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LETTER TO EDITOR |
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| Year : 2006 | Volume
: 60
| Issue : 6 | Page : 247-248 |
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Reply letter
Emin Gurleyik
Department of Surgery, Abant Izzet Baysal University, Duzce Medical Faculty,Duzce, Turkey
Correspondence Address:
Emin Gurleyik
Abant Izzet Baysal University, Duzce
Turkey
How to cite this article:
Gurleyik E. Reply letter. Indian J Med Sci 2006;60:247-8 |
Sir,
We thank Mishra and Agarwal for their interest in our manuscript.[1] They have given us the opportunity to further explain and clarify some points stated in their letter. We present our replies for their comments.
Our region has been determined and labeled as endemic goiter area, based on many previous studies on school children using ultrasound for goiter formation and urine biochemistry for iodine output. Iodine supplementation with iodinated salt has been prescribed for the population in the last 10-15 years. Today the status is better than 1990s for goiter formation in children and young adults. Please remember that our patients have a man age of 48 (21-75) years. Their goiter and nodule formation (solitary, solid and large) is not new and acute and mostly depends on endemic features of the region.
The results of FNAC are dependent on the surgeon (for FNA) and pathologist (cytological interpretation). Nondiagnostic and unsatisfactory FNAC has been reported 15% in average and its sensitivity between 83 and 85% in the recent series.[2],[3],[4],[5],[6]
We used nuclear scan in all our patients with large solitary solid nodule in the thyroid. Serum TSH levels are normal in 24 and low in 20 patients. Our indications for surgery are based on patients' history, physical examination, blood chemistry, nuclear scan and ultrasound imaging and FNAC results as reported in our manuscript. Nuclear scan is only a part of the patient's evaluation; therefore, surgical indication is not only based on thyroid scintigraphy. No operative complication was noted in this series.
In this small series of patients with solitary solid nodule of the thyroid, we did not determine autoimmune thyroiditis. Our results of serum TSH levels at 6th month postoperatively showed that 39 patients with unilateral total lobectomy are euthyroid.
Many studies have previously showed that iodine supplementation has some effects on thyroid nodules.[7],[8],[9],[10],[11],[12],[13] Therefore, high rate of hyperthyroidism and papillary cancer in endemic and previously endemic regions reveals potential influence of alimentary iodine on the pathogenesis of thyroid nodule(s).
| References | |  |
| 1. | Gurleyik E, Coskun O, Aslaner A. Clinical importance of solitary solid nodule of the thyroid in endemic goiter region. Indian J Med Sci 2005;59:388-95.  |
| 2. | Taneri F, Kurukahvecioglu O, Ege B, Yilmaz U, Tekin E, Cifter C, et al . Prospective analysis of 518 cases with thyroidectomy in Turkey. Endocr Regul 2005;39:85-90. |
| 3. | Capelli C, Pirola I, Cumetti D, Micheletti L, Tironi A, Gandossi E, et al . Is the anterior and transverse diameter ratio of nonpalpable thyroid nodules a sonographic criteria for recommending fine needle aspiration cytology. Clin Endocrinol (Oxf) 2005;63:689-93. |
| 4. | Jogai S, Al-Jassar A, Temmim L, Dey P, Adesina AO, Amanguno HG. Fine needle aspiration cytology of the thyroid: A cytohistologic study with evaluation of discordant cases. Acta Cytol 2005;49:483-8. [PUBMED] |
| 5. | Mehrotra P, Hubbard JG, Johnson SJ, Richardson DL, Bliss R, Lennard TW. Ultrasound scan guided core sampling for diagnosis versus freehand FNAC of the thyroid gland. Surgeon 2005;3:1-5. [PUBMED] |
| 6. | Kojic Katovic S, Halbauer M, Tomic-Brzac H. Importance of FNAC in the detection of tumours within multinodular goitre of the thyroid. Cytopathology 2004;15:206-11. [PUBMED] [FULLTEXT] |
| 7. | Lind P, Kumnig G, Heinisch M, Igerc I, Mikosch P, Gallowitsch HJ, et al . Iodine supplementation in Austria: Methods and results. Thyroid 2002;12:903-7. |
| 8. | Laurberg P, Bulow PI, Knudsen N, Ovesen L, Andersen S. Environmental iodine intake affects the type of nonmalignant thyroid disease. Thyroid 2001;11:457-69. |
| 9. | Niedziela M, Breborowicz D, Trejster E, Korman E. Hot nodules in children and adolescents in western Poland from 1996 to 2000: Clinical analysis of 31 patients. J Pediatr Endocrinol Metab 2002;15:823-30. |
| 10. | Azizi F, Daftarian N. Side-effects of iodized oil administration in patients with simple goiter. J Endocrinol Invest 2001;24:72-7. [PUBMED] |
| 11. | Burgess JR. Temporal trends for thyroid carcinoma in Australia: An increasing incidence of papillary thyroid carcinoma (1982-1997). Thyroid 2002;12:141-9. [PUBMED] [FULLTEXT] |
| 12. | Burgess JR, Dwyer T, McArdle K, Tucker P, Shugg D. The changing incidence and spectrum of thyroid carcinoma in Tasmania (1978-1998) during a transition from iodine sufficiency to iodine deficiency. J Clin Endocrinol Metab 2000;85:1513-7. [PUBMED] [FULLTEXT] |
| 13. | Delange F, Lecomte P. Iodine supplementation: benefits outweigh risks. Drug Saf 2000;22:89-95. [PUBMED] |
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