obligations to prepare truly masterful presentations and for the large amount of work in reviewing and commenting on the chapters.
And although this book was written for clinicians, it is our hope that the millions of patients with thyroid disease will be the primary beneficiaries. It is therefore, with great humility that we have the distinct honor to be the editors of the first edition of the “ITS Textbook of Thyroid Disorders”.
Sarita Bajaj
Rajesh Rajput
ACKNOWLEDGMENTS
Publishing “ITS Textbook of Thyroid Disorders” is in every way a collaborative effort. We are deeply indebted to the executive committee of Indian Thyroid Society, Dr Pramila Kalra, Dr Arun S Menon, Dr Shashank R Joshi, Dr Mohd Ashraf Ganie, Dr Himagirish K Rao, Dr Krishna G Seshadri, Dr Sujoy Ghosh, Dr Mini G Pillai, Dr PK Jabbar, Dr Sushil Kumar Gupta, and section editors—Dr Sanjay Kalra, Dr KAV Subrahmanyam, Dr Narendra Kotwal, Dr SK Singh, Dr Mahendra Kumar Garg, Dr Rakesh K Sahay, Dr Mala Dharmalingam, Dr SK Wangnoo, Dr Manoj Chadha who have each made major contributions in edition and writing chapters as well as for their considerable time, effort, and commitment to maintaining the high standards of the textbook. Special thanks to our patrons Dr RV Jayakumar and Dr Prasanna Kumar for their constant support and encouragement.
We have assembled an outstanding group of authors, all recognized as leaders in their field and we would like to thank them for taking the time away from their busy clinical schedules and other academic responsibilities to write these chapters.
We are immensely grateful to Dr Susan J Mandel for the Foreword.
We would also like to thank the editorial staff at Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their patience, encouragement, and support. We particularly thank Ms Chetna Malhotra (Senior Director – Professional Publishing, Marketing and Business Development), Ms Pooja Bhandari (Production Head), Ms Nedup Bhutia Pillai (Team Leader – Print Publishing) and entire team who has contributed in a very significant way to the concepts, design, and preparation of the 1st edition of “ITS Textbook of Thyroid Disorders.” Our special thanks to Shri Jitender P Vij (Group Chairman), Mr MS Mani (Group President), and Mr Ankit Vij (Managing Director) for their help in publishing this book.