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Proportion of Malignancy and Evaluation of Sonographic Features of Thyroid Nodules Classified As Highly Suspicious Using ACR TI-RADS Criteria

Hussain, Najia; Goldstein, Michael B; Zakher, Mariam; Katz, Douglas S; Brandler, Tamar C; Islam, Shahidul; Rothberger, Gary D
OBJECTIVES/OBJECTIVE:The reported malignancy rate of highly suspicious thyroid nodules based on the ACR TI-RADS criteria (TI-RADS category 5 [TR5]) varies widely. The objective of our study was to determine the rate of malignancy of TR5 nodules at our institution. We also aimed to determine the predictive values of individual sonographic features, as well as the correlation of total points assigned to a nodule and rate of malignancy. METHODS:Our single-institution retrospective study evaluated 450 TR5 nodules that had cytology results available, in 399 patients over a 1-year period. Sonographic features and total TI-RADS points were determined by the interpreting radiologist. Statistical analyses included logistic regression models to find factors associated with increased odds of malignancy, and computing sensitivity, specificity, positive and negative predictive values of various individual sonographic features. RESULTS:Of the 450 nodules, 95 (21.1%, 95% exact confidence interval 17.4-25.2%) were malignant. Each additional TI-RADS point increased the odds of malignancy (adjusted odds ratio 1.35, 95% confidence interval 1.13-1.60, P < .001). "Very hypoechoic" was the sonographic feature with the highest specificity and positive predictive value for malignancy (95.5 and 44.8%, respectively), while "punctate echogenic foci" had the lowest positive predictive value (20.0%). CONCLUSIONS:The rate of malignancy of TR5 nodules at our institution was 21.1%, which is lower than other malignancy rates reported in the literature. The total number of points assigned on the basis of the TI-RADS criteria was positively associated with malignancy, which indicates that TR5 should be viewed as a spectrum of risk.
PMID: 36106704
ISSN: 1550-9613
CID: 5336322

Utility of Thyroid Function Testing in the Inpatient Setting

Goldstein, Michael; Islam, Shahidul; Piccione, Julie; Migasiuk, Laura; Rothberger, Gary
BACKGROUND:Previous studies have reported low value of ordering inpatient thyroid function tests (TFTs), with few changes in clinical management resulting from these tests. This study was designed to evaluate how often testing TFTs during hospitalization leads to medication initiation or adjustment, and to determine if the frequency of medication initiation or adjustment differs based on the indication for testing. METHODS:This is a retrospective observational study of 2278 patients who had TFTs tested while admitted to an academic hospital during a 5-month period. Indications for ordering TFTs were determined by reviewing clinical documentation, and those with abnormal tests were reviewed to assess whether thyroid medication was initiated or adjusted. RESULTS:The percentage of abnormal TFTs that led to medication initiation or adjustment was 15.1%, 12.2%, and 6.0%, for those tested on the basis of history of functional thyroid disease, suspicion of thyroid dysfunction, and reasons not directly related to thyroid dysfunction, respectively. Overall, 63 patients were started on thyroid medication or had their thyroid medication dose adjusted, which represents 10.1% of those with abnormal TFTs and only 2.8% of those tested. CONCLUSION/CONCLUSIONS:Abnormal TFTs are common, but a disproportionate amount of tests are needed to find a small percentage of clinically significant thyroid dysfunction, of which only a low percentage lead to changes in management. Education on this topic should be provided to inpatient providers to limit thyroid function testing to instances in which they are clinically indicated and abnormal results would lead to changes in management.
PMID: 35793752
ISSN: 1530-891x
CID: 5280442

Correlation of hemoglobin A1c and outcomes in patients hospitalized with COVID-19

Patel, Amy J; Klek, Stanislaw P; Peragallo-Dittko, Virginia; Goldstein, Michael; Burdge, Eric; Nadile, Victoria; Ramadhar, Julia; Islam, Shahidul; Rothberger, Gary D
BACKGROUND:) level and poor outcomes in hospitalized patients with diabetes and COVID-19. METHODS:results for each patient were divided into quartiles; 5.1-6.7% (32-50 mmol/mol), 6.8-7.5% (51-58 mmol/mol), 7.6-8.9% (60-74 mmol/mol), and >9% (>75 mmol/mol). The primary outcome was in-hospital mortality. Secondary outcomes included admission to an intensive care unit, invasive mechanical ventilation, acute kidney injury, acute thrombosis, and length of hospital stay. RESULTS:Five hundred and six patients were included. The number of deaths within quartiles 1 through 4 were 30 (25%), 37 (27%), 34 (27%) and 24 (19%), respectively. There was no statistical difference in the primary or secondary outcomes between the quartiles except acute kidney injury was less frequent in quartile 4. CONCLUSIONS:should not be used for risk stratification in these patients.
PMCID:8286241
PMID: 34284145
ISSN: 1530-891x
CID: 4981152

Utility of thyroid function testing in the inpatient setting [Meeting Abstract]

Goldstein, M; Piccione, J; Migasiuk, L; Islam, S; Rothberger, G
Thyroid function tests (TFTs) are routinely checked in hospitalized patients with or without pre-existing thyroid disease, sometimes even without suspicion of thyroid derangement. Although alternative diagnoses may explain presentations, cultural norms often encourage routine assessment. The objective of this study was to evaluate whether routine measurement of TFTs is beneficial, unnecessary, or even harmful in cost-effective care for hospitalized patients. This is a retrospective observational study of 2278 patients admitted to an academic hospital over a 5.5-month period who had their TFTs checked. Chart notes were reviewed to evaluate for preadmission diagnosis of thyroid disease and clinical indications for ordering TFTs. Results of thyroid function testing were reviewed. Medical records of those with abnormal TFTs were reviewed to assess whether thyroid medication was initiated or adjusted. Of the thyroid function tests ordered, 20.1% were ordered due to suspicion of thyroid dysfunction, 20.8% due to history of thyroid disease, and 59.0% for reasons not directly related to thyroid dysfunction. 27.3% of those tested had abnormal results. The percentage of abnormal TFTs that led to medication initiation or adjustment was 15.1%, 12.1%, and 5.7%, for those tested on the basis of history of thyroid disease, suspicion of thyroid dysfunction, and reasons not directly related to thyroid dysfunction, respectively. Overall, 65 patients were started on thyroid medication or had the dosage of their thyroid medication adjusted, which represents 10.4% of those with abnormal TFTs and only 2.9% of those tested. Abnormal thyroid function test results are common, but a disproportionate amount of tests are needed to find a small percentage of clinically significant thyroid dysfunction, of which only a low percentage lead to changes in management. TFTs checked for reasons not directly related to thyroid dysfunction had the lowest percentage of results that led to medication initiation or adjustment, while those checked on the basis of history of thyroid disease had the highest. Education on this topic should be provided to inpatient providers to limit thyroid function testing to instances in which they are clinically indicated and abnormal results would lead to changes in management
EMBASE:636273775
ISSN: 1557-9077
CID: 5179412

Continuous Subcutaneous Insulin Infusions vs. Multiple Daily Injections of Insulin in Hospitalized Patients: Glycemic Trends in the First 24 Hours of Admission

Halstrom, Amanda; Moledina, Iram; Peragallo-Dittko, Virginia; Ancona, Karena; Islam, Shahidul; Klek, Stanislaw; Rothberger, Gary
BACKGROUND/UNASSIGNED:Continuous subcutaneous insulin infusion (CSII) is a common diabetes treatment modality. Glycemic outcomes of patients using CSII in the first 24 hours of hospitalization have not been well studied. This timeframe is of particular importance because insulin pump settings are programmed to achieve tight outpatient glycemic targets which could result in hypoglycemia when patients are hospitalized. METHODS/UNASSIGNED:This retrospective cohort study evaluated 216 hospitalized adult patients using CSII and 216 age-matched controls treated with multiple daily injections (MDI) of insulin. Patients using CSII did not make changes to pump settings in the first 24 hours of admission. Blood glucose (BG) values within the first 24 hours of admission were collected. The primary outcome was frequency of hypoglycemia (BG < 70 mg/dL). Secondary outcomes were frequency of severe hypoglycemia (BG < 40 mg/dL) and hyperglycemia (BG ≥ 180 mg/dL). RESULTS/UNASSIGNED: = 0.06). CONCLUSIONS/UNASSIGNED:Patients using CSII experienced fewer events of both hypoglycemia and hyperglycemia in the first 24 hours of hospital admission than those treated with MDI. Our study demonstrates that CSII use is safe and effective for the treatment of diabetes within the first 24 hours of hospital admission.
PMID: 33563036
ISSN: 1932-2968
CID: 4931892

THYROTOXIC PERIODIC PARALYSIS IN A COMPETITIVE BODYBUILDER WITH THYROTOXICOSIS FACTITIA [Case Report]

Patel, Amy J; Tejera, Stephanie; Klek, Stanislaw P; Rothberger, Gary D
Objective/UNASSIGNED:We report a case of thyrotoxic periodic paralysis (TPP) in a bodybuilder who developed paralysis secondary to thyrotoxicosis factitia after taking a supplement containing thyroid hormone. Interestingly, the patient had no intrinsic thyroid disease. Prompt recognition of thyrotoxicosis is critical to avoid progression of paralysis and subsequent complications. Methods/UNASSIGNED:We discuss a 27-year-old body builder who presented after a 3-day bodybuilding competition with sudden upper and lower extremity paralysis. He admitted to taking anabolic steroids, a supplement containing an unknown amount of thyroid hormone for 2 weeks, and furosemide 40 mg twice daily with near-complete fluid restriction for 3 days. Results/UNASSIGNED:Laboratory results showed a thyroid-stimulating hormone (TSH) level of <0.010 μIU/mL (normal, 0.3 to 5.8 μIU/mL), normal total triiodothyronine level, elevated free thyroxine level of 3.6 ng/dL (normal, 0.8 to 1.9 ng/dL), and potassium level of 1.9 mEq/L (normal, 3.7 to 5.2 mEq/L). Thyroid peroxidase antibody, thyroid-stimulating immunoglobulin, and thyroglobulin antibody levels were normal. Thyroid uptake was 1% (normal, 8 to 25%) after administration of I-123 and thyroglobulin level was 9 ng/mL (normal, 1.4 to 29.2 ng/mL). The patient was treated with normal saline infusion, magnesium supplementation and a total of 230 mEq of potassium within 12 hours of hospitalization. Muscle weakness resolved within this time period and potassium level normalized. By the third day of hospitalization free thyroxine level also normalized and TSH improved to 0.1 mIU/L. Conclusion/UNASSIGNED:TPP is a rare complication of thyrotoxicosis that should be considered in bodybuilders who are presenting with acute muscle weakness.
PMCID:7511107
PMID: 32984532
ISSN: 2376-0605
CID: 4981142

Non-autoimmune hyperthyroidism caused by a somatic mosaic GNAS gene mutation involving part of the thyroid gland

Franca, Monica M; Levine, Robert L; Pappa, Theodora; Ilaka-Chibuluzo, Sandra; Rothberger, Gary D; Dumitrescu, Alexandra M; Refetoff, Samuel
Non-autoimmune hyperthyroidism caused by activating mutations in the GNAS gene is a rare condition. Here we report a 5-year-old girl diagnosed with non-autoimmune hyperthyroidism and tall stature harboring a somatic mosaic gain-of-function mutation in the GNAS gene (NM_080425.3: c.2530C>T;p.Arg844Cys previously reported as NM_000516.5:c.601C>T;p.Arg201Cys) and referred thereafter as R201C, in three of four quadrants of the thyroid gland. Provision of a molecular diagnosis may avoid unnecessary complete ablation of the thyroid gland.
PMID: 31910104
ISSN: 1557-9077
CID: 4294852

Method of detection of thyroid nodules: correlation with frequency of fine-needle aspiration and malignancy rate

Rothberger, Gary D; Cohen, Melissa; Sahay, Priya; Szczepanczyk, Paula T; Islam, Shahidul
BACKGROUND:Thyroid nodules are commonly found by screening, and the clinical implications are unclear. METHODS:We retrospectively studied 460 patients who were evaluated for thyroid nodules. Medical records were queried to determine how the nodules were detected. We compared the rates of fine needle aspiration (FNA) and malignancy between nodules detected clinically, incidentally on imaging, or by screening. RESULTS:Nodules were detected clinically in 184 patients (40%), incidentally in 121 patients (26%), and by screening in 155 patients (34%). The rates of FNA and malignancy were lower for patients with nodules detected by screening (28% and 1%, respectively), compared to patients with clinically apparent nodules (75% and 15%) and patients with incidental nodules (69% and 8% [P < .001]). CONCLUSION/CONCLUSIONS:Thyroid nodules detected via screening has a lower rate of FNA and is less likely to be diagnosed as a malignancy compared to nodules detected clinically or incidentally on imaging. Thyroid ultrasound examinations should be reserved for nodules that are clinically apparent or to evaluate nodules found incidentally on imaging.
PMID: 31613420
ISSN: 1097-0347
CID: 4158942

Low Free T3 Is Associated With Worse Outcomes in Patients in the ICU Requiring Invasive Mechanical Ventilation

Rothberger, Gary D; Valestra, Paul K; Knight, Khalilah; Desai, Anish K; Calixte, Rose; Shapiro, Lawrence E
OBJECTIVE/UNASSIGNED:) levels. This condition, known as nonthyroidal illness syndrome (NTIS), is associated with poor outcomes. The association of NTIS and outcomes in patients in the intensive care unit (ICU) requiring mechanical ventilation has not been well studied. This study aimed to determine the impact of NTIS on the outcomes of these patients. METHODS/UNASSIGNED:levels. Patients who died while on mechanical ventilation were assigned a VFD of 0. RESULTS/UNASSIGNED:< .001 for both mean and median VFDs). CONCLUSIONS/UNASSIGNED:due to NTIS in patients in the ICU requiring mechanical ventilation is associated with poor outcomes.
PMID: 31774023
ISSN: 1525-1489
CID: 4215502

Low Free T3 Is Associated with Worse Outcomes in Patients with Acute Respiratory Failure Requiring Invasive Mechanical Ventilation [Meeting Abstract]

Desai, A.; Rothberger, G.; Valestra, P.; Khalilah, D.; Calixte, R.; Shapiro, L.
ISI:000449978900136
ISSN: 1073-449x
CID: 3513492