Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for non-small cell lung carcinoma (NSCLC) but are associated with immune-related adverse events (irAEs), including thyroid dysfunction. This study examines the incidence and clinical impact of thyroid dysfunction in NSCLC patients receiving ICIs at the Clinic of Oncology, Clinical Center University of Sarajevo. In this retrospective cohort study of 50 patients with metastatic NSCLC treated with ICIs-either in combination with chemotherapy or as monotherapy for those with programmed death-ligand 1 (PD-L1) expression ≥ 50%-we collected data on demographics, treatment regimens, thyroid function tests, and survival outcomes. Thyroid dysfunction occurred in 24 patients (48%), with 12 (24%) developing hypothyroidism, 4 (8%) developing hyperthyroidism, and 8 (16%) experiencing a transition from hyperthyroidism to hypothyroidism. The incidence of thyroid dysfunction was significantly higher in patients treated with atezolizumab compared to pembrolizumab (P = 0.04), with 87.5% of affected patients receiving atezolizumab. The median time to onset of thyroid dysfunction was 10 cycles (interquartile range [IQR]: 5) for hypothyroidism and six cycles (IQR: 19) for hyperthyroidism. Progression-free survival (PFS) was significantly longer in patients who developed thyroid dysfunction, with the median PFS not reached, compared to a median PFS of 14 months (95% CI: 9.68-18.32) in patients without thyroid dysfunction (P = 0.038). No significant associations were found between thyroid dysfunction and patient age or gender. These findings suggest that thyroid dysfunction is a common irAE in patients with metastatic NSCLC receiving ICIs, particularly atezolizumab, and its development may be associated with improved PFS. Regular monitoring of thyroid function is recommended to promptly identify and manage thyroid abnormalities during ICI therapy, potentially improving patient outcomes.

Objective : Aim of this study was to retrospectively validate the effectiveness of TIRADS classification in diagnosis of thyroid cancer compared to cytological and pathohistological findings. Methods : This observational, retrospective study included adult patients of both genders who were diagnosed with thyroid cancer and underwent thyroidectomy. The study was conducted at the Clinic for Nuclear medicine and Endocrinology of the Clinical Center University of Sarajevo in the period from June 2018 to November 2018. All patients had ultrasound (US) and TIRADS classification, fine needle aspiration (FNA) biopsy of the suspected nodules, thyroidectomy and pathohistological (PHD) analysis. TIRADS classification was compared to the results of FNA and PHD findings. Results : A total of 100 nodules (from 76 patients) were included in the study. TIRADS classification showed that there was 1 (1.0%) nodule in TR2 class, 20 (20.0%) nodules in TR3 class, 72 (72.0%) nodules in TR4 class and 7 (7.0%) nodules in TR5 class. Comparing the results of FNA with TIRADS classification showed that there were no malignant nodules in TR2 class, in TR3 class there were 14 (70.0%) malignant nodules, in TR4 class there were 60 (83.3%) malignant nodules and in TR5 all nodules were malignant (7, 100.0%). Comparing the results of PHD with TIRADS classification showed that there were no malignant nodules in TR2 class, in TR3 class there were 17 (85.5%) malignant nodules, in TR4 class there were 71 (98.6%) malignant nodules and in TR5 class there were 7 (100.0%) malignant nodules. Conclusion : TIRADS classification showed valid efficacy in identifying malignant thyroid nodules, although fine needle aspiration remains the most effective method. With continious improvement of TIRADS classification system we can expect decrease in unnecessary thyroid biopsies and an overall improvement of thyroid cancer diagnostics. Keywords : Thyroid Nodule, Ultrasound Imaging, Thyroid Cancer, TIRADS, Risk Classification

Introduction: Family medicine as a part of the primary health care is devoted to provide continuous and comprehensive health care to the individuals and families regardless of age, gender, types of diseases and affected system or part of the body. Special emphasis in such holistic approach is given to the prevention of diseases and health promotion. Family Medicine is the first step/link between doctors and patients within patients care as well as regular inspections/examinations and follow-up of the health status of healthy people. Most countries aspire to join the European Union and therefore adopting new regulations that are applied in the European Union. Aim: The aim of this study is to present the role and importance of family medicine, or where family medicine is today in 21 Century from the beginning of development in these countries. The study is designed as a descriptive epidemiological study with data from 10 countries of the former Communist bloc, Slovenia, Croatia, Bosnia and Herzegovina, Serbia, Montenegro, Macedonia, Kosovo, Albania, Bulgaria, Romania, Czech Republic, Slovakia and Hungary, just about half of them are members of the EU. We examined the following variables: socio-organizational indicators, health and educational indicators and health indicators. The data used refer to 2002 and as a source of data are used official data from reference WebPages of family medicine doctors associations, WONCA website (EURACT, EQuiP, EGPRN), WebPages of Bureau of Statistics of the countries where the research was conducted as well as the Ministries of Health. Results: Results indicates that the failures and shortcomings of health care organizations in Southeast Europe. Lack of money hinders the implementation of health care reform in all mentioned countries, the most of them that is more oriented to Bismarck financing system. Problems in the political, legal and economic levels are obstacles for efficient a problem reconstructing health care system toward family medicine and primary prevention interventions. The population is not enough educated for complicated enforcement for and prevention of diseases that have a heavy burden on the budget. Health insurance and payment of health services is often a problem, because the patients must be treated regardless of their insurance coverage and financial situation. The decrease in production and economic growth, as well as low gross national income in the countries with economic crisis, lead to the inability of treatment for a large number of the population. Such situation a system leads to additional debts and loans to healthcare system. Measures implemented for provision of acute curative care largely did not lead to improvements in the health status of the population. Educational and preventive measures, as well as higher standards for quality and accessibility of health care services for entire population in each country, especially those struggling are bound to joining the European Union and their implementation must start. The most A large number of medical institutions are is inefficient in health education and health promotion and must work to educate patients and families and increase the quality of preventive health services. Modernization of health care delivery and joining the European Union by increasing overall economic stability of countries is one of the primary goals of all countries in Southeast Europe.