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PubMed1993

Analysis and prevention of recurrent goiter.

The current study was done to analyze our experience with recurrent goiter. Prevention must be stressed because reoperations of the thyroid gland present technical difficulties and are associated with an increased risk of hypoparathyroidism and permanent hoarseness. Nodular recurrences occurred in 36 of 1,456 patients (2.5 percent) who underwent thyroidectomy between 1968 and 1983. All patients had the initial operation at Jean Bernard Hospital, Poitiers, France, and had follow-up evaluation from five to 20 years. Multinodular goiter accounted for 70 percent of the recurrences. Sixty percent of the recurrences were in patients with multinodular goiters. Recurrent goiter was usually first detected about eight years after thyroidectomy. Thirty patients with recurrence had reoperations. Two patients had paralysis of the vocal cord and one patient had permanent hypoparathyroidism. Recurrent goiter may occur because of the development of new nodules (true recurrence) or because of the growth of "residual" or persistent macroscopic or microscopic nodules left at the previous thyroid operation. Intraoperative digital palpation of the entire thyroid gland is essential for detecting residual macroscopic thyroid nodules, and all enlarged nodules should be removed. Thyroid-stimulating hormone (TSH) suppressive therapy is recommended by some authorities to prevent "true" recurrences, although its efficacy is debated. Since recurrence is uncommon in the current series, perhaps TSH suppressive therapy should only be used in high-risk patients. In the current experience, only the multinodular character of the nodules in euthyroid patients has a significant correlation with subsequent development of recurrent goiter (p < 0.01), and one must consider patients with multinodular goiter at risk for recurrence. Once TSH treatment is begun, it will logically be continued for life. Total thyroidectomy has been recommended by some endocrine surgeons for treating patients with multinodular goiter. We prefer subtotal thyroidectomy and reserve total thyroidectomy for patients when no normal thyroid tissue can be preserved because only 2.5 percent of the patients in the current study had recurrent goiter. Prevention of residual nodules is probably best assured by systematic palpation during operation of the two thyroid lobes. This considerably lessens the risk of recurrence. Since nodular recurrences occurred in only 2.5 percent of the patients in the current study, although multinodular goiter must be considered at risk for recurrence, we do not recommend systematic total thyroidectomy in multinodular goiter.

Adolescent↗
PubMed1985

Hyperthyroidism due to Graves' disease and due to autonomous goiter.

An attempt was made to classify 326 patients with hyperthyroidism due to Graves' disease and due to autonomous goiter in an area of endemic iodine deficient goiter using the following two sets of criteria: Primary criteria: the presence of endocrine ophthalmopathy (Graves' disease) and the absence of endocrine ophthalmopathy and the absence of microsomal antibodies greater than or equal to 1:1600 (autonomous goiter). Sixty-nine percent of the patients could be divided in the two groups with the aid of these criteria. Secondary criteria: age greater than 50 years, presence of a goiter, presence of thyroid nodules, activity distribution in the scan, iodine intake determined by iodine excretion in the urine. These criteria had to be applied in the 31% of the patients who could not be divided into one of the two groups using the primary criteria. The secondary criteria were accumulative. Using these criteria 55% of the 326 patients were classified as having Graves' disease and 45% as having autonomous goiter. The probability of correct grouping when both primary and secondary criteria were applied was estimated to be 90% compared to 54% when we used only the classical terms, i.e. endocrine ophthalmopathy and diffuse goiter on the one hand and multinodular goiter without endocrine ophthalmopathy on the other hand. In a second group of 120 hyperthyroid patients classified in this way, thyrotropin displacing activity was determined independently. Its prevalence was 79% in patients classified as having Graves' disease but only 3% in those classified as having autonomous goiter. The prevalence of TDA observed in patients who presumably had autonomous goiter was in the same range as in the following groups: 45 normal individuals; 126 patients with euthyroid goiter; and in 112 patients with euthyroid and hyperthyroid autonomous adenoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Ultrasound scanning assessment of L-thyroxine treatment effectiveness in a group of children with diffuse goiter.

Ultrasound scanning is an accurate and objective method to assess thyroid volume; therefore it is useful to evaluate the effectiveness of L-thyroxine treatment in reducing goiter size, especially in children where clinical evaluation is inaccurate. In this prospectic study we evaluated the effectiveness of one-year L-thyroxine treatment in a group of children with nontoxic diffuse goiter coming from an area with low iodine intake. We examined 11 children (7 females, 4 males), age range 9-14 years. At clinical examination, 6 patients had a goiter classified Ia (according to WHO criteria), 4 had a class Ib and only 1 had a class II goiter. In order to achieve an accurate goiter evaluation, the thyroid volume was determined by ultrasonic scanning with a 5 MHz linear probe before and after treatment. Patients were given a dose of L-thyroxine (1.5-2.0 micrograms/kg/die) in order to significantly reduce serum TSH levels (from 1.8 +/- 0.6 to 0.8 +/- 0.5 mU/l, mean +/- SD). Patients were reexamined at 12 months of therapy and again at 10 months after therapy withdrawal. A significant reduction of the goiter volume (greater than 20%) was obtained in 6/11 (54%) patients, although serum TSH levels were fully suppressed only in one. The mean goiter size reduction in "responders" was -31.2 +/- 9.3% (m +/- SE). After therapy withdrawal goiter size increased in the majority of cases (in 4/11, greater than 20%). Our study demonstrates that L-thyroxine treatment is effective in reducing goiter size in the majority of children with a diffuse goiter.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Does radioiodine therapy have an equal effect on substernal and cervical goiter volumes? Evaluation by magnetic resonance imaging.

Most often thyroidectomy is recommended in patients with large goiters. However, high-dose (131)I therapy may be used in case of contraindications to surgery. Large goiters are often partially located in the mediastinum. The aim of this study was to evaluate the impact of (131)I therapy on the cervical and the substernal goiter volume, separately. Fourteen patients (median age, 69 years; range, 52-86 years) with a large multinodular goiter (three hyperthyroid) and with a substernal extension greater than 15 mL were included. T1-weighted magnetic resonance (MR) estimates of the thyroid volume in the cervical and substernal compartments were obtained before and 1 year after high-dose (131)I therapy. The total goiter volumes ranged from 182 to 685 mL. The median substernal volume was 66 mL (fraction of total volume, 17.6%; range, 8.0%-78.9%). One year after treatment, the median substernal goiter volume was reduced by 29.2% (range, -6.1%-59.4%, mean: 26.1% +/- 6.0%), and the cervical goiter volume by 30.3% (range, 6.0%-75.4%, mean, 35.6 +/- 5.6%) compared to baseline values; p = 0.25 for difference in a regional effect. The volume reduction was unrelated to initial substernal goiter size. Likewise, deterioration of the inspiratory capacity did not correlate with the magnitude of the substernal goiter extension. In conclusion, high-dose (131)I therapy seems as effective in reducing the substernal as the cervical goiter volume. However, because the overall effect is modest, this therapy should primarily be considered for the patient with a high surgical risk.

Aged↗
PubMed2006

[Endemic goiter and iodine deficiency: are they still a reality in Spain].

OBJECTIVE: To estimate the prevalence of goiter and iodine deficiency in a health district in the Autonomous Community of Valencia, given the absence of data in this region of Spain. MATERIAL AND METHODS: We conducted a descriptive, epidemiologic, cross-sectional study, stratified by age and sex, in four interior regions of the province of Valencia. We selected students aged from 6 to 14 years old in 20 centers. Thyroid examination was performed by means of palpation and inspection (goiter > or = 0B). Urinary iodine excretion was analyzed in a routine urine sample. Sociodemographic and anthropometric data, as well as nutritional iodine status, were recorded in a standardized survey. In children with goiter, thyroid-stimulating hormone (TSH), free T4, and antithyroid antibodies were determined. RESULTS: We studied 928 children (478 boys and 450 girls). The prevalence of goiter was 33.7 % (95 % CI: 30.7-36.9 %). There were no significant differences in the prevalence of goiter by age or sex, but an inverse correlation was detected between the prevalence of goiter and parental socioeconomic position. Mean urinary iodine excretion was 155 .g/l, with no significant correlation with the prevalence of goiter. In children with goiter, 13 had positive antithyroid antibodies, 18 had high TSH (subclinical hypothyroidism), and one had suppressed TSH (subclinical hyperthyroidism). CONCLUSIONS: There is endemic goiter in the region studied. Urinary iodine levels were in the normal range and could be interpreted as indicating a transition phase to an improvement in iodine deficiency. Autoimmune diseases would only explain 4 % of cases of goiter.

Adolescent↗
PubMed1984

Low molecular weight thyroglobulin leading to a goiter in a 12-year-old girl.

We characterized the abnormal thyroglobulin (TG) in the thyroid and serum of a 12-yr-old girl with a large sporadic multinodular goiter first noted at age 4 yr. She developed normally and had no clinical evidence of hypothyroidism. However, her serum T4 was less than 1.0 microgram/dl, T3 was 125 ng/dl, and TSH was 155 microU/ml. Serum PBI was 9.7 micrograms/dl, and more than 90% was not extractable with butanol. The 24-h radioactive iodine uptake was 55%, not dischargeable by perchlorate. Hormone formation was tested by the administration of 131I before surgery. [131I]T4 and [131I]T3, but not 131I-labeled iodotyrosines, were present in the thyroidal venous blood. Hydrolysis of 10,000 X g supernatants from three randomly obtained samples of the goiter revealed 66-77% of the 131I as iodotyrosines, 2-4% as iodothyronines, and 10-12% as undigestable material; the MIT to DIT ratio ranged from 3.1-8.7, and the T4 to T3 ratio ranged from 2.3-8.3. The TG level was 2.5 mg/g in the goiter and 9.4 micrograms/ml in the serum. The RIA displacement curves for the goiter and serum TG levels were both identical to the curve produced by normal human TG. The iodine contents of goiter and serum TG were 0.49% and 0.47% (wt/wt), respectively. The T4 to T3 ratio was lower in the goiter (approximately 5) than in the serum iodoprotein (approximately 45), whereas the calculation of the T4 to T3 ratio in the thyroidal secretion was less than 1. The goiter and serum TG bound normally to Concanavalin A, indicating that they contained carbohydrate. When either serum- or goiter-soluble proteins were gel-filtered (Bio-Gel A-5m), TG immunoreactivity and stable iodine elution profiles were the same, suggesting that no significant amounts of other iodoproteins were present in the thyroid or circulation. Both serum and goiter TG elution volumes corresponded to mol wt of approximately 9 X 10(4). A sedimentation rate of 10-11 S was found for both goiter and serum TG. An abnormally low mol wt of 8.5-9.0 X 10(4) was determined by sodium dodecyl sulfate-electrophoresis, in good agreement with the estimates from gel filtration studies. A single band was present on sodium dodecyl sulfate-electrophoresis regardless of whether the TG was reduced before the analysis. Thus, it is very unlikely that the low molecular weight was due to partial hydrolysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed1987

Toxic multinodular goiter: a variant of autoimmune hyperthyroidism.

The aim of this study was to examine whether at least a subgroup of patients with toxic multinodular goiter may have autoimmune thyroid disease. Thyroid-stimulating immunoglobulin (TSI) activity, measured by a sensitive bioassay employing cultured human thyroid cells, was determined in patients with toxic multinodular goiter and other thyroid disorders. All patients with active Graves' disease (n = 47) had detectable serum TSI activity, whereas TSI was undetectable in patients with thyroid disease not believed to be of autoimmune origin: toxic adenoma (n = 13), cold nodule (n = 5), and nontoxic goiter (n = 19), with a single exception in the latter group. Toxic multinodular goiter (n = 26) was diagnosed based on clinical and laboratory evidence of hyperthyroidism associated with a multinodular goiter on palpation and scintiscan. The toxic multinodular goiter group was then subclassified according to scintiscan pattern (type A, diffuse but uneven distribution of technetium uptake; type B, multiple discrete nodules of varying size and function). All but 1 of the 11 TSI-positive toxic multinodular goiter patients had a type A scintiscan pattern. The patients with the type A scintiscan pattern were younger and more often had elevated antithyroid antibody titers, ophthalmopathy, and concurrent development of goiter and hyperthyroidism (rather than long-standing goiter preceding hyperthyroidism) compared to the type B patients. Thus, a subgroup of patients with clinically defined toxic multinodular goiter (type A) probably have autoimmune hyperthyroidism (a variant of Graves' disease), while in another subgroup (type B) hyperthyroidism is not related to an autoimmune etiology (a variant of toxic adenoma).

Adenoma↗
PubMed2000

Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency.

OBJECTIVES: In 1994, WHO/International Council for the Control of Iodine Deficiency Disorders recommended replacing the WHO 1960 four-grade goiter classification with a simplified two-grade system. The effect of this change in criteria on the estimation of goiter prevalence in field studies is unclear. In areas of mild iodine deficiency disorders (IDD) where goiters are small, ultrasound is preferable to palpation to estimate goiter prevalence. However, in areas of moderate to severe IDD, goiter screening by palpation may be an acceptable alternative to thyroid ultrasound. To address these two issues, we compared WHO 1960 and 1994 criteria with thyroid ultrasound for determination of goiter prevalence in areas of mild and severe IDD in Morocco. DESIGN: A cross-sectional study of 400 six- to 13-year-old children from two mountain villages (Ait M'hamed and Brikcha) in rural Morocco was carried out. METHODS: Urinary iodine concentration (UI), whole blood TSH and serum thyroxine were measured. Thyroid size was graded by inspection and palpation by two examiners using both WHO 1960 and 1994 criteria. Thyroid volume was determined by ultrasound. Variation between examiners and examination methods was assessed. Sensitivity and specificity of the two classification systems compared with ultrasound were calculated. RESULTS: Median UIs in Aït M'hamed and Brikcha were 183 and 24 microg/l respectively. In Ait M'hamed, using 1960 and 1994 criteria, goiter prevalence was 21 and 26% respectively, compared with 13% by ultrasound. In Brikcha, with 1960 and 1994 criteria, goiter prevalence was 64 and 67% respectively, compared with 64% by ultrasound. Agreement between observers was better with the 1994 criteria than with the 1960 criteria in Ait M'hamed (kappa=0.53 and 0.47 respectively), while in Brikcha observer agreement was similar with the two systems (kappa=0.67). Using either the 1994 or 1960 criteria, agreement with ultrasound was only moderate in Ait M'hamed (kappa=0.41-0.44), but good in Brikcha (kappa=0.55-0.64). Overall, compared with ultrasound, sensitivity increased 3-4% using 1994 criteria, while specificity decreased 4-5%. CONCLUSIONS: The WHO 1994 criteria are simpler to use than the 1960 criteria and provide increased sensitivity with only a small reduction in specificity. Agreement between observers is better with the 1994 criteria than with the 1960 criteria, particularly in areas of mild IDD. Like the 1960 criteria, the 1994 criteria overestimate goiter prevalence in areas of mild IDD, compared with ultrasound. However, the 1994 palpation criteria provide an accurate estimate of goiter prevalence in areas of severe IDD, and may be an acceptable and affordable alternative to thyroid ultrasound in these areas.

Adolescent↗
PubMed2002

MR imaging of large multinodular goiters: observer agreement on volume versus observer disagreement on dimensions of the involved trachea.

OBJECTIVE: MR imaging and sonography are considered to be among the most reliable methods available for estimating goiter volume. Our aim was to assess the observer variability of MR imaging for estimating the volume of a large multinodular goiter and the dimensions of the related trachea. Additionally, we compared the goiter volume estimates from MR imaging with those from sonography. SUBJECTS AND METHODS: The effect of high-dose (131)I therapy on the thyroid gland and the impact on the trachea in 23 patients with a large multinodular goiter (range in volume, 100-703 mL) were monitored by observers unaware of duplicated measurements on MR imaging (n = 68) before, 1 week after, and 1 year after (131)I therapy. In goiters exclusively cervically located (n = 12), cross-sectional planimetric sonographic measurements (n = 24) were performed simultaneously with MR imaging. RESULTS: The mean intraobserver difference for the MR imaging measurements of goiter volume was 2.1 mL (1.4%, p = 0.32), and the coefficient of variation (CV) +/- SD was 3.6% +/- 2.6%. The mean interobserver difference was 0.4 mL (0.3%, p = 0.86), and the CV +/- SD was 4.1% +/- 3.5%. Compared with MR imaging, sonography underestimated goiter volume; the mean percentage difference between the volume estimates on MR imaging and those on sonography (volume estimated on MR imaging - volume estimated on sonography) was 19.5% (95% limits of agreement: -22.2% to 83.7%), and the CV +/- SD was 15.0% +/- 12.4%. The mean interobserver difference in the MR imaging measurement of tracheal volume along the goiter extension was 7.4% (95% confidence interval: 4.0-10.8%) and that of the smallest cross-sectional area of the trachea was 7.9% (95% confidence interval: 2.9-13.2%). The corresponding CV +/- SD were 8.1% +/- 6.6% and 10.3% +/- 10.3%, respectively. CONCLUSION: For the estimation of goiter volume, MR imaging has low intra- and interobserver variations. In contrast, the determination of tracheal dimensions using MR imaging has a high variability and, thus, is imprecise. Sonography significantly underestimates thyroid volume compared with MR imaging in patients with a large goiter.

Adult↗
PubMedDate not supplied

Effects of iodized salt consumption on goiter prevalence in Isfahan: the possible role of goitrogens.

OBJECTIVE: To evaluate the success of the Iranian Iodine Deficiency Disorders Committee in achieving World Health Organization (WHO) goals for reducing the prevalence of goiter in children by adding iodine to table salt beginning in 1989. METHODS: In 1997, 8,000 male and female 6- to 18-year-old students were selected by cluster sampling in schools of Isfahan. Their thyroids were examined by four endocrinologists, and goiter was staged on the basis of the WHO classification. As an index of iodine consumption, urinary iodine concentrations were measured in 3,000 students. RESULTS: Goiter was observed in 62% of the students. Of the overall study group, 94% had sufficient iodine consumption (urinary iodine concentration of 10.0 microg/dL or more). Of those students who had sufficient iodine intake, 63.2% had goiter. Of the 6% of students with iodine deficiency, 5% had mild, 0.9% had moderate, and only 0.1% had severe iodine deficiency. Goiter was absent in half of the students with severe iodine deficiency. The prevalence of goiter in 6- to 10-year-old children was 65%. CONCLUSION: Despite sufficient iodine intake, the prevalence of goiter is still high in Isfahan City. Apparently, either this high prevalence has no relationship to iodine deficiency and possibly other unknown goitrogens are involved in the pathogenesis of goiter in Isfahan or the period of iodine intake has been too brief to affect thyroid sizes. Inasmuch as goiter prevalence is also high in the 6- to 10-year-old children, who have had iodized salt available for most of their lives, the second option is less probable. Another possibility is an increased rate of autoimmune thyroid diseases (because of iodine repletion) that resemble goiter during their early stages.

Adolescent↗
PubMedDate not supplied

[Nontoxic multinodular goiter: evaluation of recurrence rate and function after partial thyroidectomy. Retrospective analysis of 39 cases].

The postoperative goiter recurrence and hypophysial-thyroid function in 39 patients who underwent partial thyroidectomy for nontoxic multinodular goiter, during the 1970-1983 period, was evaluated, seeking relations among thyroid function, extension of surgery and goiter recurrence. The incidence of recurrent goiter was approximately 15%, most of these goiters having been identified ten or more years after thyroidectomy. More extensive surgery lowered the recurrence rate but increased the risk of subclinical-hypothyroidism. No statistical significant differences with regard to serum T3, T4, F T4 and TSH (basal and after TRH) of patients with and without recurrent goiter were found. Thus, the maintenance of a recurrent nontoxic goiter does not seem to depend exclusively on increased serum TSH levels. In one patient, the postoperative treatment with thyroxine did not prevent the appearance of recurrent goiter. Since most patients who underwent thyroidectomy remain euthyroid and the goiter recurs in only a small number, the routine postoperative use of thyroid hormone for the prophylaxis of multinodular goiter recurrence seems to be questionable.

Adolescent↗
PubMed1996

Evaluation and management of multinodular goiter.

Nodular goiters are encountered commonly in clinical practice by primary care physicians, endocrinologists, surgeons, and otolaryngologists. Epidemiologic data suggest that in the United States, the incidence of such goiters is approximately 0.1% to 1.5% per year, translating into 250,000 new nodules annually. Nodular goiters are more common in women than in men, with advancing age, and after exposure to external irradiation. These goiters may be asymptomatic, with normal TSH levels (nontoxic), or may be associated with systemic thyrotoxic symptoms (toxic MNG or Plummer's disease). Diagnostic evaluation of patients with nodular goiters consists of clinical evaluation, biochemical testing, FNA, and imaging studies. The serum TSH level is a sensitive and reliable index of thyroid function. FNA results are pivotal to assess cancer risk in patient management for prominent palpable and suspicious nodules. Chest radiography, high-resolution ultrasonography, and computed tomography help to delineate the size and extent of a goiter in evaluating compression symptoms. Indications for treatment in patients with MNG include hyperthyroidism, local compression symptoms attributed to the goiter, cosmesis, and concern about malignancy based on FNA results. The use of levothyroxine suppression therapy to effectively decrease and control MNG size is controversial. Thyroid hormone should not be used, however, in patients with suppressed serum TSH levels, to avoid the development of toxic symptoms. Management of toxic MNG by surgery is well established. Radioiodine is also effective therapy for many of these patients. When treatment is necessary for nontoxic MNG, surgical excision is preferred. Our recommendations are as follows. For patients who have small, nontoxic multinodular goiters that are clinically asymptomatic, who are biochemically euthyroid according to serum TSH levels, and who have prominent palpable or suspicious nodules benign by FNA, yearly evaluation with serum TSH determinations and thyroid palpation is sufficient. Patients with modest but stable MNG size and normal serum TSH levels may also be managed by yearly clinical observation. In this second group, levothyroxine suppression therapy is often unsuccessful and has the potential for untoward effects from exogenous hyperthyroidism. For large nontoxic multinodular goiters with local compression symptoms, the preferred treatment is surgery. In patients with toxic MNG, treatment with either surgery or radioiodine is recommended, although patients with large goiters and large, autonomously functioning nodules become euthyroid more quickly following surgery.

Age Factors↗
PubMed1978

[Radioimmuno-assay of TSH before and after TRH in 350 patients with previous resection of euthyroid goiter (author's transl)].

Radioimmuno-Assay (RIA) of Thyroid-Stimulating-Hormone (TSH) was performed before and after i.v.-injection of Thyrotropin-Releasing-Hormone (TRH) in 350 patients subsequent to previous resection of euthyroid goiter to find out the optimal treatment schedule for preventing recurrent goiter. In patients without recurrent goiter the dosis of thyroid hormone was considered to be sufficient, if the difference in TSH-levels before and after TRH (delta-TSH) was equivalent to or less than 10 microunits/ml. In patients with recurrent goiter the optimal suppressive dosis of thyroid hormone was accepted for a delta-TSH less than or equal to 2,5 microunits/ml. 126 out of 135 patients, who were set on an immediate and continuous postoperative treatment were free of goiter, 58 presented a delta-TSH less than or equal to 10 microunits/ml (average interval of treatment = 2,5 years), 68 patients had elevated delta-TSH (average interval of treatment 2,1 years) as a sign of insufficient treatment. In 9 patients recurrent goiter was detected in spite of "adequate" treatment. 41 out of 57 patients, set on delayed and partly continuous, partly discontinuous treatment had recurrent goiter (in average after 10 years). delta-TSH was not indicative. 158 patients without any treatment had borderline or slightly increased delta-TSH (in average after 10 years). 122 of these 158 patients had recurrent goiter, 36 were free of goiter. The results favor the necessity of treatment with thyroid hormones starting immediately after operation and with continuous treatment. The combined use of TSH-RIA and TRH-test reliably informs about the individual thyroid hormone dosis necessary for prevention or treatment of recurrent goiters.

Goiter↗
PubMed2006

Surgical strategies in cervico-mediastinal goiters.

AIM: We retrospectively studied clinical picture, diagnosis, treatment and complications of patients with cervico-mediastinal goiter who underwent surgery. METHODS: Sixty-three patients underwent surgical treatment for cervico-mediastinal goiter in the last 10 years. Thirty-two patients (50.8%) had cervico-mediastinal goiter, 24 patients (33.3%) had mediastino-cervical goiter and 7 patients (11.1%) had mediastinal goiter. Forty-seven cases were prevascular goiters and 16 were retrovascular goiters. We performed total thyroidectomy in 25 patients, subtotal thyroidectomy in 31 patients and in 7 cases the resection of residual goiter. In 50 patients we used a cervical approach, in 12 patients the cervical incision was combined with median sternotomy (6 in total) and in 1 patient with transverse sternotomy. RESULTS: Three patients (4.7%) died in the postoperative period (2 cardio-respiratory failure and 1 pulmonary embolism). The histologic study revelead 5 (7.9%) carcinomas. Postoperative complications were: dyspnea in 7 cases (11.1%), transient vocal cord paralysis in 5 patients (7.9%), temporary hypoparathyroidism in 6 patients (9.5%) and kidney failure in 1 case (1.6%). CONCLUSIONS: Cervicotomy is the approach of choice but in some limited cases (carcinoma, thyroiditis, retrovascular goiter, ectopic goiter) the sternotomy should be performed. Postoperative mortality and morbidity is very low, independent of surgical techniques.

Journal Article↗
PubMed2003

[Correlation between serum thyroglobulin and thyroid stimulating hormone in populations with non-toxic goiter].

OBJECTIVE: To investigate the correlation between serum thyroglobulin (Tg) and thyroid stimulating hormone (TSH) in populations with non-toxic goiter. METHODS: Thyroid ultrasonography was conducted, and determination of serum triiodothyronine (FT3), thyroxin (FT4), Tg, thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb) and TSH, and urine iodine were carried out among 609 persons with an average age of 35.4 in Panshan county, a mild iodine-deficient area in Liaoning province, and 1136 persons aged 39.1 on average in Zhangwu county, an iodine sufficient area in Liaoning province, totally 2 320 persons. RESULTS: The serum TSH levels of the populations with diffuse and nodular goiter in Panshan county were (0.11 +/- 0.08) mU/L and (0.90 +/- 0.10) mU/L, significantly higher than those of the normal population in the same areas (1.33 +/- 0.04) mU/L, both P < 0.01. The serum TSH levels of the populations with diffuse and nodular goiter in Zhangwu county were (1.29 +/- 0.13) mU/L and (0.89 +/- 0.14) mU/L, significantly higher than those of the normal population in the same areas (1.74 +/- 0.04) mU/L, both P < 0.01. The serum TSH level of normal population in iodine deficient area was significantly lower than that of normal population in iodine sufficient area (P < 0.01). The serum TSH level of the normal population in Panshan County was significantly lower than that of the normal population in Zhangwu County (P < 0.01). The serum Tg level of the populations with diffuse and nodular goiter in Panshan county were (12.0 +/- 1.21) ng/L and (50.1 +/- 12.20) ng/L, significantly higher than that of the normal population in the same area (9.1 +/- 2.44) ng/L, P < 0.05 and P < 0.01. The serum Tg level of the populations with diffuse and nodular goiter in Zhangwu county were (12.4 +/- 2.11) ng/L and (61.2 +/- 11.86) ng/L, significantly higher than that of the normal population in the same area (7.7 +/- 2.3) ng/L, P < 0.05 and P < 0.01. The Tg level of the normal population in Panshan County was significantly higher than that of the normal population in Zhangwu county (P < 0.01). The Tg level was positively correlated with the thyroid volume in the nodular goiter population. CONCLUSION: The occurrence of goiter is not directly related to TSH stimulation in mild iodine deficient area. Nontoxic goiter shows a thyroid autonomic function. The major cause of high serum Tg in nodular goiter may be the leakage of Tg into blood circulation caused by degeneration of large colloid follicles and destruction of follicular architecture, not the volume increase of thyroid and its autonomic function.

Adult↗
PubMed1986

[Goiter].

Studies in Switzerland (1979), in Austria (1982) and in Germany (1975) revealed that greater than 10% of the population has a goiter. Simple guidelines are offered to the practising physician for the work-up and therapy of this fairly common pathological condition. In the work-up one investigates firstly whether the goiter in question could be malignant, and, secondly, whether it could be due to thyroiditis. If this is not the case the goiter is probably benign (Graves' goiter or "simple" goiter). Malignant goiters are referred to the endocrinologist/surgeon for further work-up and therapy. Subacute thyroiditis is treated with salicylates or steroids. The hyperthyroid phase of thyroiditis is treated with beta-blockers and possibly steroids and the hypothyroid phase with thyroxine. The hypo- and euthyroid variants of "simple" goiter are treated with thyroxine. Goiters which grow during this therapy are removed surgically. The hyperthyroid variant of "simple" goiter should preferably be treated surgically.

Austria↗
PubMed1989

Anomalously low endemic goiter prevalence among Efe pygmies.

The existence of endemic goiter, caused by iodine deficiency and the presence of a dietary goitrogen, has been noted in eastern Zaire by a number of authors (De Visscher et al.: Journal of Clinical Endocrinology and Metabolism 21:175-188, 1961; Delange et al.: Journal of Clinical Endocrinology and Metabolism 34:1059, 1972). In the Ituri Forest of Huate-Zaire, two distinct populations, the Efe (pygmy) and Lese (Bantu), live in association with each other and have similar diets. The goiter survey reported here documents differences in goiter prevalence and severity between the nomadic pygmy and village-living Bantu populations. While the Efe have an overall goiter prevalence of 9.4%, the Lese have a goiter prevalence of 42.9%. Furthermore, Efe women living in Lese villages and subsisting on a Lese diet have a prevalence of goiter similar to that of forest-living Efe women. Village-living individuals born of Efe mothers and Lese fathers have a prevalence of goiter greater than that of pure Efe but less than that of Lese. While our data cannot exclude dietary explanations for the difference in goiter prevalence between the Efe and Lese, they do support the hypothesis that the Efe possess an adaptation to an iodine-deficient environment that does not result in the development of goiters.

Adolescent↗
PubMed2003

Cytologic distinction of goiterous nodules from morphologically normal thyroid: analyses of cytomorphologic features.

BACKGROUND: Fine-needle aspiration (FNA) is the predominant method for triaging thyroid nodules into operative and nonoperative lesions. Accurate needle placement assuring representative sampling of a suspicious nodule is required. Criteria are well established for separation of nodular goiter from most neoplasms but are less well developed for recognition of normal thyroid tissue. Identification of normal tissue is vital when investigating solitary nodules. Cytologic identification of only normal thyroid tissue would indicate a failure to sample the index nodule. The authors investigated a set of criteria to determine whether any were useful for separating goiterous nodules from normal thyroid tissue. METHODS: FNA specimens from 10 patients with histologically confirmed goiters were compared with bench aspirates from 7 nodular goiters and 9 thyroid specimens that showed no histologic change. The three sets of specimens were scored for 21 cytomorphologic variables, and differences in the frequency of the variables between sets of FNA specimens were recorded. The patient specimens were compared with bench specimens to find differences secondary only to in vivo and in vitro specimen types. These features were excluded from analysis of differences between bench specimens of hyperplastic nodules and normal tissue. RESULTS: Cells with feathered cytoplasmic edges occurred with statistically significantly different frequency between bench specimens and patient goiter specimens. Cytomorphologic features that showed differences between FNA specimens from goiters and normal thyroid tissue included the presence of microfollicles, prominent nucleoli, abundant cytoplasm, the number of cells with paravacuolar granules, the presence of Hürthle cells, and the presence of cells with feathered cytoplasmic edges. CONCLUSIONS: The results of the current study indicate that there are cytologic differences between FNA specimens from normal thyroid and from goiterous nodules. The presence of Hürthle cells, prominent nucleoli, and cells with abundant cytoplasm favored the diagnosis of nodular goiter, whereas large numbers of cells with paravacuolar granules favored a determination of histologically normal thyroid. These differences may aid in the distinction of normal thyroid tissue from hyperplastic goiters in cytologic specimens obtained by FNA.

Biopsy, Needle↗