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PubMed2005

[Epidemiology of endemic goiter in Racha region].

1.034 inhabitants (270 men, 459 women and 305 children) were examined in Racha region (North-western Georgia) on endemic goiter at the age from 1 to 75. The investigated population was selected by randomized method. Diagnostic criteria for the evaluation of the degree of endemic goiter were based on the data of palpation and ultrasonography. In children iodine excretion by urine was also determined. Obtained data were analyzed by means of computer program Epi info-6. Prevalence of endemic goiter in examined population was 62,4% (45,2% in men, 72,1% in women and 62,9% in children). The highest spreading of the endemic goiter is noticed in the 21-30 year age group among women (78,8%). The main form of endemic goiter in Racha region is euthyroid diffuse goiter (56,1%). High index of spreading of endemic goiter in Racha region is caused by iodine deficiency along with irrational feeding and genetic factors.

Adolescent↗
PubMedDate not supplied

Substernal goiters.

BACKGROUND: Substernal goiter, also said cervico-mediastinic goiter, is a thyroid formation with cervical departure that goes beyond, with stretched neck, the superior thoracic strait for at least 3 cm and that preserves, generally, the parenchimal or fibrous connections between the cervical and thoracic portion, maintaining a direct vascularization supplied by the thyroid arteries. The prevalence of this pathology is very variable and fluctuates between 1.7% and 30% of all thyroid damages. The actual classification is provided by the radiologic examination of the chest and, above all, by the new techniques of imaging. METHODS: In the period between January 1998 and December 2003, 332 patients with thyroid pathology have been treated surgically. Forthy-five (13.5%) of these were afflicted with a cervico-mediastinic goiter. In 32/45 (71.1%) cases a total thyroidectomy has been performed by collar carving in accordance with Kocher; in 11/45 (24.5%) cases an hemithyroidectomy has been performed by collar incision; in 2/45 (4.4%) cases, already submitted to surgical intervention of isthmus-lobectomy a totalization has been performed. RESULTS: The surgical technique foresees always an anterior collar neck incision. This way of access is to prefer in the substernal goiters, both for the presence of a cervical vascularization easy to control and for the possibility, nearly always realizable, to dislocate the goiter by that way. As for what concerns the results of the histological examination, in 2/45 (4.5%) cases it has been set a diagnosis of follicular carcinoma (one of them surely invading and the other, leastly invading), in 3/45 (6.6%) cases papillary carcinoma, in 4/45 (8.8%) cases colloido-cystic goiter, in 33/45 (73.5%) cases micro-macrofollicular hyperplasia (in one of which contemporarily compromise from lymphoma of Hodgkin); in 3/45 (6.6%) cases of adenomatous hyperplasia of the thyroid. DISCUSSION: The surgical approach has been in all cases the collar neck incision in accordance to Kocher, and it has never been necessary to associate a sternotomy or thoracotomy. After the intervention, in all the patients the symptomatology tied to the mediastinal compression has disappeared. The goiter showed signs of neoplastic degeneration in 11.1% of the cases, with prevalence of the papillary carcinoma in the 6.6% and, in the remaining 4.5%, of follicular carcinoma. These data are superimposable to the data gathered in other surveys. All the patients passed the post-operating hospitalization in optimal conditions and have been discharged during the fourth post-operating day with the prescription of increasing levothyroxine doses according to the body weigh.

Adenocarcinoma, Follicular↗
PubMed2005

[Nodular goiter surface detection by FTIR spectroscopy].

A novel non-invasive diagnosis method of nodular goiter is proposed in the present study by recording FTIR spectra on the skin overlying thyroids using fiber optical technique and attenuated total reflection probe. FTIR spectra from 20 nodular goiters and 34 normal controls were collected. Twenty seven spectral variables of 13 bands including peak position and relative intensities were extracted from the FTIR spectra so that statistic work could be conducted using SPSS. The results demonstrate that peak positions of 2 925 and 1 250 cm(-1) both shifted toward lower wave number (P < 0.05) in the FTIR spectra of nodular goiter. The relative intensity ratios of H1 740/H1 460, H1 160/H1 460, and H1 160/H1 120 decreased significantly in FTIR spectra of nodular goiter (P < 0.05). Inversely, H1 080/H1 460 increased significantly (P < 0.05) in nodular goiter. The above statistic differences suggest that nodular goiter may produce some characteristic chemical substance which can diffuse onto the surface of skin and therefore be detectable using FTIR spectroscopy with fiber optic techniques. These differences are the basis of diagnosing nodular goiter by FTIR surface detection.

Goiter, Nodular↗
PubMed2005

Role of fine needle aspiration cytology in the diagnosis of goiter.

Enlargement of the thyroid gland is a common occurrence in most parts of the world especially in the iodine-deficient goiter belt areas. Vast majority of these lesions are benign but they invariably lead to a series of investigations among which FNAC plays a pivotal role. Although many studies have reported diagnostic accuracy of FNAC in detecting neoplasms, there have been few studies where the role of FNAC in the diagnosis of goiter along with their diagnostic pitfalls has been evaluated. The present study was undertaken to assess the accuracy of FNAC in diagnosis of goiter and to highlight its limitations and diagnostic pitfalls. 771 cases over a five-year period were retrieved from the files of Cytopathology Laboratory, Department of Pathology at the All India Institute of Medical Sciences, New Delhi. They included 733 cases where the cytological diagnosis was goiter or suggestive of goiter along with 38 cases in which the histological diagnosis was goiter while the cytological diagnosis was cystic change or neoplasm. FNAC with minimum of two passes were performed in each case and May Grünwald Giemsa and Papanicolaou stains were done. Histology was available in 192 cases. The cytological and histological concordance was determined and the FNAC smears and histological sections in cases showing discordance were reviewed. There was cytological and histological concordance 130/168 (77.38%) cases. In 34 cases (20.23%) no diagnosis could be offered because of cystic change. A false positive cytologic diagnosis of neoplasm was made in 4 cases. Presence of hurthle cell metaplasia, hyperplastic nodules and papillary hyperplasias were responsible for the false positive diagnoses. In 24 cases neoplasms were initially missed on FNAC of which 10 cases could be detected on review while 5 cases were considered unsatisfactory. Sampling errors were mainly responsible for these false negative diagnoses. FNAC is thus an accurate and reliable diagnostic tool for management of goiters provided strict adherence to adequacy criteria are maintained.

Adenoma↗
PubMedDate not supplied

[Antithyroid antibodies and endemic goiter].

Relationship between thyroid autoantibodies and endemic goiter have been studied in 164 subjects from three different areas of endemic goiter: 91 patients and 31 healthy controls from Central Sardinia, 23 patients from Northern Latium, and 19 patients from Southern Latium. In subjects with endemic goiter from Sardinia higher levels of thyroid autoantibodies were present as compared to the healthy controls; microsomal fraction autoantibodies titer was higher than antithyroglobulin autoantibodies. In subjects from the two other endemic goiter areas the antimicrosomal and antithyroglobulin autoantibodies were absent, with the exception of one patient with basedow's goiter. It is suggested that some of the areas classified as positive for endemic goiter are indeed characterized by an extensive genetic predisposition to lymphocytic chronic thyroiditis complicated by nodular goiter.

Adolescent↗
PubMed1990

[Incidence of goiter and thyroiditis in chronic inflammatory rheumatism].

In our investigations 201 patients with rheumatoid arthritis show in 127 cases according 63.2% (123 women = 71.1%; 4 women = 14.3%) and 32 patients with collagen diseases in 11 cases according 34.4% (11 women = 43.3%) a goiter. In comparison to a control group with a goiter incidence of 29.5% in women (168 out of 570 women), we found in female patients with rheumatoid arthritis or collagen diseases a clearly higher prevalence of goiter. But there was no difference of goiter frequency between the small groups of men. A second aim of our study was to investigate, whether an increased occurrence of the hypertrophic kind of Hashimoto's thyroiditis is to find in patients with rheumatic diseases, because of a possible association of two immunological induced affections. The results of sonographical, immunological and cytological examinations of the thyroid gland suggested no high responsibility of Hashimoto's thyroiditis for the goiter frequency in rheumatism. Only in three out of 201 investigated patients with rheumatoid arthritis (1.5%) we were able to diagnose this disease. In comparison to a rheumatologically healthy population out of the same catchment area (HT-frequency less than 0.5%), indeed the morbidity rate in rheumatic patients seems to be 3 times higher. But for a goiter frequency of altogether 63.2% in this disease the Hashimoto's thyroiditis is only of very small importance. Other causes such as pharmacotherapy with goitrogenic antirheumatic drugs, conditions of iodine deficiency, disposition and probably also an increase of thyroid growth stimulating immunoglobulins may be alone or in combination or a much higher degree responsible for goiter development in patients with rheumatoid arthritis or collagen diseases.

Adolescent↗
PubMed1989

Intrathyroidal dendritic cells, epitheloid cells, and giant cells in iodine deficient goiter.

Immunohistochemistry and immunofluorescence were performed on thyroid sections of 44 consecutive patients undergoing thyroid surgery for goiter due to iodine deficiency. Sections were compared with specimens from ten individuals without goiters from the same endemic area, with specimens from ten sporadic nontoxic goiter patients, and with specimens from an area with sufficient iodine supply from nine healthy subjects. Cells were characterized using monoclonal antibodies to the CR3 receptor (CD11b) and the p150/95 antigen (CD11c) present on macrophages, to HLA-DR, to antigen presenting cells (RFD1), to T helper (CD4) and to T suppressor/cytotoxic cells (CD8), and with a polyclonal antibody to human cytokeratin. In iodine deficient goiters, focal aggregates were found of RFD1-positive dendritic cells. Furthermore, RFD1-positive epitheloid cells were seen. In 27% of cases, these epitheloid cells completely filled the thyroid follicles. Within the epitheloid cell clusters, multinucleated giant cells could be detected that carried the macrophage markers. Dendritic cells, epitheloid cells, and giant cells were strongly HLA-DR positive. In nongoitrous thyroids from the endemic area such aggregates could also be seen but they were more sparse and were RFD1 negative. Giant cells were absent there. In normal thyroids with sufficient iodine supply, only a few isolated dendritic cells were seen. All except RFD1, which was negative, showed the same marker pattern. In sporadic nontoxic goiters from an area with sufficient iodine supply, dendritic cells occurred in much higher numbers than in the normal thyroids from that area, and they were RFD1 positive. They never aggregated as in iodine deficiency, and giant cells were not observed. These observations on iodine deficient goiter strongly suggest involvement of active antigen-presenting cells in this disorder. However, the immunohistologic difference between this disease and sporadic goiter suggests different underlying mechanisms.

Adult↗
PubMedDate not supplied

[Results and prospects for the study of endemic goiter in Kazakhstan].

The results of many-year-old research into endemic goiter epidemiology in Kazakhstan were summed up. Methods for the assessment of potential goiter risk were worked out. Multipurpose expedition investigations including mass screenings of the population and animals in all climatic and geographic zones of the republic, an analysis of the concentration of iodine and some other trace elements in the environment and the level of their consumption by man, resulted in compiling a variety of medicogeographic maps on endemic goiter epidemiology. Borders of goiter foci with various degree of endemia were defined; regions on the territory of Kazakhstan were singled out with relation to a degree of potential goiter risk, iodine deficiency, the concentration of cuprum, cobalt, manganese and fluorine. A zone of relative iodine deficiency where endemia was characterized by normal iodine consumption, was defined. Methods of differentiated antigoiter prevention with account of specific biogeochemical conditions of one or another focus, were worked out. Their introduction significantly raised the efficacy of antigoiter measures reducing goiter prevalence up to a sporadic level. The prospects of further advances in goiter control are associated with defining a biogeocemical situation in various endemic zones.

Goiter, Endemic↗
PubMed1988

Iodine-123 SPECT of the thyroid in multinodular goiter.

Iodine-123 single photon emission computed tomography (SPECT) imaging of the thyroid was performed in two patients with multinodular goiter and swallowing difficulty to provide the functional and anatomic orientation of the goiter in relation to the airway. Transaxial slices showed the retrolaryngeal extension of the enlarged thyroid and the tracheal compression by the goiter in both patients. Sagittal and coronal sections confirmed the posterior extension of the goiter. Tracheal displacement was confirmed by roentgenography of the neck in both patients. Vocal cord paralysis demonstrated by fiberoptic laryngoscope and esophageal compression shown by esophagography were found in a patient with toxic multinodular goiter with coexisting papillary carcinoma of the thyroid. In this patient, both the tracheal compression noted in SPECT imaging and the tracheomalacia suggested by the flow volume loop pattern in pulmonary function test were confirmed at the time of thyroidectomy. Our observation suggests that SPECT imaging of large multinodular goiter may be useful in preoperative delineation of the functional anatomy and the extension of goiter in relation to the airway.

Adult↗
PubMed1983

Rationale for the operative management of substernal goiters.

During the course of 872 thyroidectomies performed at the University of Michigan Medical Center between 1972 and 1982, 50 patients (5.7%) were found to have substernal goiters, 42 of which were benign and eight malignant (16%). Symptoms included airway compression (22 patients), dysphagia (13 patients), hoarseness (four patients), weight loss (three patients), and thyrotoxicosis (10 patients). Five patients with compression symptoms, four of whom had benign disease, had superior vena cava syndrome. Most patients were elderly (mean age 66 years), were women (3.2 women:1 man), and had long-standing goiters (mean duration 16 years). All but one operation was performed through a cervical incision. There were no intraoperative deaths. Complications were: pneumonia (one patient), wound hematoma (one patient), transient hypocalcemia (two patients), and atrial fibrillation (two patients). This series illustrates five reasons to support operative management. (1) There is no other treatment for long-standing large multinodular goiters. (2) Iodine 131, the alternative to operation for patients with large thyrotoxic goiters, can precipitate acute reactions in the elderly that can result in respiratory distress. (3) A long history of having a large multinodular goiter precluded neither malignancy, hyperfunction, nor complications such as tracheal or esophageal compression. (4) Malignancy occurs in a significant number of these lesions, which are inaccessible to needle biopsy. (5) Nearly all substernal goiters can be removed through a cervical incision. Presence of a substernal goiter is in itself an indication for operation.

Adult↗
PubMed1995

Goiter in Thai schoolchildren: study in Hat Yai, southern Thailand.

Examination for goiter was performed in 6,035 schoolchildren (2,899 girls, 3,136 boys), aged 8-17 years, from primary and secondary schools in Hat-Yai municipality, Songkhla province. Goiter was detected in 355 children (combined prevalence 6%; 232 or 8% in girls, 123 or 4% in boys). Of the 355 children with goiter, 214 (60%; 148 girls, 66 boys) participated in the study, and had blood drawn for free thyroxine (FT4), triiodothyronine (T3), thyroid stimulating hormone (TSH), and thyroid antibodies. All had urine collected for iodine excretion. The diagnoses of goiter were as follows: simple goiter in 192 (89.8%; 129 girls, 63 boys); juvenile autoimmune thyroiditis in 18 (8.4%; 16 girls, 2 boys); Graves' disease in 2 girls (0.9%); thyroid adenoma in 1 boy (0.45%), and ectopic thyroid in 1 girl (0.45%). Acquired hypothyroidism was found in 4 out of 18 children with juvenile autoimmune thyroiditis (22.2%). Iodine deficiency disorder was not evident in children examined shown by high urinary iodine excretion of more than 50 mcg/gm creatinine (mean 298, range 70-630). In conclusion, simple goiter is a common occurrence in children and adolescents in Southern Thailand. Juvenile autoimmune thyroiditis should be identified and differentiated from simple goiter as it is the most common cause of acquired hypothyroidism. Iodine deficiency is not evident in Southern Thailand, at least in the urban areas of a large city.

Adolescent↗
PubMed1995

[Etiopathogenesis and therapy of iodine deficiency goiter].

The main cause of endemic goiter is iodine deficiency. For the last four decades, it has been thought that the reason for goiter development is the increased action of thyreotropin (TSH) on thyroid cell proliferation. During the last years, however, it became evident that local growth factors may be more directly involved in goiter formation and, furthermore, iodinated derivatives of membrane lipids are modulators of this growth factor's actions. TSH modulates both, the growth factor and growth factor receptor expression as well as the iodine content of the thyroid gland. In addition, most of the effects of TSH on thyroid volume seems to be the induction of thyroid hypertrophy, but not hyperplasia which is related to the action of local growth factors. These new insights in the pathophysiology of goiter development are important for the regimen of endemic goiter therapy. The current concept of goiter treatment by a TSH suppressive therapy has been derived from the previous hypothesis that TSH alone is more effective in causal goiter treatment than the TSH suppressive therapy.

Adolescent↗
PubMedDate not supplied

[Endothoracic goiter operated on by cervicosternotomy. Apropos of 18 cases].

From 1968 to 1992, 18 sternotomies were performed on a total amount of 225 operated substernal goiters (8% of cases). These operations concerned 14 females and 4 males aged of about 67.8 years. 7 patients had already been operated of a goiter within 1 to 50 years. The substernal goiter was discovered on a systematic x ray chest 5 times, and a x-ray scanner once, also clinical symptoms were still present with compressive troubles in 16 times (particularly acute dyspnea 3 times). The sternotomy was always total. It was only required if the operative problems were important at the time of the cervicotomy. Indications for sternotomy were:--impossibility to extraction due to the volume of the goiter 10 times, (including 5 recurrent goiters), independent retrosternal goiter without cervical connexion, 2 times (including 2 recurrent goiters), hemorrhagic linkage, 3 times, invasive cancer, 3 times. Excluding the 3 invasive cancers, the mortality was inexistant and the morbidity very low, especially without respiratory problems. Post operative complications were 2 definitive hypoparathyroidism and 1 regressive recurrential palsy (plus 2 recurrential palsy still present before the operation). The authors pointed out the good tolerance of the sternotomy which, in special case, should be absolutely preferable the cervicotomy alone, in order to reduce the operative risks, especially hemorrhagic and nervous.

Aged↗
PubMedDate not supplied

[Thyroid status in anemic pregnant women under conditions of endemic goiter].

Anemia is a highly prevalent condition among pregnant women in the Republic of Kazakhstan. The causes of this anemia are not quite clear, as is the problem of resistance of this type of anemia to therapy with iron preparations. The authors propose that this may be explained by the fact that many regions of the Republic are foci of endemic goiter, because tentative studies indicate a relationship between endemic goiter and hypothyrosis. The present study was aimed at examination of the thyroid status in pregnant women suffering from anemia in the town of Alma-Ata, a region endemic for goiter. Altogether 120 anemic pregnant women were examined, 60 of these with goiter and 60 without it. Control group consisted of 20 healthy pregnant women. Clinical and ultrasonic examinations, puncture biopsy of the thyroid, measurements of blood levels of TTH, total and free triiodothyronine and thyroxin, thyroxin-binding globulin, as well as of peripheral blood red cell counts, levels of hemoglobin, serum iron, assessment of total iron-binding capacity of the serum and saturation coefficient, were carried out. Healthy pregnant women from a focus of endemic goiter were found to represent a group at risk of anemia in the third pregnancy trimester. In anemic pregnant women endemic goiter aggravated anemia. Chronic iodine deficiency is conductive to formation in pregnant women of subclinical hypothyrosis whose severity increased in the presence of anemia, more so if anemia is paralleled by goiter.

Adult↗
PubMed1993

Iodine intake and goiter incidence among schoolchildren living in Warsaw Region (Warsaw and Ciechanów Voivodships--Warsaw coordinating center).

The results of study concerning iodine deficiency among children attending primary schools in Warsaw and Ciechanów voivodships have been presented. The study was a part of a nationwide program on iodine prophylactics and incidence of goiter in Poland. Altogether 675 children, 356 girls and 319 boys of age between 6 and 13 years, were included into the study. Of these, 337 inhibited urban, and 338 rural areas. The presence of goiter was found in 48.6% of the studied population. In 60% of the affected children the degree of thyroid enlargement was small (IB). The incidence of goiter was higher in rural than in urban children and higher in girls than in boys. In above 90% goiter was of the diffuse type. In almost 65% of cases the diagnosis of goiter by palpation was confirmed by ultrasonography. The urinary concentration of iodine was low in 85% of the children studied. This was true for 88% of children with goiter and for 83% of children with normal size of the thyroid. Only 12% of the children studied used iodinated salt in the diet. The use of iodinated salt was more popular among urban children than among the rural ones. Low urinary concentration of iodine was found both in children not consuming and in the majority of those consuming iodinated salt. The individual iodine prophylactics had no effect on the incidence of goiter. The results obtained indicate the presence of iodine deficiency in the studied region suggesting urgent need for informative action explaining the existing situation and necessity of undertaking the widespread and effective prophylactic measures.

Adolescent↗
PubMed1993

The results of epidemiological studies concerning iodine deficiency and goiter in Poznań Region (Poznań coordinating center).

The studies concerning iodine deficiency and occurrence of goiter, being a fragment of the program covering different parts of Poland, included 2620 children of age between 7 and 12 years attending randomly chosen schools situated in towns and villages of Poznań, Pila, Leszno, Konin, Kalisz, Bydgoszcz and Zielona Góra districts. Among the children studied, 1009 children (522 boys and 487 girls) attended town schools, and 1611 (774 boys and 837 girls) country schools. All children were subjected to anamnesis by using a standard questionnaire. Also physical examination of the thyroid aimed at the evaluation of size and morphology of the gland was carried out by palpation (according to the obligatory WHO scale) and by ultrasonography. Urine samples were taken from the majority of children for the determination of urinary excretion of iodine. In 736 (28.1%) of the studied children an enlargement of the thyroid was found. Among these children 253 are inhabitants of towns (this number represents 27.8% of all urban children studied) and 483 are inhabitants of villages (30% of all rural children studied). In 92.7% of cases the goiter could be classified as type IB according to WHO and in 56 cases it was of nodular character. There was a clear relation between the incidence of goiter and the age of the children studied. Frequency distribution of goiter in the individual age groups was as follows: for urban children--21.8% in age group of 7-8 years, 23.5% in age group of 9-10 years and 29.7% in age group 11-12 years, and for rural children the corresponding values were 21.1%, 30.2% and 38.2%. Mean urinary iodine excretion was 96 micrograms/L (median 84 micrograms/L) for urban children, and 87 micrograms/L (median 64 micrograms/L) for rural children. Among 2620 answers concerning the use of iodized salt in the household, only 980 (37.1%) were positive. In towns, the use of iodized salt declared about 41% of families and in villages about 35%. Altogether, among 736 cases of goiter, 464 are children not using iodized salt. Only in 272 cases goiter appeared despite the use of iodized salt. The data concerning family occurrence of goiter and the type of iodized salt used can be treated as approximate because of subjective character. According to the results obtained, the region covered by the study falls according to the WHO and ICCIDD classification to the category of an area of mild iodine deficiency requiring more intensive iodine prophylaxis.

Child↗
PubMed1997

Evaluation of hyperplastic goiter in a colony of Syrian hamsters (Mesocricetus auratus).

Hyperplastic goiter was diagnosed during routine health monitoring of a closed Syrian hamster colony (SG). Adult and juvenile hamsters were affected at a prevalence of 45%. Histologic examination of the enlarged thyroid gland revealed marked follicular cell hyperplasia. Because prevalence of thyroid hyperplasia in this colony exceeded the 6 to 7% prevalence expected in aged hamsters, additional studies were performed to investigate the pathogenesis of this condition. Juvenile male SG hamsters and age- and sex-matched Syrian hamsters that did not have increased prevalence of goiter were obtained from an unrelated source (Fredrick Cancer Research and Development Center [FCRDC]). The thyroid glands of hamsters were evaluated by 123I radionuclide imaging. Eight of 18 SG hamsters and none of the FCRDC hamsters had a diagnosis of enlarged thyroid gland. Serum baseline and post-thyrotropin thyroxine concentrations in SG hamsters were not statistically different from those in FCRDC hamsters. To investigate whether diet played a role in development of hyperplastic goiter, for 6 months 15 FCRDC hamsters were fed the diet that had been fed to SG hamsters (mouse breeder diet), and five were fed a control diet. To determine whether dietary change would result in resolution of goiter, affected SG hamsters were fed a control diet for 3 months. At the end of each feeding trial, thyroid gland uptake of 123I was reevaluated. The amount of 123I taken up by the thyroid glands of FCRDC hamsters fed the mouse breeder diet was not significantly different from that of controls. In contrast, thyroid gland uptake of 123I remained high for all affected SG hamsters fed the control diet. On the basis of results of these investigations, diet was ruled out as the cause of goiter. Also, a diagnosis of euthyroid hyperplastic goiter was made for the SG hamsters. A genetic cause is suspected to play a role in the increased prevalence of goiter in SG hamsters.

Animals↗
PubMedDate not supplied

Thyroid dysfunction and nodular goiter in hemodialysis and peritoneal dialysis patients.

OBJECTIVE: To investigate the prevalence of nodular goiter and thyroid dysfunction in uremic patients undergoing hemodialysis (HD) and peritoneal dialysis. DESIGN: Cross-sectional study. SETTING: Single dialysis unit and outpatient clinic. PATIENTS: The study included 221 patients [143 HD and 78 continuous ambulatory peritoneal dialysis (CAPD) patients] along with 135 consecutively selected outpatients as controls. MAIN OUTCOME MEASURES: Ultrasonography was used to detect patients' thyroid function and nodular goiter. RESULTS: Nodular goiter was detected in 54.8% of the uremic patients and in 21.5% of the controls. Uremic patients had higher prevalence of thyroid dysfunction, which included reduced serum concentration of total T3, total T4, and free T4, and increased serum level of TSH. Hypothyroidism was also observed more frequently in uremic patients than in the control group (5.4% vs 0.7%, p < 0.05). Nodular goiter was more frequently found in females than in males (63.5% vs 48%, p < 0.05). Moreover, the prevalence of nodular goiter increased with age (p < 0.02) in uremic patients. Hemodialysis patients had a higher frequency of reduced total T3 level (46.9% vs 29.5%, p < 0.02). However, CAPD patients had lower T4 levels (6.23+/-1.82 microg/dL vs 7.15+/-1.99 microg/dL, p < 0.05). CONCLUSION: Because of the high incidence of hypothyroidism and nodular goiter in uremic patients, screening of thyroid function and goiter detection with ultrasound should be considered in evaluation of end-stage renal disease patients.

Case-Control Studies↗