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PubMed1998

Role of apoptosis of thyrocytes in a rat model of goiter. A possible involvement of Fas system.

Apoptosis, a physiological process of cell death, may modulate the mass of the thyroid gland. We investigated the role of apoptosis and the possible involvement of Fas/Fas ligand (FasL) system in apoptosis during goiter formation and involution in a rat model of goiter. Rats were fed a low iodine diet and a goitrogen, 6-propyl-2-thiouracil, to induce goiter. Rats with goiter were then fed a high iodine diet to study the phase of involution. We examined the presence of apoptosis by electron microscopy (EM) and terminal deoxy-UTP nick end labeling (TUNEL). We also investigated the association between Fas and FasL expression and thyrocyte apoptosis using immunohistochemistry and Western blotting. To evaluate the proliferation of thyrocytes, proliferating cell nuclear antigen was examined immunohistochemically. The number of apoptotic cells increased during goiter formation and the early stage of involution, which were also associated with increased number of Fas-positive thyrocytes, and some of these cells contained TUNEL-positive nuclei. However, the expression of FasL was almost constant throughout the experiment. Proliferating cell nuclear antigen/TUNEL ratio markedly increased during goiter formation but decreased particularly during the late stage of goiter involution. Our results indicate that apoptosis of thyrocytes is a main factor of cell loss during goiter formation and involution and suggest that the Fas/FasL system is involved in the induction of apoptosis of these cells. Moreover, the delicate balance between apoptosis and cell proliferation may play an important role in the control of thyroid gland mass.

Animals↗
PubMed1996

A variant of adenomatous goiter with characteristic histology and possible hereditary thyroglobulin abnormality.

A variant type of adenomatous goiter was identified in 24 of 2160 patients with adenomatous goiter who underwent thyroidectomy. The characteristics of the thyroid gland in these 24 patients included large goiter, small follicles, scant colloid, and columnar follicular cells containing yellow-green granules on hematoxylin-eosin staining. The thyroid gland was slightly orange-red, and electron microscopic examination showed abundant lysosomes with colloid droplets. When comparing the features of this group with those of 24 patients with common adenomatous goiter, the incidence of familial predisposition to thyroid diseases in the former group was higher. The age at the time of detection of goiter was lower, i.e. 17 +/- 15 vs. 44 +/- 17 yr (P < 0.001, variant type vs. common type), the serum total T4 concentrations were lower (84 +/- 21 vs. 103 +/- 18 nmol/L; P < 0.01), and the serum TSH concentrations were higher (2.4 +/- 2.1 vs. 1.0 +/- 0.9 mU/L; P < 0.01). Thyroid radioiodine uptake was remarkably increased (49 +/- 22 vs. 16 +/- 9%; P < 0.001), and lower levels of serum thyroglobulin were noted (33 +/- 51 vs. 484 +/- 603 micrograms/L; P < 0.01). The thyroglobulin content was low in the thyroid gland studied. The data suggest that the etiology of this variant type of goiter is a hereditary abnormality in thyroglobulin synthesis, and this type of goiter may be distinguished from common adenomatous goiter by the characteristic morphology of the thyroid gland in addition to clinical findings.

Adult↗
PubMed1995

Endemic goiter in the Jos Plateau region of northern Nigeria.

This study is an endemic goiter survey of 3476 school children in 13 Local Government Councils (LGCs) and 1004 subjects in a whole community of one LGC, Plateau State, Northern Nigeria, to determine the prevalence of goiter as well as to identify some of the etiological agents involved. Results of the survey showed that the disease is highly endemic in the area with prevalence varying in places from 1 to 23% of these subjects. Females showed a markedly higher prevalence of goiter. Analysis of 729 urine samples indicated that iodine excretion ranged from 3.5 to 1.3 microgram/dl (32-154 microgram/g creatinine) and was similar to that in iodine deficient areas in the world, but no relation was observed between the prevalence of goiter and urinary iodine. Urinary thiocyanate levels were less than 0.5 mg/dl, suggesting that the role of the thiocyanate as a goitrogen is not important in the region. Thyroid hormone parameters in village subjects with goiter were similar to those in goiter endemia except serum thyroxine (T4). An interesting result found in village subjects was very high serum thyroxine binding globulin, which leads to an increase in serum T4. This study indicated that Northern Nigeria is an area of endemic goiter. Although some areas in Plateau State are iodine deficient zones, we could not conclude that the etiology of endemic goiter in this area is associated with iodine deficiency. There may be an interplay of multiple factors of etiological importance.

Adolescent↗
PubMed1999

Relationship between intrathyroid calcifications and thyroglobulin in endemic goiter.

Intrathyroid calcifications represent a common finding within simple or nodular goiters, but, as far as they can be found also inside papillary and medullary thyroid carcinomas, an ultrasonographic detection of intrathyroid calcifications stands as a different diagnosis problem. We have been looking for the presence of parameters associated with thyroid calcifications in patients affected by simple or nodular goiter, either sporadic or endemic. We studied 284 euthyroid subjects, 250 females, ageing from 24 to 90 years, affected by a simple goiter, in the 9.51% of the cases, and by a nodular goiter in the remaining part. 69.37% of the patients came from an endemic goiter area, while the others were affected by sporadic goiter. We tested fT3, fT4, TSH, hTG, Ab-TG, Ab-TPO and performed an ultrasonography in all the subjects, 57.75% of patients shown intrathyroid calcifications in the 57.75% of them. We applied a multistep discriminant analysis taking for the presence/absence of calcifications as dependent variable and we tried to find which variable, by itself or in combination with others, could foretell its presence. We also created a new variable (TG1) to differentiate normal from supraphysiologic concentrations of hTG (< 60 ng/ml). The variable with the highest significance F originated from endemic goiter area (F = 96.36), followed by TG1 (F = 24.46) and age (F = 10.61). On the contrary hTG did not relate to calcifications, due to non-proportionally direct relationship between these two parameters, afterwards we used the multistep logistic regression that gave overlapping significances. This means that supraphysiologic hTG rates are sufficient to predict the possible presence of intrathyroid calcifications. In conclusion, as far as a follicular hyperstimulation can be assumed, especially if long-lasting, the presence of intrathyroid calcifications should rise a clinical suspect toward an old goiter rather than a neoplastic lesion.

Adult↗
PubMed2000

Surgical management of substernal goiter.

PURPOSE: We describe the clinical results and complications associated with different surgical approaches to the treatment of substernal goiter. METHODS: We retrospectively reviewed the medical records of 56 patients treated for substernal goiter from 1983 through 1999. Eight had undergone previous thyroidectomy. Posterior mediastinal goiter was diagnosed in eight patients, hyperthyroidism in seven, acute respiratory failure in three, and superior vena cava syndrome in two. All but one of the patients underwent thyroidectomy. RESULTS: Thyroid scan revealed that 88% of patients had substernal goiter. A cervical incision alone was used in 46 of 55 patients. Nine patients underwent thyroidectomy via a thoracic approach. Both lobes were resected in 16 patients. Two deaths occurred: one patient suffered a stroke and another patient developed pneumonia after surgery. The most frequent complication was recurrent laryngeal nerve injury, followed by removal of a normal parathyroid gland and pneumonia. Multinodular goiter occurred in 52 patients. Resected goiter with occult malignancy was found in three patients, two of whom underwent lobectomy only. These three patients had survived at 5, 7, and 11 years postoperatively, respectively. All patients with tracheal lumen narrowing showed a normal sized tracheal lumen 2 to 3 months postoperatively. CONCLUSION: Our data indicate that the presence of a substernal goiter should be considered an indication for resection based on risk of acute respiratory distress, risk of malignancy, and lower surgical morbidity. Most secondary substernal goiters can be simply resected through cervical incision and curation.

Adult↗
PubMed2002

Endemic goiter in pregnant women: utility of the simplified classification of thyroid size by palpation and urinary iodine as screening tests.

OBJECTIVE: To validate urinary iodine (I) excretion and the simplified classification of goiter by palpation, comparing them with ultrasound of the thyroid gland as the gold standard, to identify endemic goiter in pregnant women. POPULATION AND SETTING: 300 pregnant women identified in referral hospitals, in three geographic regions. METHODS: Two endocrinologists, previously trained, evaluated thyroid size by palpation and by ultrasound. Urinary iodine excretion in a sample of urine was determined. Thyroid size below the 90th centile by ultrasound was considered normal. RESULTS: Mean age of study women was 23 years old. The prevalence of low weight for gestational age was 39% and of anaemia 47%. Our sample distribution showed that 120 microg I/L was the best cut off for low urinary iodine excretion to identify endemic goiter in pregnant women (sensitivity 57% and specificity 70%, likelihood ratio of 1.4). The prevalence of goiter was 10% using ultrasound. Palpation had a sensitivity of identification goiter of 94% (95% CI 89-99%), a specificity of 80% (95% CI 75-85%), a likelihood ratio of 4.7, positive post-test probability of 36.5% and negative post-test probability of 99%. CONCLUSIONS: Low urinary iodine excretion identified up to 46% of women with goiter. This test by itself is not useful as a screening tool to identify pregnant women at risk of goiter. Identification of thyroid size by palpation was a better screening test. However, when both tests were combined in parallel, up to 100% of women with goiter were correctly identified. Our results suggest that the commonly used cut off point of 100 microg I/L to identify low urinary iodine excretion may under-estimate the prevalence of iodine deficiency disorders when used during pregnancy.

Adult↗
PubMed1992

Prevalence of goiters in school children residing in villages where underground water is used.

A representative of Fuder village in Taichung County complained that many residents had a goiter problem, which he felt might be related to pollution from the nearby Youshi industrial area. The purpose of this study was to determine whether school children in the Fuder area have a high prevalence of goiters. We chose children of the Schichi elementary school in the Fuder area as the study population, and children of the Goumei elementary school, far from the Youshi industrial area, as controls. Both groups were from a similar geographic location (near the sea), had similar socioeconomic status, and both drank underground water. Thyroid enlargement was examined by palpation as recommended by the World Health Organization. Thyroid antibodies and hormones were determined in school children with a goiter and age-sex-matched normal control children using the particle agglutination method and radioimmunoassay, respectively. In total, 1,692 school children were examined, including 875 males and 817 females. Of these, 126 school children (7.4%) had a goiter of Grade I or above. The prevalence of goiters in Shichi and Goumei were 8.8% (59/671) and 6.6% (67/1,021), respectively. There was no significant difference between these two areas. We compared the prevalence of goiters in these two schools where underground water is drunk with another previous study in Peimen and Putai where tap water is used. There was a statistically significant difference (7.4% vs 2.6%, p < 0.0001). This suggests that the higher prevalence rate of goiters in Shichi and Goumei is related to the drinking of underground water. We recommend that the use of tap water and continued salt iodization is the way to prevent endemic goiter in these areas. A further comprehensive study is needed to determine the nature of the goitrogen in the underground drinking water of the Fuder area.

Child↗
PubMedDate not supplied

Assessment of goiter prevalence, iodine status and thyroid functions in school-age children of rural Yusufeli district in eastern Turkey.

According to previous studies, Turkey has generally been accepted as a moderate endemic iodine deficient country. However, it has recently been reported that there are regions in Turkey where iodine deficiency is more severe than previously known. The current study was aimed at ascertaining the goiter prevalence by thyroid volumes, iodine status and thyroid functions in school-age children living in an area which is suspected to have moderate or severe iodine deficiency. Overall goiter was found in 47.6% of children, in 22.8% of girls and in 24.8% of boys. Mean thyroid volumes did not differ significantly according to sex. Significant correlation was found between thyroid volume and body surface area and age. There was a negative correlation between the urinary iodine concentration and thyroid volume (r = 0.45, p < 0.01). Median urinary iodine concentrations in subjects with and without goiter were 20 microg/dl and 5.2 microg/dl, respectively. While median urinary iodine levels of the subjects with goiter were consistent with severe-moderate iodine deficiency, levels in subjects without goiter were comparable to moderate-mild iodine deficiency. None of the subjects had the signs or symptoms of hyper-or hypothyroidism. The differences in the mean values of thyroid hormones and TSH levels between subjects with or without goiter were not significant (p > 0.05). No correlation was found between urinary iodine concentrations and thyroid hormone levels. A weak correlation was found between urinary iodine concentration and TSH levels (r = 0.12, p = 0.05). Individuals with goiter were investigated etiologically: biochemical hypothyroidism was detected in 2%, compensated hypothyroidism in 12.6%, autoimmune thyroiditis in 2%, nodular goiter in 3% and isolated high TSH level with autoimmune thyroiditis in 0.08%. In conclusion, although a salt iodization program has been started in Turkey, our study indicates that some regions with severe iodine deficiency are still present. This research suggests that this program should be re-evaluated for remote areas with self-contained economic systems, and should be expanded and more effectively applied nation-wide.

Child↗
PubMed2005

Iodine deficiency and goiter prevalence of the adult population in Erzurum.

It is believed that total goiter prevalence in Turkey is as high as 30.5%. The iodine deficiency is the distinct etiologic factor in the development of goiter. The aim of this study was to determine goiter prevalence and iodine deficiency in adults living in Erzurum (1659 m above sea level) for at least 10 year. The study involved 340 people (192 females, 148 males). The median age was 38.5 year (ranging from 20 to 76 years). Ultrasound-measured thyroid volume (TV) for men (TV>25 ml) and for women (TV>18 ml) was considered goiter indicator. By this evaluation, goiter was diagnosed in 94 (27.6 %) cases, whereas the goiter prevalence, based on the palpation method, was 5.6%. Urinary iodine concentration (UIC) was measured by ammonium persulfate method. UIC in subjects with goiter was significantly lower than that of the others (median values 5.0 vs 7.8 microg/dl, p<0.0001). While the value of UIC > or = 10 microg/dl (no. 121, 36.6%) was accepted normal, the extent of iodine deficiency in other subjects was classified as severe (UIC<2.0 microg/dl, no.53, 15.6%), moderate (UIC=2.0-4.9 microg/dl, no.75, 22%) and mild (UIC=5.0-9.9 microg/dl, no.91, 26.8%). TV values were found to be significantly different among the four groups (p<0.05). TV values were significantly correlated with body surface area and UIC (r=0.15 and r=-0.16, respectively, p<0.005). Also, the prevalence of thyroid nodules was estimated as 2.1% by palpation and 18% by ultrasonography. We conclude that goiter originating from iodine deficiency has been an important health problem in Erzurum. Besides taking measures at national level, local factors and risks which interfere with the nationwide efforts should also be dealt with for the eradication of the iodine deficiency problem. In the region, periodical evaluation of iodine level and iodine related disorders will guide the measures to be taken for the well being of people's general health.

Adult↗
PubMedDate not supplied

[Multinodular diving goiters: 100 cases in Morocco].

OBJECTIVE: To assess 100 cases of multinodular diving goiters, the authors review the literature to compare the epidemiology, clinical pictures, additional required work-up, treatments, complications, and sequelae. METHOD: Records of 100 cases of multinodular diving goiters were collected in the surgical department of the Military Hospital of Marrakesh in Morocco from 1991 through 2004. They accounted for 6% of all goiters. The sex ratio was clearly female, and the mean age 50 years. The clinical symptoms of diving goiters involves mainly signs of compression, with dyspnea seen in 50% of cases. Thyroid dysfunction was found in only 25% of our patients. A diagnosis of diving goiter must be suspected when there are signs of mediastinal compression and a palpable cervical goiter, as seen in all our patients. The diagnosis can often be confirmed with thoracic radiography and thyroid scintigraphy. Treatment is mainly surgical and depends on disease course. Cervicotomy was performed in 97% of our patients and was sufficient to extract even most voluminous goiters and those deepest in the mediastinum. RESULTS: Immediate operative results were satisfactory. More long-term results were also generally satisfactory, except for 4 cases of recurrent paralysis and 5 cases of hypoparathyroidism. Both have been reported by several authors. CONCLUSION: Surgical management of multinodular diving goiters is necessary. In general, cervicotomy is sufficient, and the results generally satisfactory, except some complications and neoplasms.

Adult↗
PubMed1991

[Endemic goiter in Argentina. Epidemiologic studies before (1968) and during (1986) prophylaxis with iodized salt in the city of Buenos Aires].

An epidemiological survey on goiter was conducted in Buenos Aires, on 3882 schoolchildren, a randomized sample of 160,026 children of public schools, before establishing prophylactic measures in 1968. With an estimated error of 5% the result was 14.8% of goiter prevalence. This figure qualified Buenos Aires as an endemic area and was, therefore, included in the National Programme to Combat Endemic Goiter, through iodized salt (proportion 1:30,000 of salt). Schools were qualified according to their social level in high, middle and low; the prevalence of goiter was 6.8%, 12.2% and 26.4%, respectively. The prevalence was also higher in older ages. In 1986, using the same randomized sample, a second survey was conducted, after 18 years of prophylaxis. Goiter prevalence was 8.5%. Goiter in the low social class was about the same as in the middle class. In randomized samples of 49 urines, iodine concentration was determined yielding an average of 139.6 micrograms/g creatinine (median 120.9 micrograms/g creatinine). Urinary iodine level in 14 children with goiter was 146.1 micrograms/g creatinine and in 12 without goiter was 171.4 micrograms/g. There was no statistical difference between these three groups. Variations in radioiodine uptake, urinary iodine, plasma inorganic iodine levels, and water iodine are discussed.

Adolescent↗
PubMed1989

Low thyrotropin (TSH) levels in goiter. Relationship with scintigraphic findings and other biological parameters.

Low TSH levels are frequently encountered in patients presenting with goiter. We assayed TSH in 599 goitrous patients who were referred to us for scintigraphy and ultrasonography. When TSH levels were low or when a hot nodule was discovered at scintigraphy, free T3, free T4 and sex hormone-binding globulin (SHBG) were also assayed. TSH levels were always low in overt hyperthyroidism with elevated free T3. TSH levels were also low in patients with normal free T3 and free T4 in circumstances leading to mild hyperthyroidism such as hot nodules that suppressed extranodular thyroid tissue uptake, toxic multinodular goiter, De Quervain thyroiditis and some patients on amiodarone treatment. Low TSH levels were also encountered in 29% of the clinically euthyroid patients presenting with a multinodular goiter with normal iodine uptake, no hot area and normal free T3 levels. In diffuse goiter, low TSH and normal free T3 levels were more frequently associated when iodine uptake was low, mainly due to subacute thyroiditis which can be clinically silent. Low TSH levels were rarely observed in patients with "simple" goiter or uninodular goiter without hot areas. SHBG, which was elevated in 94% of the Graves' disease patients tested, was normal in all but two patients with low TSH and normal free T3 levels. This assay appeared to be of little relevance in goiter. In addition to imaging techniques which are usually performed first, TSH should be systematically assayed in goiter, except in cases of solitary cold nodules. When low, the patient is at risk of developing overt hyperthyroidism. Conversely, when an isolated low TSH level is observed, scintigraphy should be performed.

Goiter↗
PubMed1983

Endemic goiter in western Colombia.

Goiter continues to occur in some areas of western Colombia despite iodine supplementation for 30 years. In 1973-1977, an average goiter prevalence of 15% (range 1-42%) still persisted among schoolchildren of 41 localities. Significant relationships were found between goiter prevalence and both the geological composition of watersheds and bacterial contamination of water supplies. Together, these associations account for 80% of the observed variation in goiter prevalence. The presence of sedimentary rocks rich in organic matter (coals, shales, etc.) was the best indicator of disease. The second best indicator, presence of K. pneumoniae in the water source, was associated with lower goiter prevalence but, as in other investigations, contamination of the pipeline system (households and schools) with gram-negative bacteria was associated with higher disease rates. Thus, epidemiological evidence indicates a cause-effect relationship between sources of drinking water and the persistence and development of goiter in this part of the world. Furthermore, identification of resorcinol, phthalate esters, and sulfur-bearing organic compounds, possibly aliphatic disulfides, in the water supplying the endemic goiter district of Candelaria town in western Colombia adds experimental support to this hypothesis. Resorcinol is derived from coal and humic substances, high molecular weight complex polymeric organic compounds present in sedimentary rocks, soils and water. Resorcinol is goitrogenic in man and experimental animals. Phthalate esters, also related to humic materials, undergo biodegradation by gram-negative bacteria with production of intermediate metabolites possessing antithyroid activity. Like phthalates and resorcinol, organic disulfides have also been identified as water contaminants in other parts of the world, and are known to be potent antithyroid compounds. The goitrogenic effect of organic and bacterial pollutants in water supplies is more pronounced in segments of the population with dietary iodine deficiency--as seen prior to the iodine prophylaxis program--and/or poor socio-economic conditions. Studies are underway to provide both insight into the biogeochemical cycle of water-borne goitrogens and knowledge essential to the development of rapid, inexpensive, and precise methods for detecting and quantifying the offending agents, as well as devising effective sanitation techniques for their inactivation and/or elimination. The impact of such measures will be determined on goiter prevalence and other parameters of health and nutrition of the communities under study.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1981

[Endemic goiter in Austria's youth?].

After 17 years the efficiency of iodine prophylaxis of endemic goiter (1 : 100000) in Austria was checked by control field studies in 3 Tyrolean towns n Austria. The data obtained there were compared with those of 123 school age children from the iodine deficient endemic goiter area of the province of Bolzano (Italy). The results show a reduction in goiter incidence from 50 to 35% in the total population in Austria, where goiter incidence in schoolchildren dropped from 45.9% to 12%. Urinary iodine/g creatinine was 65 micrograms in Austria, the 24 hr radioiodine uptake with 41.8% was normal. In comparison the ethnologically and geographically similar endemic goiter zone in the province of Bolzano showed a goiter incidence in schoolchildren of up to 46%, while urinary iodine/g creatinine was 35.9 micrograms and radioiodine uptake after 24 hr about 50%. Extensive studies of peripheral hormone parameters (T4, TBG, T3, TSH, rT3, FT3, FT4) revealed a significantly higher rT3 concentration of 24.7 ng/dl in Austria compared with a value of only 19.8 ng/dl in the province of Bolzano. These facts suggest an increased conversion of T4 to real T3 in iodine deficiency, which might contribute to the adaptation of the organism to this condition. No statement, however, can be presented regarding the regulation of this phenomenon. Even as endemic goiter is decreasing in Austria, an increase of salt iodization to 1 : 50000 according to the swiss procedure might eliminate definitely endemic goiter in Austria.

Austria↗
PubMed1995

Prevalence of goiter in Taiwanese adults: a preliminary study.

Although there have been many studies on the prevalence of goiters in Taiwanese school children, the goiter prevalence in Taiwanese adults is unknown. This is a preliminary study of the prevalence of goiter in adults admitted for health examinations to the National Taiwan University Hospital. The thyroid glands of 1,020 adults were palpated. Thyroid ultrasonography was also performed on all adults to confirm the palpation findings and to check goiter nodularity. Fine-needle aspiration cytology was done in nodular goiters with or without ultrasound guidance, depending on whether or not the thyroid nodules were easily located by palpation. The adult goiter prevalence was found to be 19.4% in males, 33.6% in females and 25% in total. Seven out of 1,020 adults (0.7%) had thyroid cancers diagnosed by aspiration cytology and confirmed by surgery and pathology. Of the seven adults with thyroid cancer one did not have a palpable goiter. The results show a high prevalence of goiter in these adults. Thyroid ultrasonography is useful for screening thyroid malignancy in adults. If thyroid nodules are detected, fine-needle aspiration cytology can be done with or without ultrasound guidance to confirm the malignancy.

Adult↗
PubMed1995

Prevalence of goiters in children residing in Tung-Lo Township, Taiwan.

This study investigated school children in the Tung-Lo Township in central Taiwan to determine the prevalence of goiters compared to other areas of Taiwan and to elucidate the possible etiology. All children attending elementary schools in Tung-Lo were examined for thyroid enlargement by neck palpation, as recommended by the World Health Organization. Thyroid antibodies and thyroid hormones were determined in children with goiters, and in normal age- and sex-matched controls. Additionally, analysis of drinking water for humic substances was done by fluorospectrophotometry. In total, 1,823 school children were examined (965 boys and 858 girls). Of these, 174 (9.5%) were found to have a goiter of grade I or above. The prevalence was higher than our recent surveys in other areas of Taiwan (2.6%-8.8%). Goiter prevalence in school children residing in hill regions (12.9%), mainly dependent on underground water for drinking, was higher than that of school children residing in plain regions (8.2%), who depend on tap water for drinking. The quality of drinking water bore a close relationship to the prevalence of goiter. From the ratio of T3/T4 in this study, and a study of urinary iodine excretion done by others, it is concluded that goiters in Tung-Lo are not related to iodine deficiency. There was no statistically significant correlation between the relative fluorescence intensity of humic substances and the prevalence of goiter. The results of this study suggest that the higher prevalence of goiter in children living in Tung-Lo, an oil-bearing area, may be related to the quality of drinking water.

Child↗
PubMed1990

Interrelationships between age, thyroid volume, thyroid nodularity, and thyroid function in patients with sporadic nontoxic goiter.

PURPOSE: To test the hypothesis that during the natural history of sporadic nontoxic goiter (SNG), a diffuse goiter precedes a multinodular goiter with gradual development of autonomous thyroid function. PATIENTS AND METHODS: A cross-sectional survey of 102 consecutive patients with SNG (seven male, 95 female) was performed. Thyroid volume was measured by ultrasonography, and plasma thyroid-stimulating hormone (TSH) by a sensitive assay (TSH immunoradiometric assay). RESULTS: Patients with a multinodular goiter were older and had a larger thyroid volume than patients with a diffuse or uninodular goiter. Plasma free thyroxine (T4) and total triiodothyronine (T3) were higher and plasma TSH was lower in patients than in normal subjects. Free T4 was higher in the subgroup of patients with a multinodular goiter and a decreased TSH response to thyrotropin-releasing hormone. Plasma TSH (y, in mU/L) was negatively related to thyroid volume (x, in mL): y = 8.2x-0.667 (r = 0.578, p less than 0.001). Thyroid volume (y, in mL) was positively related to age (x, in years): y = -21.8 + 2.0x (r = 0.455, p less than 0.001); and to duration of goiter (x, in years): y = 40.6 + 2.1x (r = 0.505, p less than 0.001). The annual increase in thyroid volume was calculated at 4.5%. CONCLUSION: The data suggest a continuous growth of SNG and provide support for the concept of increasing thyroid nodularity and autonomy of thyroid function--related to increasing thyroid volume--during the natural history of this disorder.

Adult↗
PubMed1975

Findings relating to goiter and iodine in the Ten-State Nutrition Survey.

Examinations for thyroid size were carried out on 35,999 individuals in the Ten-State Nutrition Survey. Overall goiter prevalence was found to be 3.1 per cent with the higher prevalence of goiter among adolescents and adults. Females of all ages had a higher prevalence of goiter than did males. No consistent regional pattern of the occurrence of goiter was observed. Urinary iodine excretion values used to estimate iodine intake indicated very few persons with excretion values suggesting iodine deficiency. No association between goiter and low iodine excretion was observed. On the contrary, a higher prevalence of goiter was found among persons excreting high levels of iodine. There is no indication from this study of widespread, iodine-deficiency goiter.

Adolescent↗