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PubMed1998

[Current situation of goiter endemic and iodine intake in the population of the Pyrenees and the Segrià region of Lleida].

OBJECTIVE: To assess the prevalence of goiter in five areas of the Pyrineans and in the region of Segrià in Lleida. DESIGN: Transversal descriptive study. SETTING: Five Pyrinean's regions and Segrià. PATIENTS: Randomised selection of a sample of 601 subjects from the population over 6 years old. MEASUREMENTS: The field work, which was preceded by an informative campaign in the media, was carried out from October of 1994 through February of 1995. Survey with a personal interview, blood pressure, weight, height, goiter palpation, blood analysis with thyroidal hormones and urine analysis with the iodine/creatine ratio determination. RESULTS: The prevalence of goiter was 18.3% which was higher among women, the ratio being 3.7/1 (women/men). No significant differences were found in regard to geographic distribution. Mean iodinuria was 120 micrograms/l, though it was below 50 in 11.1% subjects. The prevalence of goiter has been founded to be related to age, increasing from the age of 45 onwards. Higher percentage of goiter was found among individuals with a family history of the disease and women who have had children. The prevalence of hypothyroidism was 3.4%. CONCLUSIONS: We have found a medium degree of goiter's endemia in the study area, the mean iodinuria in the population is in normal range. The women with children have a higher prevalence of goiter probably due to a lack of sufficient iodine intake being a subgroup at risk.

Adolescent↗
PubMed1992

[Epidemiologic examinations of goiter in the population of the Sejny community].

The study was aimed at the evaluation of incidence of goiter in the population of the community of Sejny. The survey comprising 1520 subjects revealed the presence of thyroid enlargement in 31.8% of the subjects studied, indicating the occurrence of a mild endemy. The facts speaking for this type of endemy are: predominance of cases with goiter of OB or I degree (83%), higher incidence of goiter in women than in men (3.3 times), occurrence of nodular goiter in 12% of cases with goiter, and sporadic appearance of hypothyroidism. Goiter endemy in the population of this area can be attributed to such goitrogenic factors as low level of iodine and high content of calcium in the water, tobacco smoking, and a habit of drinking tap water.

Adolescent↗
PubMedDate not supplied

Sequential occurrence of toxic nodular goiter followed by Graves' disease.

OBJECTIVE: To present the first case of Graves' disease occurring after toxic nodular goiter in a patient who had not received radioiodine therapy. METHODS: We describe the clinical, laboratory, and radiologic findings in a 65-year-old woman with toxic nodular goiter followed by Graves' disease and review related reports in the literature. RESULTS: Although isolated case reports have documented the sequential occurrence of toxic nodular goiter or toxic adenoma and Graves' disease, no definite connection currently exists between these two types of hyperthyroidism. In cases previously described, Graves' disease appeared after the use of radioiodine for the treatment of the toxic nodular goiter. In our current patient, toxic nodular goiter was treated surgically, followed by the occurrence of Graves' disease 3 years later. CONCLUSION: This is the first published case of sequential toxic nodular goiter and Graves' disease in which radioiodine was not used for treatment of the goiter and thus cannot be implicated as the inciting event for the subsequent development of Graves' disease.

Journal Article↗
PubMed1977

Kentucky Appalachian goiter without iodine deficiency. Evidence for evanescent thyroiditis.

In Breathitt County, Kentucky, an Appalachian Mountain community, 1,267 children were examined to determine goiter prevalence. Matched pairs of 82 goitrous and nongoitrous children were reexamined six months later for family history, urinary iodine excretion, serum thyroxine, triiodothyronine, protein-bound iodine, thyrotropin, and thyroid autoantibodies. Goiter prevalence was 8.4%. Iodine deficiency was not found. Thyroid stimulating hormone levels were higher in the goitrous group. Microsomal autoantibody titers were elevated in 20% of the children with goiters vs 6% of controls (P less than .05). Fluorescent antibodies were associated with positive microsomal (P less than .01) but not with positive tanned RBC autoantibodies. Unexpectedly, on repeat examination, goiter was absent in 17 (21%) of the originally goitrous group, but was now present in 22 (25%) of the controls. We concluded that while evolving thyroiditis is common in Appalachian children, it does not explain all goiters in an area of abundant iodine intake and known familial goiter.

Adolescent↗
PubMed1998

Management of substernal goiter.

OBJECTIVE: To analyze the presentation, evaluation and treatment of patients with large substernal goiters, with emphasis on the radiographic evaluation and the results of treatment. STUDY DESIGN: A retrospective chart review of 150 patients undergoing thyroidectomy at the Vanderbilt University Department of Otolaryngology-Head and Neck Surgery. METHODS: Charts of patients undergoing thyroidectomy were reviewed. Those with substernal goiter, defined as a major portion of the goiter within the mediastinum, were included in the study. When available, the radiographic studies were reviewed by a staff neuroradiologist. RESULTS: Twenty-three patients (15.3%) presented with substernal extension of the goiter. Characteristics of these patients included mean age of 59 years, 78% female, symptoms of compression such as dyspnea, choking, and dysphagia (65%), hoarseness (43%), and previous thyroid surgery (30%). Seventeen percent were asymptomatic. Preoperative radiographs demonstrated tracheal compression (73%), tracheal deviation (77%), esophageal compression (27%), and major vessel displacement (50%). Histology revealed multinodular goiter (16/23, 70%), thyroiditis (3/23, 13%), and malignancy (4/23, 17%). The average size of the resected specimen in greatest dimension was 8.0 cm (range, 3.0-14.0 cm) and weighed 148 g (range, 39-426 g). All were successfully approached through a transcervical incision without the need for sternotomy, and total thyroidectomy was performed in 83% of the cases. No major complications have been documented, and no evidence of tracheomalacia was encountered. CONCLUSION: Despite the large size of these goiters and the significant involvement of the major mediastinal structures, all were approached through the transcervical incision. Further, despite significant tracheal involvement, there were no cases of tracheomalacia or major complications. For intraoperative planning, the authors advocate the routine use of preoperative computed tomography scanning.

Adult↗
PubMed2024

Exploring the potential of genetic analysis in historical blood spots for patients with iodine-deficient goiter and thyroid carcinomas in Switzerland and Germany (1929-1989).

Iodine deficiency-induced goiter continues to be a global public health concern, with varying manifestations based on geography, patient's age, and sex. To gain insights into clinical occurrences, a retrospective study analyzed medical records from patients with iodine deficiency-induced goiter or thyroid cancer who underwent surgery at the Community Hospital in Riehen, Switzerland, between 1929 and 1989. Despite today's adequate iodine supplementation, a significant risk for iodine-independent goiter remains in Switzerland, suggesting that genetic factors, among others, might be involved. Thus, a pilot study exploring the feasibility of genetic analysis of blood spots from these medical records was conducted to investigate and enhance the understanding of goiter development, potentially identify genetic variations, and explore the influence of dietary habits and other environmental stimuli on the disease.Blood prints from goiter patients' enlarged organs were collected per decade from medical records. These prints had been made by pressing, drawing, or tracing (i.e., pressed and drawn) the removed organs onto paper sheets. DNA analysis revealed that its yields varied more between the prints than between years. A considerable proportion of the samples exhibited substantial DNA degradation unrelated to sample collection time and DNA mixtures of different contributors. Thus, each goiter imprint must be individually evaluated and cannot be used to predict the success rate of genetic analysis in general. Collecting a large sample or the entire blood ablation for genetic analysis is recommended to mitigate potential insufficient DNA quantities. Researchers should also consider degradation and external biological compounds' impact on the genetic analysis of interest, with the dominant contributor anticipated to originate from the patient's blood.

Humans↗
PubMed2004

Epidemiology of palpable goiter in greater Buenos Aires, an iodine-sufficient area [corrected].

The Hospital de Clínicas organized a free program of goiter detection by palpation. This campaign was aimed at the population of the metropolitan area of Greater Buenos Aires (11 million inhabitants), with the prerequisite that each participant should be quite unaware whether he/she was a carrier of any thyroid disease. Attendees were split into two groups, i.e., Random and Induced. The former consisted of 542 individuals who came to consultation due to mere curiosity, while the latter involved 500 subjects, comprising consanguineous family members of patients with thyroid disorders and also individuals who suffered from other ailments. Ages ranged from 2 to 85 years. In the Random Group, goiter prevalence of 8.7% was observed, while in the Induced Group it climbed to 14.4%. Since both groups were mostly made up of women (87.2%), a correction based on the masculinity index was applied to members of the Random Group. Thus, the total observed prevalence of goiter was 6%, diffuse goiters corresponding to 3.5% and nodular ones to 2.5%. The frequency of nodules increased with age, 90.5% occurring in those over 40 years. In the Induced Group, goiter prevalence among relatives of patients with thyroid disorders proved to be 13.1%, rising to 17.8% in those who suffered from other complaints. The epidemic data presented herein are the first arising from a screening survey carried out in a large iodine-sufficient population of the southernmost tip of the American continent. These results are useful to build up the world map of goiter prevalence in non-endemic areas.

Adolescent↗
PubMed1988

[Treatment of endemic and sporadic goiter].

Early continuous hormonal treatment, inhibiting TSH secretion, reduces the volume of recent homogeneous goiters. This treatment is usually well tolerated, but can induce thyrotoxicosis in subjects with blunted response of TSH to TRH stimulation before treatment. Surgery is used for large goiters, compressive goiters or suspicion of cancer and after failure of the hormonal treatment. In all cases, hormonal treatment must be associated to surgery. Radio-iodine can be used for large or compressive goiters, when surgery is inadvisable. Despite the risk of thyrotoxicosis, iodine addition in food intake is useful to prevent goiters. The frequency of thyrotoxicosis can be decreased by ruling out subjects over 50 years old, with nodular goiters or with blunted response of TSH to TRH stimulation.

Goiter↗
PubMedDate not supplied

Morphologic relationships between thyroid carcinoma and associated thyroid lesions in thyroidectomized patients. Comparison between 60 malignancies and 40 non-malignant goiters.

Given the endemic goiter in Romania, the authors sought to evaluate the morphologic prognostic factors with histogenetic implications in the development of thyroid cancer. On this purpose, the morphologic factors that correlate the type of thyroid cancer to the host stromal alterations were studied on 3 groups of 20 patients each and 2 control lots for multinodular goiter and nodular goiter. One group consisted of cases of thyroid carcinoma associated with endemic goiter, the second group included cases of thyroid carcinoma with thyroiditis and nodular goiter and the third group, the cases of thyroid sclerosing occult carcinoma. The study showed in all the cases, that thyroid cancer evoluates as an autonomic lesion, independent of the endemic goiter which is not a risk factor.

Adenocarcinoma↗
PubMedDate not supplied

Surgical indications in endemic goiter. Pre- and postoperative care.

The authors express their opinion with respect to anatomo-clinical forms of endemic goiter. First they suggest preoperative thyroid re-equilibration to avoid postoperative complications such as hypothyroidism or recurrence. Then operative indications for endocrine goiter, especially in an endemic area are discussed. Opinions are also expressed with respect to diffuse parenchymatous (endemic) goiter, nodular and polynodular goiter together with the various forms that may have a nodular or polynodular aspect both anatomically and as localization. Extemporaneous examination is viewed by the authors as compulsory in all such goiters, whereas preoperative thyroid puncture is counterindicated. Surgical care of mixed endemic goiter (diffuse hyperplasia with nodules imbedded in the hyperplasia) is also reviewed. It is recommended that each operation be preceded by an adequate preoperative treatment, for which therapeutic schemes are indicated as well as postoperative care directions taking into account the anatomo-clinical form. The surgical approach recommended is subtotal thyroidectomy. The paper also provides some statistical figures concerning surgery in the Institute of Endocrinology in Bucharest.

Aging↗
PubMed1997

[Surgical treatment of cervicomediastinal goiter].

To review our experience with the surgical treatment of cervicomediastinal goiters. Charts of patients with cervicomediastinal goiters undergoing thyroidectomy within the last 10 years were reviewed. Data regarding previous disease, clinical features, diagnostic procedures, surgical intervention and postoperative evolution were recorded. Twenty-eight patients (19 female and 9 male) 62 +/- 2 years old underwent surgery to treat cervicomediastinal goiter during the period reviewed. Among patients with compressive manifestations (75.6%), dyspnea was the most common (36.6%) symptom, followed by dysphagia and superior vena cava syndrome. An extrathoracic obstruction pattern was found in 3 (11.2%) cases. Thyroid scintigraphy showed increased thyroid size in 25 patients, and in 9 of them a cold nodule was present as well. Fine needle aspiration of the thyroid gland was performed in 5 patients; malignancy was found only in 1 case. Fiberoptic bronchoscopy was performed in 15 patients; in 7 (25%) tracheal compression was found. In these patients there was no higher rate of postoperative complications. Cervicotomy was the surgical approach used in 23 (82.1%) patients. Cervicosternotomy was used in 4 (14%), and thoracotomy in 1 (3.6%). The surgical procedure was bilateral subtotal thyroidectomy in 15 (53.6%), total thyroidectomy in 3 (10.7%), right lobectomy in 6 (21.4%), and left lobectomy in 4 (14.3%). Colloid goiter was the most common histological type (42.8%), followed by nodular hyperplasia (35.8%), cancer (10.7%) and adenoma (10.7%). Three patients showed transient recurrent paralysis in the postoperative period, and another 3 patients presented major complications: 1 case of postoperative bleeding and 2 cases of tracheomalacia requiring tracheostomy. Cervicomediastinal goiter is a disease that may involve compressive symptoms. In our experience, most cases were resected through cervicotomy, colloid goiter and the nodular hyperplasia being the most common histological types. There was no relationship between surgical procedure and the incidence of complications.

Adult↗
PubMed2006

Stimulation with 0.3-mg recombinant human thyrotropin prior to iodine 131 therapy to improve the size reduction of benign nontoxic nodular goiter: a prospective randomized double-blind trial.

BACKGROUND: Use of recombinant human thyrotropin increases the thyroid radioiodine (iodine 131 [(131)I]) uptake and may have a role in the context of (131)I therapy of benign goiter. METHODS: In a double-blind, placebo-controlled trial, 57 patients with nodular nontoxic goiter (51 women and 6 men) were randomized to receive either 0.3 mg of recombinant human thyrotropin (n = 28) or placebo (n = 29) 24 hours before (131)I therapy. The (131)I dose was calculated based on thyroid size (measured by ultrasound), thyroid (131)I uptake, and (131)I half-life. The follow-up period was 1 year and included measurements of thyroid size and function and patient satisfaction. RESULTS: Baseline median goiter volume was 51 mL (range, 20-99 mL) in the placebo group and 59 mL (range, 25-92 mL) in the thyrotropin group (P = .75). At 12 months, the mean +/- SEM relative goiter reduction was 46.1% +/- 4.0% in the placebo group and 62.1% +/- 3.0% in the thyrotropin group (P = .002 between groups). The difference was most pronounced among patients with large goiters. Within each group, there was no significant correlation between retained thyroid (131)I dose and goiter reduction. Adverse effects were significantly more frequent in the thyrotropin group (34 vs 12 events; P<.001). Permanent hypothyroidism developed in 3 patients (11%) in the placebo group compared with 16 patients (62%) in the thyrotropin group (P<.001). Patient satisfaction was high and uninfluenced by the use of recombinant human thyrotropin. CONCLUSIONS: Stimulation with recombinant human thyrotropin prior to (131)I therapy improves thyroid size reduction by 35%, with a 5-fold higher rate of hypothyroidism. These effects are, at least partially, mediated through mechanisms other than an increase in retained (131)I thyroid dose. Further recombinant human thyrotropin dose-finding studies are warranted before routine use.

Adult↗
PubMed2004

Predictors of airway complications after thyroidectomy for substernal goiter.

HYPOTHESIS: Airway complications after thyroidectomy for substernal goiter can be predicted by preoperative symptom profiles, radiologic findings, or other factors. DESIGN: Retrospective review. Settings A university tertiary care center and a veterans' hospital. PATIENTS: Sixty patients with substernal goiter who underwent thyroidectomy between 1993 and 2002. MAIN OUTCOME MEASURES: Symptoms, preoperative radiologic findings, extent of thyroid resection, tumor size, and postoperative complications. RESULTS: Dysphagia was the most common preoperative symptom (n = 26), followed by dyspnea (n = 21), orthopnea (n = 13), and hoarseness (n = 6); 18 patients (30%) had superior vena caval obstruction. Thirteen patients (22%) were asymptomatic. Preoperative imaging identified tracheal deviation or compression in 45 patients (75%). Substernal goiter was resected via a cervical approach in 59 patients (98%). Of 47 patients with preoperative symptoms, 41 (87%) reported improvement postoperatively. Seven patients (12%) had postoperative airway complications: 1 developed a neck hematoma requiring reoperation, and 6 could not be immediately extubated; all 6 were successfully extubated after 1 to 10 days. Patients with airway complications were older (mean +/- SEM, 70.3 +/- 3.6 years vs 61.5 +/- 2.2 years), had larger goiters (mean +/- SEM, 210.7 +/- 37.0 g vs 112.2 +/- 7.7 g), and were more likely to have tracheal compression on preoperative imaging than those who did not have complications (P<.05). CONCLUSIONS: Most patients with substernal goiters underwent thyroid resection via a cervical approach with an improvement in symptoms. The few patients who developed postoperative airway complications were older, had larger goiters, and were more likely to have tracheal compression on preoperative imaging than those without airway complications.

Age Factors↗
PubMedDate not supplied

Incidence of carcinoma of the thyroid in nodular goiter.

Since the incidence of cancer in nontoxic nodular goiter as reported by us in 1944 appeared high (17.1%), we made another study during the next four years and discovered an incidence almost identical (17.2%). Our figures on incidence of cancer in nontoxic nodular goiter appeared so high because we were the first authors to break down the goiters into the three different types and to discover that the incidence was high in only one type of goiter and not in the others. The incidence of cancer was only 4.6% in toxic nodular and toxic diffuse goiter added together. For decades, we have known that goiter is a geographic disease. It is possible that carcinoma of the thyroid is slightly geographical. At least it appears that there is a slightly geographical relationship in regard to the 16 patients we have observed in our clinic with cancer during 1944-1949; of these 16 patients, 11 had advanced malignant disease. We cannot have accurate figures on results regarding treatment of our cases until long-term follow-up is concluded.

Carcinoma↗
PubMed1993

Immunological features of sporadic multinodular goiter.

The origin of sporadic multinodular goiter is still uncertain. To obtain information on a number of unexplored immunological features, the distribution and characterization of T, B, and natural killer lymphocyte subsets were studied in the peripheral blood of 15 patients with multinodular goiter; 8 patients with Graves' disease (for reference purposes with a well-characterized autoimmune disease) and 29 age- and sex-matched healthy controls, combining double-staining immunofluorescence technique with monoclonal antibodies and flow cytometry. Although in both thyroid diseases increased CD3+ HLA-DR+ activated T cells (P < 0.01) were detected, in Graves' disease this was associated with decreased numbers of CD8 cells (P < 0.05) and an increased CD4/CD8 ratio (P < 0.01). These abnormalities were absent in multinodular goiter, which displayed increased CD8+ CD57+ cytotoxic/suppressor cells (P < 0.01). There was an increase in the percentage of natural killer cells expressing CD16 and CD57 antigens in multinodular goiter but not in Graves' disease. The B-cell associated antigens CD19 and CD19+ CD5+ were significantly increased in Graves' disease (P < 0.01), while the multinodular goiter patients exhibited only an increased number of B cells coexpressing the CD5 antigen (CD19+ CD5+), which was unrelated to the titers of anti-microsomal and antithyroglobulin autoantibodies. Our results point to the presence of several abnormalities of peripheral T, B, and natural killer lymphocytes in sporadic multinodular goiter, with a distribution pattern quite different from that observed in Graves' disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Iodine and zinc, but not selenium and copper, deficiency exists in a male Turkish population with endemic goiter.

Although endemic goiter has been shown to have a high prevalence in Turkey, little is known about the concentration of urinary iodine, plasma selenium (Se), copper (Cu), and zinc (Zn) in these patients. We studied on 140 male patient with endemic goiter (mean age: 22.2 +/- 0.19 yr) and 140 healthy male subjects (mean age: 21.8 +/- 0.28 yr). Daily urinary iodine excretion was determined by the ionometric method. Plasma Se, Zn, and Cu were determined by using atomic absorption spectrometry. Daily urinary iodine excretion was found to be significantly lower in the patient group (38.7 +/- 2.26 microg/d) than that of controls (50.73 +/- 2.56 microg/day, p = 0.001). Plasma Zn concentrations were also found to be significantly lower in the patient group (1.04 +/- 0.03 microg/mL) than that of controls (1.16 +/- 0.02 microg/mL, p = 0.001). No significant difference was determined in Se and Cu concentrations between the patient and control groups. Our study shows that a moderate iodine deficiency exists in both patients with endemic goiter and control subjects, which indicates the important role of iodine deficiency in the etiopathogenesis of endemic goiter in Turkey. Zinc deficiency may also contribute to the pathogenesis of endemic goiter. However, Se and Cu do not seem to have any role in the etiopathogenesis of endemic goiter in Turkey. A community-based iodine fortification program throughout the country may be proposed to take over the problem, which also can prevent the contributing effects of other element deficiencies that occur when iodine deficiency is the prevailing factor.

Adult↗
PubMed1987

Low TSH-response to TRH in a former endemic goiter area.

During 30 yr of iodine prophylaxis endemic goiter in school children had disappeared in the Savonlinna area which has been the location of continuous surveillance in the East of Finland. In adults goiter is still found to some extent especially in older people. The iodine intake has increased from about 50 to 300 micrograms per day during these yr and the thyroidal uptake of radioactive iodine has decreased from over 60% to between 20 and 30%. However, there is a significant difference in this regard between nongoitrous individuals and goiter patients. In the present study comprising only goiter patients it was found that the thyroidal uptake was significantly higher in the group of patients with a subnormal response to TRH. These patients also had larger goiters and more palpable thyroid nodules than those with a normal response to TRH. The mean age was significantly higher (60.3 yr) as compared to that in the group which had a TSH-response to TRH of greater than 20 mU/l, smaller glands and less thyroid nodules (45.1 yr). The data fit well with the reports on increasing autonomy with increasing age in nontoxic goiter.

Adolescent↗
PubMed2003

Further indications for genetic heterogeneity of euthyroid familial goiter.

Iodine deficiency is the most important etiological factor for euthyroid endemic goiter. However, family and twin pair studies also strongly indicate a genetic prediposition. In euthyroid goiters molecular defects in the thyroglobulin (TG), and Na+/I- symporter (NIS) gene have been identified. Numerous mutations in the Pendrin (PDS) gene have been found in families with PDS characterized by deafness and euthyroid goiter. Moreover, family studies indicated two major candidate loci MNG-1 on chromosome 14q31 and Xp22. However, all previous linkage studies investigated only one family. To clarify the general relevance of these previously identified two major candidate loci for the etiology of euthyroid goiter we investigated four families with a total number of 74 family members by linkage analysis with microsatellite markers. Moreover, we analyzed the thyroid candidate genes TG, thyroperoxidase (TPO), NIS, TSH receptor, and PDS. In a further family with 12 members in whom we have previously demonstrated linkage to the MNG-1 locus we investigated the Xp22 locus and the PDS gene in addition to our initial study. Linkage analysis results of our study are not significant enough to definitely exclude or confirm linkage to the investigated candidate genes and loci. Nevertheless, we obtained very weak indications for possible linkage to Xp22 in one family by a maximal multipoint LOD score of 1.15, and cosegregation of haplotypes among affected family members. Moreover, in another family linkage to PDS was indicated by a maximal multipoint LOD score of 1.87 as well as cosegregation of haplotypes. However, sequencing of the PDS gene did not reveal germline mutations. A significant total NPL score of 6.5 for PDS over all families most likely indicated linkage to a genomic region close to PDS. Furthermore, the likelihood of linkage to MNG-1 and Xp22 is reduced, because multipoint LOD scores were below 1 or negative. In all families there was no significant evidence for linkage for the thyroid candidate genes TG, TPO, NIS, or the TSH receptor. In conclusion, a general role of MNG-1 and Xp22 for the etiology of euthyroid goiter is unlikely but cannot clearly excluded. The multipoint parametric and nonparametric LOD scores further suggest genetic heterogeneity in the etiology of familial euthyroid goiter. To identify other susceptibility loci it is necessary to perform genome-wide linkage analysis studies with more families.

Adolescent↗