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PubMed2006

[Hydatic cyst of thyroid gland].

INTRODUCTION: Primary hydatid cyst of thyroid gland is an exceptional localization. The thyroid gland is an uncommon site even in Morocco where echinococcal disease is endemic. The aim of this study was to report our experience of this rare disease, and to review diagnosis problems and management. PATIENTS AND METHOD: Retrospective study of six patients with primary hydatid cyst of thyroid gland during a 4-year period. RESULTS: We report six cases of primary hydatid cyst of thyroid gland. Symptoms were isolated thyroid nodules. Diagnosis was based on echography and echinococcal immunologic test. However, hydatic origin was suspected in only 50% of patients preoperatively and immunologic test had 33% false positive rate. Surgical management was a lobo-isthmectomy with a total resection of the cyst in four cases (67%) and a resection of the cyst prominent dome in two cases (33%). Diagnosis was always confirmed by macroscopic aspects and pathology. In all cases, the postoperative course was uneventful and no recurrence occurred with a 19 months follow up. CONCLUSION: Primary hydatid cyst of thyroid gland is a potential but rare situation. Positive diagnosis can be difficult during preoperative period. Cyst size and diagnosis doubt are two crucial criteria to decide the optimal surgical strategy (lobo-isthmectomy with total cyst resection vs resection of the cyst prominent dome).

Adolescent↗
PubMed1986

[Changes in the levels of reverse triiodothyronine (rT3) during and after surgery of the thyroid gland].

The thyroid activity of twenty euthyroid patients, with single or multiple "cold" nodules was investigated, with determination of seric T3, T4, reverse-T3 (rT3) and TSH. The blood-drags were performed respectively, during (with seric samples from the inferior thyroid vein ipsilateral to the affected lobe) and after (1, 3 and 7 days) surgery. The results of this study--and particularly the significative decrease of T3 and the rapid rT3 increase, either during or after operation - suggests a condition similar to the described "Low T3 syndrome", as expression of both the stress determined by surgery and the correlated thyroid metabolic "adaptation". The clinical and biochemical euthyroidism, expressed by normal levels of TSH in all the samples, confirm the persistence of normal feed-back mechanism by the diencephalon-hypophysis-thyroid axis, even in stress conditions.

Adaptation, Physiological↗
PubMed2000

The thyroid gland: physiology and pathophysiology.

The thyroid gland contains many follicular cells that store the thyroid hormones within the thyroglobulin molecule until they are needed by the body. The thyroid hormones, often referred to as the major metabolic hormones, affect virtually every cell in the body. Synthesis and secretion of the thyroid hormones depend on the presence of iodine and tyrosine as well as maturation of the hypothalamic-pituitary-thyroid system. Interruption of this development, as occurs with premature delivery, results in inadequate production of thyroid-stimulating hormone and thyroxine, leading to a variety of physiologic conditions. Pathologic conditions occur in the presence of insufficient thyroid production or a defect in the thyroid gland. Laboratory tests are important in diagnosing conditions of the thyroid gland. A thorough history in combination with clinical manifestations and radiologic findings are also useful in diagnosing specific thyroid conditions. Nurses play an important role in identifying and managing thyroid disorders and in providing supportive care to infants and their families.

Congenital Hypothyroidism↗
PubMed1999

Gastroenteropancreatic neuroendocrine tumor metastases to the thyroid gland: differential diagnosis with medullary thyroid carcinoma.

Neuroendocrine tumors (NET) of the thyroid gland are rare. Apart from medullary thyroid carcinoma (MTC), metastases of gastroenteropancreatic (GEP) NET may also occur. Features of six patients (five men, one female: age range, 39-67 years) with thyroid metastases from a GEP-NET are described. Thyroid metastases were bilateral in all patients and were associated with enlarged neck lymph nodes in five. In four cases, the thyroid tumor was either the first sign of the disease (n = 2) or was an isolated site of recurrence (n = 2). The tumors were well (n = 3) or poorly differentiated (n = 3). Five tumors for which the primary site could be determined corresponded to foregut-derived tumors (3 lungs, 1 thymus and 1 pancreatic NET). One tumor demonstrated calcitonin (CT) production as shown by immunohistochemistry and elevated plasma CT levels. However, the disease history and the clinical features strongly favored a metastasizing GEP-NET. No tumoral RET proto-oncogene mutation was found in this patient. The differential diagnosis between metastatic GEP-NET and MTC is crucial because prognosis, work-up, and treatment differ greatly.

Adult↗
PubMedDate not supplied

The pituitary-thyroid axis in severe falciparum malaria: evidence for depressed thyrotroph and thyroid gland function.

Abnormal thyroid function is strongly associated with mortality in severe non-thyroidal illness. We have assessed the pituitary-thyroid axis serially in 18 Thai adults with severe falciparum malaria and in 18 matched controls. The admission total serum thyroxine (T4) concentrations of the patients (median [range]: 64 nmol/litre [less than 30-91]) were significantly lower than those of controls (81 nmol/litre [61-133]; 2P less than 0.01), and remained depressed until after fever and parasite clearance. Two patients who died in hospital had admission serum T4 concentrations less than 35 nmol/litre. The admission basal serum thyrotropin (TSH) levels of the patients (0.9 mU/litre [less than 0.2-3.1]) were similar to those of controls (1.3 mU/litre [less than 0.2-3.7], 2P greater than 0.1) and remained normal throughout fever and parasitaemia. Thirty-minute TSH increments during a thyrotropin-releasing hormone test on admission were reduced in 13 patients with severe malaria (4.1 mU/litre [0.7-8.1]) relative to those in convalescence (7.1 mU/litre [1.7-14.4], n = 10, 2P less than 0.01) and controls (5.6 mU/litre [3.3-12.9], n = 9, 2P less than 0.05). These findings suggest that thyrotroph and thyroid gland function are depressed during acute, severe malaria. As these changes may be an adaptation to accelerated catabolism, the role of thyroid replacement in such patients is uncertain.

Adolescent↗
PubMed2000

Renal cell carcinoma with metastasis to the thyroid gland.

Cancers that metastasize to the thyroid gland are uncommon. Metastasis to the thyroid gland has been reported in renal cell carcinoma (RCC), breast cancer, lung cancer, gastrointestinal malignancies, malignant melanoma, sarcoma, hematologic malignancies, and other genitourinary cancers. A computer search of the records of the department of pathology at Loyola University Medical Center was done to determine the number of thyroidectomies performed between 1988 and 1998. A detailed review of the clinical records of patients with metastasis to the thyroid gland from RCC was done. A total of 941 thyroidectomies were performed between 1988 and 1998. Metastasis to the thyroid gland was seen in six cases (0.64%). Three of these six cases had metastasis from RCC. The interval between the diagnosis of the primary RCC and the thyroid metastasis was 2 to 10 years. Two of these three patients had an adenomatous thyroid gland. Metastases to the thyroid, though relatively rarely diagnosed clinically as a cause of thyroid nodule, must be considered in the differential diagnosis of thyroid nodule, particularly in patients who have a history of RCC.

Journal Article↗
PubMedDate not supplied

[Ectopy of the thyroid gland as cause of neck or tongue base tumour].

One of the most important causes of congenital hypothyroidism found in 35-42% of cases, is ectopy of the thyroid gland. Thyroid gland can be displaced at base or under the tongue, or under the hyoid bone. Ectopic gland is also hypoplastic, secreting not enough amounts of thyroid hormones. By negative feedback mechanism that cause elevation of TSH. Under the permanent TSH stimulation ectopic gland can enlarge appearing as a neck or tongue base "tumour". In this way, by measuring TSH level in a newborn, all children with thyroid gland ectopy can be detected. Ectopy of the thyroid gland as cause of congenital hypothyroidism was present in three patients as a tumour of neck or tongue base. After surgical removal of the "tumour", histopathologic analysis revealed that it was the thyroid tissue. No patient passed the thyroid function test nor identification of the thyroid tissue (ultrasound or scintigraphy) before surgery. All were born in the regions of Serbia where screening for congenital hypothyroidism was not carried out at all or only temporary. Screening of newborns for congenital hypothyroidism is based on measuring TSH level. By this method all patients with thyroid gland ectopy can be detected. Scintigraphic examination after surgery detected no thyroid tissue and replacement therapy with Na L-thyroxine started.

Child↗
PubMed1982

Immunohistochemical study of c cell follicles in dog thyroid glands.

In dog thyroid glands there are C cell follicles which are lined solely by C cells and which accumulate a colloidlike substance in the luminal cavities. In order to clarify the properties of the colloidlike substance secreted by C cells, the C cell follicles were stained with PAS reaction and immunoperoxidase method using anticalcitonin, anti-C-thyroglobulin, and anti-19S-thyroglobulin antisera, respectively. The colloidlike substance was PAS positive and revealed the strong immunoreaction for C-thyroglobulin but a faint reaction for calcitonin. It was nonreactive with anti-19-thyroglobulin antiserum. These results confirm that C cells synthesize the glycoprotein immunoreactive to anti-C-thyroglobulin antiserum in addition to calcitonin and can store it in the follicular lumens.

Animals↗
PubMed1985

Secretion of calcitonin gene-related peptide from baby rat thyroid glands in vitro.

Thyroid glands from 8-day-old rat pups were incubated in serum-free medium for 6 hr. Both calcitonin (CT) and calcitonin gene-related peptide (CGRP) released into medium were measured by radioimmunoassay. In 6 separate experiments CGRP was easily detected in medium in ng/ml concentrations. In 4 of the 6 experiments, where CT release was stimulated by high medium [Ca], the concentration of CGRP in medium showed a positive, significant correlation with the medium CT concentration (r = 0.41-0.69, p less than .05- less than .01). The results are in concert with reports describing the presence of CGRP in the C-cell, and they further show that CGRP, as well as CT, can be secreted by C-cell.

Animals↗
PubMed1996

[Why is it necessary to study the thyroid gland?].

Pathophysiological and clinical aspects of the thyroid gland include after many decades of intensive studies many yet unresolved problems. The relationship with the gastrointestinal system (iodine accumulation in the stomach and salivary glands), the function of thyroxine as a prohormone (in particular the regulation of the activity of tissues deiodinases, the action of triiodothyronine similar to that of steroid hormones, a mixture of protein anabolic and protein catabolic reactions to thyroid hormones, peculiar immune features of the thyroid gland (presence of immunogenic hyperfunctional and hypofunctional syndrome), sharing of common antigens by the thyroid gland and orbital tissues, new findings on mutations of TSH receptors in the thyroid gland, biphasic dependence of the thyroid gland on iodine - all these problems call for further research. Mutation of the TSH receptor can lead to hypothyroidism (resistance to TSH) and to multinodular goitre. The gene for the iodine transporter in the thyroid gland (Na(+)I symport) was cloned. The thyroid gland is related to malignant free radicals: this is suggested also by the raised thyroxine level in rats after methylene blue administration. The increase is recorded in intact as well as carbimazole medicated animals. All this indicates that the thyroid gland must remain in the foreground of research and clinical work: 4% of the Czech population suffer from some thyroid disorder.

Animals↗
PubMed1975

Subacute thyroiditis in a lateral thyroid gland: evaluation of the pituitary-thyroid axis during the acute destructive and the recovery phases.

Subacute thyroiditis in a lateral, ectopic thyroid has been previously unreported. A 4 10/12-YEAR-OLD GIRL HAD AN ENLARGING MASS IN THE LEFT UPPER ANTERIOR NECK. Initially, the serum concentration of T4 was normal, T3 was elevated, and TSH was undetectable without response to TRH. RAI uptake was 1%. The data were consistent with subacute thyroiditis. Twelve weeks later the serum concentration of T4 was low and TSH was elevated; thyroid replacement therapy was given for 20 weeks. When this was discontinued, there was an initial increase and then a decrease in the TSH values accompanied by an increase in serum concentrations of T3 and T4 to normal during eight weeks. One must consider a lateral ectopic thyroid gland in the differential diagnosis of masses in the neck. Physicians must be aware that temporary hypothyroidism occurs during the course of subacute thyroiditis.

Acute Disease↗
PubMed1978

Transformation of normal follicles into thyrotropin-refractory "cold" follicles in the aging mouse thyroid gland.

Autoradiographs of thyroid glands of aging mice demonstrate the gradual appearance of "cold" follicles which fail to iodinate the intraluminar iodoproteins even after intense exogeneous or endogeneous TSH stimulation. "Cold" follicles first appear at the age of 5 months. They may account for 80% of all thyroid follicles in 13-month-old mice. Morphologically, the "cold" follicles are characterized by a larger than normal colloid volume and a comparatively flat epithelium for any given follicle size. Old thyroids are twice as large as young ones. They contain twice as much normally iodinated thyroglobulin/mg wet weight. The total number of cells per gland remains constant throughout the life time. This is probably also true for the total number of follicles. The iodide pump, as judged by the tissue to serum ratio, remains normal and TSH-responsive. Yet, it is not established whether this is due to a higher activity of the pump in normal follicles or to preservation of inorganic iodide transport in "cold" follicles. Pinocytosis is defective in "cold" follicles and is poorly responsive to TSH stimulation. Furthermore, diffusion of iodocompounds is severely impaired in the colloid of "cold" follicles. It is suggested that the primary defect in the pathogenesis of "cold" follicles in old mice is the gradual failure of endocytosis to respond to normal TSH stimulation. Because exocytosis and iodination would first proceed normally, the follicular lumina would become overdistended up to a point where the apical membrane is functionally impaired. With this sequence of events, "cold" follicles would have impaired iodination while being metabolically as active as hot ones. Thus, several puzzling reports on high metabolic activity of "cold" tissue could possibly be interpreted.

Aging↗
PubMed1998

A case of Graves' disease in association with hemiagenesis of the thyroid gland.

Hemiagenesis of the thyroid gland is a rare anomaly. Few cases have been reported in the world literature. We present a case of Graves' disease in association with hemiagenesis of the thyroid gland. In this case, preoperative diagnosis was difficult because of the marked hyperplasia of the single thyroid lobe and the isthmus. Preoperative diagnosis of this anomaly is important to avoid unnecessary exploration of the side where the thyroid lobe is absent and to plan for the extent of thyroid tissue excision to avoid postoperative hypothyroidism. An ultrasound scan of the neck would have been helpful in this case.

Adult↗
PubMedDate not supplied

[Malignant lymphoma of the thyroid gland].

INTRODUCTION: Malignant lymphoma of the thyroid gland can be defined as a lymphoma arising from the thyroid gland. Lymphomas of the thyroid gland represent less than 5% of primary thyroid neoplasms and are two to three times more common in women than in men, whereas the median age is usually close to 60 years. Majority of thyroid lymphomas are diffuse, large-cell lymphomas. The incidence of thyroid lymphomas in patients with Hashimoto thyroiditis has markedly increased and this phenomenon is probably related to their pathogenesis. CLINICAL PRESENTATION: Unlike most other thyroid neoplasms, lymphomas are usually rapidly enlarging masses and local symptoms are common: pain, hoarseness, dysphagia, and dyspnea or stridor. DIAGNOSIS: To evaluate the extent of disease, a chest x-ray and CT scans of the head and neck, chest, abdomen, and pelvis are necessary. An excisional or large-needle biopsy may also be necessary to make the correct diagnosis. Occasionally, these tumors can be confused with anaplastic thyroid carcinomas, which can lead to serious mistakes in management. A gallium scan or a positron emission tomography (PET) scan can help later to establish whether any residual abnormality, observed on x-ray studies after treatment, contains active lymphoma or scar tissue. After diagnosis, patients are clinically staged (without surgery) using appropriate computed tomography scans or magnetic resonance imaging. THERAPY: Assessment of the extent of thyroid lymphomas is crucial for prognosis and treatment. Total thyroidectomy may improve the prognosis in patients with intrathyroidal disease only. It is very important to identify patients with favorable prognostic factors and to treat them with standard chemotherapy (CHOP) and radiotherapy protocols. Patients with diffuse large-cell primary thyroid lymphomas should not be treated with radiation therapy alone. CONCLUSION: The best treatment results for malignant lymphomas of the thyroid gland are achieved using a combined-modality therapy.

Aged↗
PubMed1983

Effect of hypophysectomy and administration of TSH on the activity of monoamine oxidase in the thyroid gland of rats.

The thyroid monoamine oxidase (MAO) activity was measured in rats after hypophysectomy and TSH treatment to find out whether the thyroid MAO activity can be modified with TSH. Hypophysectomy decreased MAO activity in the thyroid gland of rats. The administration of TSH (2.5 U kg-1 daily for 5 days) to hypophysectomized rats increased MAO activity and fully compensated the absence of the pituitary. These data suggest that the thyroid gland MAO activity is under the regulatory influence of TSH.

Animals↗