Further studies on delineating thyroid-stimulating hormone (TSH) reference range

The aim of the study was to evaluate thyroid-stimulating hormone (TSH) concentration in a reference group and to compare it with the TSH in subjects with high probability of thyroid dysfunction. The study population consisted of 852 subjects. The reference group consisting of 316 subjects was obtained by the exclusion of the subjects having thyroid disease, taking thyroid influencing drugs, having increased thyroid peroxidase (TPO) antibodies, or having abnormal thyroid ultrasound. 42 high probability of thyroid dysfunction subjects were defined by the association of increased TPO antibody concentration, changed echogenicity, and changed echosonographic structure of thyroid parenchyma. In the reference group TSH reference range was 0.45 mU/l (95% CI 0.39-0.56 mU/l) to 3.43 mU/l (95% CI 3.10-4.22 mU/l). To distinguish reference and high probability of thyroid dysfunction group a TSH threshold was calculated. At a threshold value of 3.09 mU/l (95% CI 2.93-3.38 mU/l), specificity was 95% and sensitivity 38.1%. Using 2 different approaches to find upper limit of the TSH reference range we obtained similar results. Using reference group only a value of 3.43 mU/l was obtained. Using both reference group and subjects with the high probability of thyroid dysfunction we obtained 95% CI for the upper reference limit between 2.93 and 3.38 mU/l. Based on these premises, it could be argued that conservative estimate of the TSH upper reference range should be 3.4 mU/l for both sexes.

Depressive phenomenology in regard to depersonalization level

BACKGROUND

It has been found that in patients suffering from unipolar depression, associated depersonalization symptomatology is more intense compared to healthy controls, and also that there is a positive correlation between depression and depersonalization. According to data that may be found in the literature, there is a relatively high prevalence of depersonalization symptomatology in unipolar depressions. Our study was aimed at finding whether the presence of depersonalization was related to a specific phenomenological expression of depressive symptomatology in unipolar depression.

SUBJECTS AND METHODS

The study included 84 subjects suffering from unipolar depression without psychotic features. Based on the Cambridge Depersonalization Scale (CDS) score, the subjects were divided into two groups - a group with associated depersonalization (CDS>or=70) (40 subjects) and a group with subsyndromal depersonalization (CDS<70) (44 subjects), the later one being treated as a control group. The groups were compared in regard to the intensity of depressive symptomatology, depressive symptoms frequency and the depressive symptoms duration. The General Socio-Demographic Questionnaire, the Cambridge Depersonalization Scale and The Patient Health Questionnaire - 9 were used.

RESULTS

The depressive patients with depersonalization had predominantly severe episodes, almost all patients had feelings of sadness, insomnia, and decrease of energetic potentials. The biggest difference between the groups, in terms of greater number of manifest symptoms in the patients with depersonalization, was for psychomotor disturbances (agitation or retardation), insomnia, decrease of energetic potentials and concentration. At the same time, 75% of the subjects with associated depersonalization had anhedonia, sadness/dysphoria, insomnia and decrease of energetic potentials continuously present. Unlike this group, the control group subjects experienced sadness, appetite problems, concentration and motor behavior changes almost half as frequently. Particularly significant were the differences regarding suicidal thoughts. It was shown that in the group with depersonalization there was a higher percentage of patients with suicidal thoughts, mostly continuously present, which represent a significant suicidal risk factor.

CONCLUSION

Unipolar depression, associated with depersonalization is more severe in its intensity .It has a bigger number of manifest symptoms which have a tendency to continuous duration. A special focus is on the negative impact on the occurrence and lasting presence of suicidal thoughts.

[Case report of corpus callosum lipoma diagnosed with computer tomography]

The case of corpus callosum lipoma that was accidentally discovered during the routine brain examination by computed tomography had been described. The CT features of corpus callosum lipoma were described as well as differential-diagnostic differences with epidermoid cyst agenesia of corpus callosum and cyst of the pellucid septum (cavum vergae).