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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

ISOLATED PARAGANGLIOMA IN A PATIENT WITH VHL P.L163F MUTATION [Case Report]

Goldstein, Michael; Neril, Rebecca E; Rothberger, Gary D
OBJECTIVE:gene in a patient with isolated PGL. METHODS:gene mutation are described. A literature review is also presented. RESULTS:. Surveillance for other tumors associated with VHL disease has been negative thus far. Her cousin has not undergone genetic testing despite recommendations to do so. CONCLUSION/CONCLUSIONS:mutation may cause a VHL disease type 2C phenotype.
PMCID:7357614
PMID: 32671223
ISSN: 2376-0605
CID: 5523762

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

Usefulness of Serum Triiodothyronine (T3) to Predict Outcomes in Patients Hospitalized With Acute Heart Failure

Rothberger, Gary D; Gadhvi, Sonya; Michelakis, Nickolaos; Kumar, Amit; Calixte, Rose; Shapiro, Lawrence E
Thyroid hormone plays an important role in cardiac function. Low levels of serum triiodothyronine (T3) due to nonthyroidal illness syndrome may have adverse effects in heart failure (HF). This study was designed to assess the ability of T3 to predict in-hospital outcomes in patients with acute HF. In total, 137 patients without thyroid disease or treatment with drugs which affect TH levels, who were hospitalized with acute HF were prospectively enrolled and studied. TH levels were tested upon hospital admission, and outcomes were compared between patients with low (<2.3 pg/ml) and normal (≥2.3 pg/ml) free T3 levels as well as between those with low (<0.6 ng/ml) and normal (≥0.6 ng/ml) total T3 levels. Low free T3 correlated with an increased length of stay in the hospital (median 11 vs 7 days, p <0.001) and higher rates of intensive care unit admission (31.8% vs 16.9%, p = 0.047), with a trend toward increased need for invasive mechanical ventilation (9.0% vs 1.4%, p = 0.056). Low total T3 correlated with an increased length of stay in the hospital (median 11 vs 7 days, p <0.001) and increased need for invasive mechanical ventilation (9.8% vs 1.3%, p = 0.045). In conclusion, low T3 predicts worse hospital outcomes in patients with acute HF and can be useful in the risk stratification of these patients.
PMID: 28017303
ISSN: 1879-1913
CID: 3535422

The Case | Elevated lactate and osmolar gap after levothyroxine overdose [Case Report]

Rothberger, Gary D; Desai, Anish K; Sharif, Sairah; Chawla, Shalinee A; Shirazian, Shayan
PMID: 26230209
ISSN: 1523-1755
CID: 3462092

Quality Improvement in Inpatient Diabetes Care Decreases Wasteful HbA1c Testing [Meeting Abstract]

Shalem, Lena; Feldman, Jonah; Rothberger, Gary; Peragallo-Dittko, Virginia; Walmsley, Sarah
ISI:000209805100212
ISSN: 0163-769x
CID: 3525822

Levels of elevated circulating endothelial cell decline after tumor resection in patients with pancreatic ductal adenocarcinoma

Sabbaghian, M Shirin; Rothberger, Gary; Alongi, Alexandra P; Gagner, Jean-Pierre; Goldberg, Judith D; Rolnitzky, Linda; Chiriboga, Luis; Hajdu, Cristina H; Zagzag, David; Basch, Ross; Shamamian, Peter
AIM: To evaluate circulating endothelial lineage cells (ELCs) as biomarkers of tumor neovascularization in patients with pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS: ELCs were isolated from the peripheral blood of patients with PDAC (n=14) or controls (n=17) before and after tumor resection/surgery and quantified using flow cytometry. Vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) were detected in tumor using immunohistochemistry and in plasma using an ELISA technique. RESULTS: Circulating ELC levels were increased in patients with PDAC compared to controls. After PDAC resection, ELC levels declined. ELC level increases were associated with cancer recurrence. VEGF and PlGF were identified in cancer cells and exocrine pancreas cells. Only PlGF was detected in tumor-associated inflammatory cells. Plasma levels of PlGF were higher in patients with PDAC compared to controls. CONCLUSION: Circulating ELCs are a potential biomarker of PDAC neovascularization, and PlGF may be an important target in treatment of PDAC
PMID: 20683032
ISSN: 1791-7530
CID: 111825

Evaluation of surgical outcomes and gallbladder characteristics in patients with biliary dyskinesia

Sabbaghian, M Shirin; Rich, Barrie S; Rothberger, Gary D; Cohen, Jonathan; Batash, Steven; Kramer, Elissa; Pachter, H Leon; Marcus, Stuart G; Shamamian, Peter
INTRODUCTION: This study was designed to compare symptomatic outcomes following cholecystectomy in patients with biliary dyskinesia. MATERIALS AND METHODS: From 1999 to 2006 at New York University Medical Center, 197 adults underwent hepatobiliary scintigraphy with cholecystokinin administration to evaluate gallbladder ejection fraction (GBEF). Biliary dyskinesia was demonstrated in 120 patients based on decreased GBEF of </=35%. Forty-four patients underwent cholecystectomy, and data from chart review and telephone questionnaires were available for 42 patients. Patients reported symptomatic improvement whether gallstones were present (25/27, 92.6%) or absent (13/15, 86.7%) prior to cholecystectomy (p = 0.90). The most common pathologic findings were chronic cholecystitis and cholesterolosis, regardless of the presence of gallstones. Additional data from 101 of the 120 patients with decreased GBEF demonstrated 74/101 (73.2%) patients were diagnosed with gastroesophageal reflux disease (GERD), and 59/101 (58.4%) patients were diagnosed with gastritis. RESULTS: The results of this study suggest that biliary dyskinesia should be considered as part of the spectrum of symptomatic gallbladder disease that can be successfully treated with cholecystectomy and that biliary dyskinesia is associated with GERD and gastritis
PMID: 18543048
ISSN: 1873-4626
CID: 93321

Circulating endothelial progenitor cells as a potential biomarker of gastrointestinal cancer neovascularization [Meeting Abstract]

Sabbaghian, M. Shirin; Rothberger, Gary; Gagner, Jean-Pierre; Basch, Ross; Shamamian, Peter
ISI:000249397300132
ISSN: 1072-7515
CID: 3525842