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Approach to Subclinical Thyroid Diseasethe community: a twenty-year follow-up of the WhickhamSurvey. Clin Endocrinol (Oxf). 1995;43:55-68.17. Parle JV, Franklyn JA, Cross KW, Jones SR, Sheppard MC.Thyroxine prescription in the community: serum thyroidstimulating hormone level assays as an indicator ofundertreatment or overtreatment. Br J Gen Pract.1993;43:107-9.18. Razvi S,Ingoe L,Keeka G, Oates C, McMillan C, WeaverJU.The beneficial effect of L-thyroxine on cardiovascularrisk factors, endothelial function and quality of life insubclinical hypothyroidism: randomised, crossover trial.JClin Endocrin Metab.2007;February 13 as dol:10.1210/JC.2006-1869.Epub ahead of print.19. Sgarbi JA, Villaca F, Garbeline B, Villar HE, Romaldini JH.The effects of early antithyroid therapy for endogenoussubclinical hyperthyroidism on clinical and heartabnormalities. J Clin Endocrinol Metab. 2003; 88:1672-720. Petretta M, Bonaduce D, Spinelli L, Vicario MLE, Nuzzo V,Marciano F ,et al.Cardiovascular haemodynamics andcardiac autonomic control in patients with subclinical andovert hyperthyroidism. Eur J Endocrinol. 2001; 145 : 691-96.21. Tamer I, Sargin M, Sargin H, Seker M, Babalik E, Tekce M,et al. The evaluation of left ventricular hypertrophy inhypertensive patients with subclinical hyperthyroidism.Endocr J. 2005; 52: 421-522. Dorr M, Wolff B, Robinson DM, John U, Ludemann J,Meng W, et al. The association of thyroid function withcardiac mass and left ventricular hypertrophy. J ClinEndocrinol Metab. 2005; 90: 673-723. Biondi B, Palmieri EA, Fazio S, Cosco C, Nocera M, SaccaL, el al.Endogenous subclinical hyperthyroidism affectsquality of life and cardiac morphology & function in youngand middle- aged patients. J Clin Endocrinol Metab. 2000;85: 4701-524. Gussekloo J, van Exel E, de Craen AJ, Meinders AE, FrolichM, Westendorp RG. Thyroid status, disability and cognitivefunction and servival in old age. JAMA. 2004; 292: 2591-9.SR Sutradhar25. Walsh JP, Bremner AP, Bulsara MK,O’Leary P, LeedmanPJ, Feddema P, et al.Subclinical thyroid dysfunction as arisk factor for cardiovascular disease.Arch Intern Med.2005;165:2467-72.26. Cappola AR, Fried LP, Arnold AM, Danese MD, Kuller LH,Burke GL, et al. Thyroid status, cardiovascular risk,andmortality in older adults. JAMA. 2006; 295: 1033-4127. Foldes j,Tarjan G, Szathmary M, Varga F,Krasznai I,Horvath C.Bone mineral density in patients withendogenous subclinical hyperthyriodism: is the thyroidstatus a risk factor for osteoporosis?ClinEndocrinol(Oxf).1993;39:512-27.28. Gurlek A, Gedik O.Effect of endogenous subclinicalhyperthyroidism on bone metabolism and bone mineraldensity in premenopausal women.Thyroid. 1999;9:539-43.29. Bauer DC, Ettinger B, Nevitt MC, Stone KL . Risk for thestudy of osteoporotic fractures. Risk for fracture in womenwith low serum levels of thyroid-stimulating hormone. AnnIntern Med .2001;134:561-8.30. Roberts LM, Pattison H, Roalfe A, Franklyn J, Wilson S,Hobbs FD, Parle JV. Is subclinical thyroid dysfunction inthe elderly associated with depression or cognitivedysfunction? Ann Intern Med .2006;145: 573-8131. Kvetny J . Subclinical hyperthyroidism in patients withnodular goitre represents a hypermetabolic state. Exp ClinEndocrinol Diabetes.2005; 113: 122-632. Brennan MD, Powell C, Kaufman KR, Sun PC, Bahn RS,Nair KS . The impact of overt & subclinicalhyperthyroidism on skeletal muscle. Thyroid .2006;16: 375-8033. Woeber KA. Observations concerning the natural history ofsubclinical hyperthyroidism. Thyroid. 2005;15:687-91.34. Weetman AP. Graves' disease. N Engl J Med.2000;343:1236-48.35. Parle JV, Maisonneuve P, Sheppard MC, Boyle P, FranklynJA. Prediction of all-cause and cardiovascular mortality inelderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet. 2001;358:861-5.96
CASE REPORTSGonadoblastoma: Primary Amenorrhoeawith Gonadal DysgenesisH BEGUM a , S KHATON b , S JAHAN cSummary:A seventeen year old unmarried girl presented with nodevelopment of breasts and non establishment ofmenstruation till then. She was with average height &weight, chromosome analysis was 46XY (SwyerSyndrome). Laparoscopy followed by laparotomy showedirregular surfaced gonads with rudimentary uterus.Gonadectomy done & histopathology revealed features ofgonadoblastoma. She had under gone 6 cycles ofcombination chemotherapy and hormone replacementtherapy and showed excellent response.(J Bangladesh Coll Phys Surg <strong>2008</strong>; 26: 97-99)Introduction:Gonadoblastoma is a rare and always a benign formof cancer. It is exclusively found in patients with anunderlying gonadal disorder. It accounts for two-thirdof gonadal tumour in women with an abnormalkaryotype 1,2,3 . Most of the cases, it is highlyassociated with abnormal development of thereproductive system 3,4 . The neoplastic nature ofgonadoblastoma has been questioned because somelesions are small & may undergo complete regressionby hyalinization & calcification 4 . In 1953,gonadoblastoma was first detected in details byScully as a gonadal tumour composed of germ cell &sex cord derivatives 1,2 . Gonadoblastoma occursalmost always in patients with pure gonadaldysgenesis with 46XY karyotype (Swyer Syndrome)7 . Some times it occurs in mixed gonadal dysgenesisor in male pseudohermaphrodites 7,8 . Dysgerninomaoccurs in 50% of patients & it may be associated withmore malignant germ cell tumours 6,7 .Case Report:A 17 year old unmarried girl was admitted ingynaecology & obstetrics department of BSMMU on12 th June, 2006 with non establishment ofa. Dr. Hamida Begum, DGO, FCPS (Gynae & Obs), Asst. Prof.,Dept. of Gynae & Obs, BSMMUb. Prof. Sabera Khaton, FCPS (Gynae & Obs), Head ofOncology Unit, BSMMUc. Prof. Sultana Jahan, Chairman & Head of the Department(Gynae & Obs) BSMMUAddress of correspondence: Dr. Hamida Begum, FCPS, AsstProfessor, Dept. of Gynae & Obs., BSMMU, Shahbag, Dhaka,Contact: 8750996 (landline), 01819243619 (cell), Email:hamidabgm@yahoo.comReceived: 27 August, 2007 Accepted: 3 March, <strong>2008</strong>menstruation and absence of development of breaststill then. She gave no history of periodic lowerabdominal pain, dysuria, frequency or retention ofurine. She had no heat or cold intolerance,constipation and no significant weight loss, visualdisturbance, trauma or tuberculosis. Her mother gaveno history of relevant drug intake during pregnancyand she had no history of difficult labor during herbirth or encephalitis in childhood. There was nofamily history of primary amenorrhea, tuberculosis ordiabetes. She gave no significant drug, medical orsurgical history.She was examined thoroughly and general parameterswere found normal. Her height was 5’ 3’’, weight 52kg, & had masculine type body built. She wasdepressed but co-operative. Her scalp hair was long,axillary & pubic hair was well developed with femaledistribution. Her visual field was normal with normalcolor vision. She gave no history of anosomia & hadno bony abnormality. Her thyroid gland was notenlarged & other lymph nodes were not palpable. Herbreasts were not developed & had widely spacednipples. She had no stigmata of chromosomal or otherendocrine diseases.Her per abdominal examination revealed no palpablemass or abnormality. Pubic hair was well developed& female type in distribution. Vulva including labiamajora, minora & clitoris was well developed. Noswelling was found in the inguinal region. Vaginalintroitus was narrow & per vaginal examination couldnot be done. Per rectal examination was done & anodular firm cord like structure was found in themidline at the apex of the examining finger.All the relevant investigations were done. Herkaryotype was 46XY with no structural or numerical
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