Kondrotienė, Aistė

Case Presentation A 33-year-old woman at 15 weeks’ gestation presented with rapid visual field deficits to the Emergency Department of the Hospital of Lithuanian University of Health Sciences Kaunas Clinics on 2025-05-08. Medical history revealed left-eye amblyopia, treated with occlusion therapy. A left-eye central scotoma manifested in November 2024 and resulted in vision loss by February 2025, followed by right-eye visual deficit. A non-contrast brain MRI on 2025-05-09 revealed a ~37x33x24 mm intra-/supra-/retrosellar mass with pronounced optic chiasm compression (OCC), indicative of CP. The patient was admitted to the Endocrinology Department for hormonal evaluation. Transsphenoidal tumor resection was performed on 2025-05-15. Postoperative MRI suggested complete tumor resection. Visual function improved, and histopathology confirmed a CP CNS WHO grade I, with 2/10 HPF mitoses and Ki-67 labeling index of 8%. Postoperative hypopituitarism required replacement therapy with desmopressin (60 mcg, single dose → 180 mcg/d), hydrocortisone (80 mg/d → 30 mg/d), levothyroxine (50 mcg/d). At 35 weeks' gestation, an MRI showed cystic recurrence causing bitemporal hemianopia. A multidisciplinary team decision led to a cesarean delivery at 36 weeks' gestation (Apgar 9/10), followed by stereotactic cyst aspiration, resulting in temporary vision recovery. With BRAF mutation negative and recurrent cysts causing visual deficits, fractionated stereotactic radiosurgery using Gamma Knife (27,5 Gy/5 fx) was performed in December 2025. Significant shrinkage of the cyst on MRI one month later, along with visual field improvement, was observed. Discussion CP usually manifests as visual disturbances during adulthood [1,5]. Visual decline might be accelerated by physiological pituitary hypertrophy during pregnancy as it exacerbates OCC [3,4]. MRI without contrast is a standard diagnostic method in pregnant women [1,3,6]. Early operative decompression in cases of visual compromise is linked to favorable visual prognosis [5,7]. Conclusions Pregnancy may accelerate CP growth. Prompt diagnosis and multidisciplinary care preserve vision and outcomes.

Nutukimas - viena aktualiausių dabartinės visuomenės problemų, neigiamai veikianti daugelį organizmo sistemų ir trikdanti sergančiojo šia liga gyvenimo kokybę, darbingumą bei trumpinanti gyvenimą. Tai - metaboliškai aktyvi ir recidyvuojanti liga, kurios metu kūno masė didėja riebalinio audinio sąskaita. Nutukimą kaip ligą Amerikos medicinos asociacija oficialiai pripažino 2013 metais. Nutukimas pastaruoju metu yra labiausiai aptarinėjama tema tiek medicinos, tiek plačiojoje visuomenėje. Kalbant apie nutukimą, dažnai ši būklė siejama su asmeniniu kaltės priskyrimu: „reikia tik noro“, „reikia suimti save į rankas“ ir t. t. Įvairiais istoriniais laikotarpiais požiūris į žmogaus kūno formas keitėsi nuo Rubenso tipo moterų iki anoreksinių mados manekenių formų. Menamų kūno formų standartų neatitinkantis žmogus gali būti pavadintas putliu, stambiu, apkūniu, didelio dydžio ar net storuliu ar apsileidusiu. Medicinos bendruomenėje vyrauja terminai: antsvoris, hipotalaminis, pilvinis, centrinio tipo, kušingoidinis, morbidinis nutukimas ir kt. Nutukimas turi kompleksines pasekmes - skatina lėtines ligas, galinčias sutrumpinti žmogaus amžių 10-15 metų. Per pastaruosius 5 dešimtmečius nutukimo paplitimas pasaulyje padidėjo daugiau nei 3 kartus, ir dabar tai įvardijama kaip nutukimo pandemija. Klinikinėje praktikoje nustatomos įvairiausios nutukimo priežastys - nuo genetinių (Prader-Willi sindromas, Aistrom sindromas, LEPR (leptino receptoriaus) ar LEP (leptino) geno mutacijos ir kt.), endokrininių (hipotirozė, hiperkorticizmas, hipogonadizmas ir kt.) iki valgymo priklausomybių. Skirtingos yra ir nutukusių kūno formos bei kūno kompozicija. Todėl kūno masės indeksas (KMI) klinikiniu požiūriu jau nebetenka prasmės. KMI tikslinga naudoti populiaciniams, palyginamiesiems tyrimams. Statistiniais duomenimis (HIS Lietuva, Eurostat, 2019-2022 m.), pagal KMI nutukusių suaugusių Lietuvoje buvo 21-23 proc. Skaičiuojama, kad apie 60 proc. suaugusiųjų Lietuvoje turi antsvorio ar yra nutukę. Tai - tik statistika, neatspindinti konkrečios individo būklės. 2025 m. pasaulio 58 ekspertų grupė, atstovaujanti įvairioms medicinos specialybėms ir šalims, išanalizavo turimus įrodymus ir, pritarus 75 medikų ir pacientų organizacijoms, rekomendavo klasifikaciją, kurioje išskiriamas ikiklinikinis ir klinikinis nutukimas. Pagal epidemiologinius ir klinikinius duomenis, nutukimas susijęs su daugiau nei 200 skirtingų ligų ir sveikatos sutrikimų. [...]

Background/Objectives: While it is known that Hashimoto’s thyroiditis (HT), goiter, thyroid nodules, and thyroid dysfunction may affect women’s reproductive health through hormonal and metabolic mechanisms, data are limited regarding the specific impacts on female sexual function. This study evaluated sexual function in women with thyroid disorders and examined its associations with thyroid function, age, menopausal status, and body mass index (BMI). Methods: A population-based survey was conducted in Kaunas, Lithuania, within the WHO MONICA framework. A random sample of 1569 women aged 25–69 years was included in the final analysis after applying the exclusion criteria. Anthropometric measurements were taken using standardized procedures, and the BMI was calculated. Sexual function was assessed using the 19-item Female Sexual Function Index (FSFI). Thyroid structure was evaluated by a team of trained physicians using ultrasound, while thyroid function was assessed via serum analysis (ELISA-based assays for TSH, fT4, and anti-TPO antibodies). Results: Of the 1569 women analyzed, 64.1% had sexual dysfunction (SD) (FSFI ≤ 26.55). Age and BMI showed significant negative correlations with all FSFI domains, with the strongest associations for arousal, lubrication, and total FSFI score (p < 0.01). SD was more prevalent among postmenopausal (43.6%) women than in premenopausal women (22.6%, p < 0.001) and increased with a higher BMI (p < 0.001). HT was found in 28.3% of participants. Compared with the reference group, women with HT were older, had higher BMI, higher TSH levels, and more hypothyroidism (p < 0.001). SD was more common in the HT group (71.7% vs. 64.2%, p < 0.001), with significantly lower lubrication and higher pain scores. In the multivariate analysis, only goiter remained an independent predictor of SD (p = 0.04). Conclusions: In conclusion, women with HT were older; had a higher BMI; and more frequently experienced SD, particularly reduced lubrication and increased pain, compared with the reference group. Although several thyroid conditions were associated with sexual dysfunction, only goiter remained an independent predictor after adjusting for age and BMI.

PASKAITOS SANTRAUKA Perioperacinis laikotarpis kelia didelį fiziologinį stresą, todėl pacientams, sergantiems antinksčių funkcijos nepakankamumu, būtina užtikrinti tinkamą gliukokortikoidų pakaitinę terapiją. Apie 5-10% pacientų su létiniu antinksčių nepakankamumu, kuriems neskiriama tinkama stresinė steroidų dozė operacijos metu, išsivysto antinksčių krizė. Iš šių atvejų, perioperacinis mirtingumas dėl krizės gali siekti iki 30-50%, jei krizė nenustatoma ir negydoma laiku [1]. Gydymo tikslas - imituoti fiziologinį kortizolio padidėjimą streso metu ir išvengti komplikacijų [2]. [...].

Skydliaukės karcinoma yra heterogeninė liga, kurios gydymas priklauso nuo onkologinės formos, genetinių pokyčių, ligos stadijos ir progresavimo. Per pastarąjį dešimtmetį pagerėjo skydliaukės karcinomos molekulinės patogenezės supratimas, o tai lėmė tikslesnius gydymo metodus. Buvo sukurta tikslinė terapija, kuri slopina pagrindinius onkogeninius mechanizmus. 2013-2015 m. Europos vaistų agentūra ir Maisto ir vaistų administracija patvirtino kelis multikinazės inhibitorius, skirtus pažengusiai ir (arba) metastazavusiai skydliaukės karcinomai gydyti. Diferencijuotos skydliaukės karcinomos (DSK) gydymui buvo patvirtinti lenvatinibas ir sorafenibas, o medulinės skydliaukės karcinomos (MSK) gydymui - kabozantinibas ir vandetanibas. Šie vaistai tapo standartiniu pirmos eilės sisteminiu gydymu esant pažengusioms skydliaukės naviko formoms. Šiuo metu sisteminės terapijos galimybės sparčiai plečiasi, atsiranda naujų farmakologinių strategijų, leidžiančių tiksliau individualizuoti gydymą. Šiame straipsnyje apžvelgiamos naujausios sisteminės terapijos naujovės, skirtos pacientams, sergantiems pažengusia/metastazavusia diferencijuota skydliaukės karcinoma, meduline skydliaukės karcinoma bei anaplastine skydliaukės karcinoma.

Introduction Subacute thyroiditis during pregnancy is a rare condition, with an incidence of 10- 20 cases per 1,000,000 pregnancies [1]. It can mimic thyroid cancer, which has an incidence of 3.6-14 cases per 100,000 pregnant women [2]. Case Presentation A 31-year-old woman, at 6 weeks of pregnancy, presented with right-sided neck pain and difficulty swallowing. Laboratory tests revealed elevated inflammatory markers: C-reactive protein 190 mg/l, erythrocyte sedimentation rate 27 mm/h, and white blood cell count (WBC) 10.9 x 10^9/l, ANtiTPO, AntiTg – negative, euthyrosis. Ultrasound of the thyroid showed a significantly enlarged right lobe, containing a large, hypoechoic, heterogeneous, and hypervascular nodule measuring approximately 4.4 x 3.3 x 3.5 cm. The nodule exhibited multiple calcifications of varying sizes, along with avascular areas, while the left lobe appeared normal. A suspicious 0.5 cm lymph node was identified in the right side of the neck (zone IV). Based on these findings, a percutaneous fine needle aspiration biopsy was performed under ultrasound guidance, with three tissue columns collected for histopathological examination. The patient was started on ibuprofen for pain and inflammation, and over the course of her treatment, there was improvement in the inflammatory markers, and her symptoms vanished. Biopsy results revealed differentiated high-grade thyroid carcinoma (DHGTC) with areas of tumor necrosis. Immunohistochemistry showed that tumor cells were positive for TTF-1, PAX-8, CK-19, and weakly positive for thyroglobulin, but negative for BRAF. The Ki-67 proliferation index was 7%. Surgical treatment was recommended. Due to the pregnancy, surgery was planned for the second trimester. A total thyroidectomy was performed, and a lymph node in zone VI, measuring 4 mm posterior to the right thyroid lobe, was also removed. The histological examination of the excised tissue confirmed the diagnosis of DHGTC carcinoma, staged as pT3 N0a LVI1. Following surgery, the patient was started on thyroxine replacement therapy with TSH suppression. In conclusion, this case highlights the diagnostic challenge of distinguishing subacute thyroiditis from thyroid cancer during pregnancy. Despite the initial suspicion of subacute thyroiditis, further investigation revealed high-grade differentiated thyroid carcinoma. DHGTC has an intermediate prognosis, falling between welldifferentiated thyroid carcinoma and anaplastic thyroid carcinoma [3]. Welldifferentiated tumors do not require immediate surgical treatment but only observation during pregnancy. On the contrary, more aggressive tumors (as in our case), also undifferentiated, require surgery during pregnancy, as delay in such circumstances can significantly reduce survival [4].

33 metų moteris kreipėsi į gydytojus endokrinologus dėl arterinės hipertenzijos, troškulio ir atkaklios hipokalemijos, išliekančios nepaisant peroraliai skiriamų kalio papildų. Atlikus metanefrinų, kortizolio seilėse tyrimus ir 1 mg Deksametazono mėginį gauti rezultatai nebuvo patologiniai, tačiau aldosterono ir renino santykis buvo ženkliai padidėjęs - 1214,9 bei gautas patologinis druskų mėginio rezultatas (aldosteronas po mėginio 482 pmol/l). Pacientei atlikta pilvo kompiuterinė tomografija, kur dešiniame antinkstyje stebėtas 2 x 1,5 cm darinukas - adenoma. Nuspręsta atlikti antinksčių venų mėginį, kurio gauti rezultatai buvo neinformatyvūs. Aptarus pacientės atvejį Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų Retų endokrininių ligų konsiliume, pakartotinai įvertinus vaizdinius tyrimus, pastebėti ir galimi pakitimai kairiajame antinkstyje, diferencijuotini tarp antinksčio hiperplazijos ar mikroadenomų. Minėto konsiliumo metu buvo nutarta pacientės atvejį aptarti su kitos šalies gydytojais specialistais. Aptarimo metu buvo nuspręsta kartoti antinksčių venų mėginį. Įvertinus pakartotinai atlikto mėginio rezultatus patvirtinta dešinio antinksčio aldosterono hiperprodukcija. Pacientė nukreipta operaciniam gydymui, kuriam besiruošiant pacientė pasiskundė šalutiniu Spironolaktono poveikiu ir medikamentinis gydymas buvo koreguotas. Pacientei sėkmingai atlikta dešinio antinksčio adrenalektomija, po operacijos regresavo antihipertenzinių medikamentų ir kalio papildų poreikis.

Širdies ir kraujagyslių inkstų metabolinis sindromas (Š/K-I-M-s) - tai sveikatos sutrikimai, atsirandantys dėl sąveikų tarp širdies ligų (širdies nepakankamumo, prieširdžių virpėjimo, išeminės širdies ligos, insulto ir periferinių arterijų ligos), inkstų ligų, cukrinio diabeto (CD) ir nutukimo [1]. [...].

This study aimed to investigate the expression of microRNAs (miRNAs) -146b-3p, -221-5p, -222-3p, and -21a-3p and the methylation pattern of the thyroid-stimulating hormone receptor (TSHR) gene in blood plasma samples from papillary thyroid cancer (PTC) patients before and after thyroidectomy compared to healthy controls (HCs). This study included 103 participants, 46 PTC patients and 57 HCs, matched for gender and age. Significantly higher preoperative expression levels of miRNAs and TSHR methylation were determined in the PTC patients compared to HCs. Post-surgery, there was a notable decrease in these biomarkers. Elevated TSHR methylation was linked to larger tumor sizes and lymphovascular invasion, while increased miRNA-222-3p levels correlated with multifocality. Receiver operating characteristic (ROC) analysis showed AUCs below 0.8 for all candidate biomarkers. However, significant changes in the expression of all analyzed miRNAs and TSHR methylation levels indicate their potential to differentiate PTC patients from healthy individuals. These findings suggest that miRNAs and TSHR methylation levels may serve as candidate biomarkers for early diagnosis and monitoring of PTC, with the potential to distinguish PTC patients from healthy individuals. Further research is needed to validate these biomarkers for clinical application.

Introduction Poorly differentiated carcinoma (PDTC) is an aggressive and rare form of thyroid carcinoma that originates from follicular cells and accounts for only 1-3 percent of all thyroid carcinomas diagnosed1 . Most of the limited instances of PDTCs have been observed in older individuals. Instances in the pediatric population are exceedingly rare2 . Case report This report refers 17-year-old female, who presented moderate hirsutism (scoring 8 points on the Ferriman-Gallwey scale), normal puberty development (Tanner stage B3P4), and regular periods. Upon physical examination, the patient exhibited an enlarged thyroid (IB degree), Laboratory examination showed normal levels of sex hormones, elevated antibodies against thyroid peroxidase and thyroglobulin, and thyroid-stimulating hormone concentration. Thyroid ultrasound revealed a right thyroid hypoechoic heterogeneous structure nodule, with microcalcifications and groups of them, measuring up to 2.7!2.8!4.1 cm in size. A fine-needle aspiration biopsy and cytological examination of the mass found undetermined significance atypia (Bethesda category III). Due to the abundant presence of lymphocytes, lymphocytic thyroiditis was suspected. In consideration of a potential tumor process, it was decided to carry out a complete thyroidectomy. Histopathology determined high-grade PDTC of the right thyroid lobe. The patient underwent radioactive iodine therapy following the completion of thyroidectomy. The treatment was well tolerated, with no observed side effects noted. Following the completion of the treatment, a PET/CT scan with fluorodeoxyglucose (FDG) was performed, during which no focal pathological FDG accumulation was detected. There were not detected pathological variants in PTEN, PRKAR1A, APC, TP53, RET, DICER1 genes. Conclusions This case emphasizes the challenges in diagnosing and treating thyroid disorders in young patients. The successful management PDTC through thyroidectomy and radioactive iodine therapy is notable. The absence of FDG accumulation posttreatment indicates a positive therapeutic response. This underscores the significance of comprehensive assessment and collaborative care for rare thyroid conditions in adolescents.