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Biomedical subjects

H Gharib

Publications and source records attributed to H Gharib.

At least 91 records · Page 5Linked to original sources
PubMed1984

Fine-needle aspiration biopsy of the thyroid. The problem of suspicious cytologic findings.

Cases in which thyroid nodules yielded suspicious cytologic findings on fine-needle aspiration biopsy were prospectively studied during a 3-year period. Of 1970 patients, 333 (17%) had suspicious cytologic findings; from this group, the cases of 253 patients were studied. The cytologic diagnoses were 96 (38%) H urthle cell neoplasms, 84 (33%) follicular cell neoplasms, and 73 (29%) nonspecific diagnoses. A thyroid scan was obtained in 123 of 203 (61%) patients with a solitary nodule, and the nodules were hypofunctional in 102 (83%). Malignant lesions were found in 60 (24%) of the 253 patients. Our findings are consistent with reports that 20% of patients who have a fine-needle aspiration biopsy will have suspicious cytologic findings and that of these, 20% may have a malignant lesion. Thyroid scanning will not distinguish between benign and malignant thyroid lesions that are suspicious on cytologic examination. Surgical excision of all suspicious lesions seems reasonable.

Adenocarcinoma↗
PubMed1984

The management of Graves' disease during pregnancy.

The management of the pregnant patient with Graves' thyrotoxicosis remains a contested issue. A retrospective review of our records from 1960 through 1979 involving 25 pregnant women with thyrotoxicosis was performed. Our 25 patients were divided into three management groups, six being managed medically, ten surgically and nine with a combination of medical and surgical therapy. Of the six patients managed medically, four were delivered of term infants and two had premature deliveries. Agranulocytosis developed in one of these women and one infant had a fetal goiter. Of the ten patients surgically managed, three underwent spontaneous abortions, four were delivered of term infants and two had premature deliveries. Of the nine patients who failed to respond to medical treatment and subsequently underwent operation, eight were delivered of term infants. Of the 19 surgically treated patients, one patient had permanent injury to the recurrent laryngeal nerve and one had temporary hypoparathyroidism. The combination of thyrotoxicosis and pregnancy is uncommon, but it requires attentive treatment when diagnosed. There are several treatment alternatives basically following either a medical or surgical approach. There appears to be no clear-cut advantage to either choice, both in the literature or in our limited series. We conclude that either choice is safe and effective.

Adolescent↗
PubMed1983

Correlation of thyroid antibodies and cytologic features in suspected autoimmune thyroid disease.

Six hundred forty-three patients with antithyroid antibody results were studied. Antithyroglobulin antibodies were found in 101, and antimicrosomal antibodies were found in 338 patients. Fine-needle aspiration biopsy, performed in 122 patients, yielded a satisfactory aspirate in 108 subjects. Significant antithyroglobulin and antimicrosomal antibody titers were found in 28 of 57 and 149 of 267 patients, respectively. In 65 patients with cytologically proved Hashimoto's thyroiditis, only 15 had positive antithyroglobulin antibody results (11 titers were 1:1,600 or higher), whereas 61 had positive antimicrosomal antibody results (50 titers were 1:1,600 or higher). Thus, cytologic diagnosis of Hashimoto's thyroiditis correlated better with antimicrosomal antibodies than with antithyroglobulin antibody titers. These data suggest that antithyroglobulin antibody determination offers no particular advantage over antimicrosomal antibody titers. In subjects with a clinical diagnosis of Hashimoto's thyroiditis and negative antibody results, fine-needle aspiration biopsy remains useful in establishing the diagnosis.

Antibodies↗
PubMed1983

Familial spastic paraplegia with Kallmann's syndrome.

A sibship is reported in which two males have spastic paraparesis and Kallmann's syndrome (hypogonadotrophic hypogonadism and anosmia). One of the brothers also is color blind. The association of familial spastic paraplegia and Kallmann's syndrome has not been described previously.

Adult↗
PubMed1983

Coexistent primary empty sella syndrome and hyperprolactinemia. Report of 11 cases.

The series involved 11 women with concurrent hyperprolactinemia and primary empty sella syndrome. Eight had amenorrhea and six had galactorrhea. All 11 patients had intact hypothalamic-pituitary function, except for having elevated prolactin levels that ranged from 33 to 498 ng/mL. One patient had primary hypothyroidism. Radiologic investigations included sellar polytomography in eight cases, computed tomography of the head in eight cases, bilateral carotid angiography in six cases, and pneumoencephalography in three cases. Of eight patients undergoing transsphenoidal exploratory surgery, one had a pituitary microadenoma and an empty sella while seven had only an empty sella with a flattened pituitary gland. Conventional histologic methods (seven cases) and immunocytologic studies (three cases) of the pituitary gland showed no abnormalities. The cause of this syndrome is unknown. It should be recognized that hyperprolactinemia, with or without galactorrhea-amenorrhea, may occur in association with an empty sella in the absence of an associated pituitary tumor.

Adult↗
PubMed1982

Triiodothyronine thyrotoxicosis complicating primary hypothyroidism in a patient with autoimmune thyroiditis.

It is increasingly recognized that autoimmune thyroiditis can have a multifaceted presentation. Documented triiodothyronine thyrotoxicosis developed in a patient with a six-year history of primary hypothyroidism that was left untreated. Serologic and cytologic evidence confirmed the thyroid dysfunction as being on an autoimmune basis. Chronic lymphocytic thyroiditis may be seen with hyperthyroidism, hypothyroidism, or euthyroidism, and in an individual patients, spontaneous progression from one metabolic state to another may occur.

Autoimmune Diseases↗
PubMed1982

The spectrum of inappropriate pituitary thyrotropin secretion associated with hyperthyroidism.

Two patients with overproduction of thyroid-stimulating hormone (TSH) are described. The first patient, a 25-year-old man with recurrent hyperthyroidism, had a pituitary adenoma and highly elevated levels of TSH. While the patient was receiving 0.3 mg of thyroid daily, and basal TSH level was 161 microM/ml. Despite an increase in the thyroid hormone therapy, serum TSH levels remained elevated. The administration of thyrotropin-releasing hormone (TRH) or dexamethasone resulted in no changes in TSH level. The second patient was an 18-year-old man who had inappropriately elevated levels of TSH 3 months after radioiodine therapy for hyperthyroidism. A gradual increase in thyroid hormone replacement therapy decreased the serum TSH levels from 250 to 14.8 microM/ml. The administration of TRH led to huge increases of TSH. Dexamethasone inhibited basal TSH but not TRH-stimulated TSH levels. The overproduction of TSH was attributed to autonomous, neoplastic secretion in the first case and to partial, selective pituitary thyrotroph resistance to thyroid hormone in the second.

Adenoma↗
PubMed1982

Fine-needle aspiration biopsy of thyroid nodules. Impact on thyroid practice and cost of care.

We studied the impact of fine-needle aspiration biopsy on the management of patients with solitary thyroid nodules. Sixty-four patients were examined before the introduction of fine-needle aspiration biopsy, and 147 patients were examined after its introduction. The percentage of patients who underwent thyroid operation decreased from 67 percent to 43 percent, while the yield of carcinoma increased from 14 percent to 29 percent. Cost of medical care per patient declined by 25 percent. The results suggest that fine-needle aspiration biopsy provides valuable information to assist in the selection for surgery of patients with solitary nodules. Fine-needle aspiration appears to be safe, reliable, and cost-effective. The merits of the technique commend it for routine use in the evaluation of thyroid nodules.

Biopsy, Needle↗
PubMed1977

Hypothalamic-endocrine dysfunction in anorexia nervosa.

Multiple endocrine determinations were carried out on 101 patients with anorexia nervosa. Ninety-five percent of the patients studied were female, and in 94% of patients the anorexia nervosa began before 30 years of age. Evidence of gonadal dysfunction was the predominant manifestation, both clinically and by laboratory studies. Amenorrhea occurred before or concurrent with onset of weight loss in 65% of the women. The average weight loss was 28% of the weight before illness began. In an additional 11%, the disease began before menarche. The mean age of menarche in patients with secondary amenorrhea was 13 years. Urinary excretion of pituitary gonadotropin was undetectable in 44 of 65 patients and was below 19 rat units per 24 hours in the remaining patients. Serum luteinizing hormone level was below 8 microgram/dl in 15 of 27 patients studied and serum follicle-stimulating hormone was below 10 microgram/dl in 7 of 27 patients studied. Mean serum or urinary estrogens, or both, were low in more than 50% of the patients. Elevation of serum corticosteroids or loss or reversal of diurnal variation, or both, was noted in 50% of patients. Fasting serum growth hormone levels were elevated in 45% of the patients. Mean total and free serum thyroxine, thyroid-stimulating hormone, and triiodothyronine levels were low. These hormonal alterations in the hypothalamic-pituitary axis in patients with anorexia nervosa probably represent adaptive and protective mechanisms for chronic starvation and weight loss.

Adrenal Cortex Hormones↗
PubMed1975

Diabetic microangiopathy in patients with pancreatitic diabetes mellitus.

Clinically evident diabetic microangiopathy (retinopathy and nephropathy) occurred in 18% of diabetic patients with acute pancreatitis and 14% of diabetic patients with chronic pancreatitis. The presence of diabetic retinopathy and nephropathy in patients with pancreatitic diabetes without a family history of diabetes mellitus suggests that these patients have "primary" diabetes mellitus unmasked by the pancreatitis. The occurrence of diabetic microangiopathy is significantly correlated with the duration of diabetes. The frequency of these diabetic complications seems to increase when there is a family history of diabetes in patients whose pancreatitis is simultaneous with or precedes the onset of diabetes. The majority of patients with diabetic microangiopathy were on insulin therapy, but the need for insulin treatment is an indication of the severity of the diabetes, rather than the insulin being a causative factor of the microangiopathy. The degree of steatorrhea in diabetic patients with chronic pancreatitis did not protect against the development of microangiopathy.

Acute Disease↗