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PubMed2005

[The use for recombinant human TSH in patients with toxic and non-toxic nodular goiter].

Radioiodine ((131)I) treatment for multinodular toxic and non-toxic goiter is therapeutic procedure especially used in patients with contraindication for surgery. (131)I treatment diminishes the size of the goiter and treats hyperthyroidism. Sometimes, due to low radio-iodine uptake (RAIU), this procedure should not be used. In patients with goiter, the elimination of medication or substances rich in iodine is the first step to increase RAIU. Recombinant TSH (rhTSH) enhances RAIU in metastases distant from thyroid cancer. Studies were performed in recent years using rhTSH to increase the radio-iodine uptake in multinodular toxic and non-toxic goiter. These methods led to enhanced radio-iodine uptake, decreased the level of activity of the (131)I administered, changed the distribution of (131)I in the thyroid, lowered the absorption dose, and increased the number of patients with hypothyroidism. The uses of rhTSH can lead to exacerbation of the signs and symptoms of hyperthyroidism, so patients should be hospitalized. Until now there has been no evidence that the adverse effects outweigh the positive results of using rhTSH. The use of rhTSH in benign goiter disease is not yet approved, but its positive activity in multinodular goiter is very interesting and promising.

Goiter, Nodular↗
PubMed2006

Retrosternal thyroid goiter: 15 years experience.

BACKGROUND: Thyroidectomy for goiter is a common surgical procedure performed in most hospitals in Israel. Both general and ear, nose and throat surgeons are familiar with thyroidectomy for cervical goiters. In about 1-15% of thyroidectomies, the goiter is intrathoracic and requires somewhat different management. This topic has not been reviewed in the literature recently. OBJECTIVE: To evaluate the clinical presentation, preoperative workup, surgical complications and risk of malignancy in retrosternal goiters. METHODS: We retrospectively reviewed the records of 75 patients who underwent thyroidectomy for retrosternal goiter in the General Thoracic Surgical Department of our institution during a 15 year period, January 1990 to January 2005. RESULTS: All the patients (41 women and 34 men) were symptomatic at presentation, with choking and dyspnea being the most common complaint. Computerized tomography scan of the neck and chest were obtained before the operation in 71 patients (95%). Ten patients (13%) had a previous partial thyroidectomy. A cervical approach was used in 68 patients (91%). Seven patients (9%) required median sternotomy to complete the operation. One patient (1.3%) died from postoperative respiratory failure. Transient recurrent laryngeal nerve palsy occurred in 5 patients (7%) and permanent RLNP in 3 (4%). The incidence of transient and permanent hypoparathyroidism was 10% and 2.6% respectively. Sixty-six lesions (88%) were benign and 9 (12%) were malignant. CONCLUSIONS: Choking and dyspnea are the most common presenting symptoms of retrosternal goiter. CT scan is an important component of the preoperative evaluation and operative planning. Surgical removal of the thyroid is the treatment of choice and most patients have symptomatic improvement following the operation. Since a substernal thyroidectomy may be technically different from cervical thyroidectomy, a surgical team familiar with its unique pitfalls should perform the procedure.

Adult↗
PubMed1991

Higher prevalence of goiter in endemic area of blackfoot disease of Taiwan.

Blackfoot disease is an endemic peripheral vascular disorder which is confined to a limited land area on the southwest coast of Taiwan. It has long been related to the consumption of high levels of arsenic found in the artesian well water. Humic substances have also been extracted from the well water and have been reported as a possible source of environmental goitrogen. The purpose of this study was to examine whether the prevalence of goiter is increased in the blackfoot disease-endemic area. This study covered all the children in the elementary schools of Putai and Peimen. They were divided into two groups according to the location of schools in the endemic area or non-endemic area of blackfoot disease. 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 particle agglutination methods and radioimmunoassays, respectively. Aspiration cytology was done in cases with a nodular goiter. In total 4,567 school children were examined, including 2,306 males and 2,261 females. One hundred and twenty school children (2.63%) had a goiter of grade I or above. The prevalence of goiters in school children from the endemic area was higher than that from the non-endemic area (3.44 vs 2.08%, p less than 0.01). The prevalence of goiters in females from the endemic area was higher than that from the non-endemic area (4.65 vs 2.69%, p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers↗
PubMed1991

Etiology of adult goiter in Taiwan--a hospital-based study.

We studied the etiology of goiter on outpatient clinic basis with thyroid function test, measuring circulating thyroid autoantibodies and urinary iodine excretion. One hundred patients from endocrine and metabolic clinic with grade I or over goiter according to the WHO classification were included by random sampling after carefully excluding the pure thyroid cyst and thyroid cancer by sonographic examination and fine needle aspiration cytology. Among these 100 studied cases, 23 were classified as Graves' hyperthyroidism (group 1), 19 autoimmune thyroiditis (group 2), 14 simple goiter (group 3), 42 nodular goiter (group 4) and 2 subacute thyroiditis. All four groups of goiter showed female predominance. The mean +/- SD age and 24-hour % RAIU for these four groups were 33.9 +/- 14.5 and 64.3 +/- 24.4; 44.6 +/- 19.5 and 27.3 +/- 11.3; 37.5 +/- 15.9 and 27.5 +/- 9.0; and 47.5 +/- 16.4 and 36.1 +/- 16.7, respectively. Patients with Graves' hyperthyroidism were significantly younger in age than the nodular goiter group and had higher RAIU than the other three groups (p less than 0.05, Kruskal-Wallis ANOVA, multiple comparisons). There was no age or RAIU difference among groups 2-4. The amount of urinary iodine excretion distributed in a very wide range and exhibited no significant difference among four groups. Only 2 subjects had urinary iodine excretion below 50 micrograms iodine/g creatinine but 50% (49.3% of group 2-4) had urinary iodine excretion higher than 300 micrograms iodine/g creatinine. Iodine deficiency is not a real problem at present.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Surgical treatment of substernal goiters.

Fifty-one patients (4.6%) underwent resection of a substernal goiter in a fifteen-year period during the course of 1103 thyroidectomies. Forty-eight (94.2%) goiters were benign and three (5.8%) malignant. Mean age was 55 years. Female:male ratio was 2:1. Four patients (7.8%) had undergone prior thyroid surgery. Most had long-standing goiters (mean duration: 15 years). The most common symptoms included airway compression (56.8%), hoarseness (13.7%), dysphagia (11.7%), superior vena cava syndrome (9.8%). Twelve patients (23.5%) were asymptomatic. Chest X-rays showed a tracheal deviation and/or a mediastinal mass in 43 patients (84.3%). Goiter extended into the right mediastinum in 28 patients (54.9%), into the left in 19 (37.2%), and bilaterally in three (5.8%). A cervical collar incision provided adequate exposure in 42 cases (82.3%). Five patients (9.8%) required a cervical incision plus partial median sternotomy and one (1.9%) a cervical incision plus a right postero-lateral thoracotomy. In three asymptomatic patients (5.8%) thoracotomy was followed by cervical incision due to a preoperative incorrect diagnosis. Major postoperative complications included two cervico-mediastinal hematoma with one subsequent death and four (7.8%) recurrent laryngeal nerve palsy. This series showed that: (1) Standard chest roetgenogram with esophagogram is still the most useful investigation, although CAT scan can help in planning the operation. (2) Cervical collar incision provides adequate exposure in nearly all cases. (3) When goiter enucleation is difficult or at risk, a complementary median sternotomy is indicated in right retrovascular goiters. (4) Operation should be recommended in all but the highest-risk patients. (5) Tracheal intubation with small caliber tubes is nearly always possible in patients with acute tracheal compression.

Adult↗
PubMedDate not supplied

[Thyroid adenocarcinoma and Hashimoto's goiter].

A comparative analysis of 2419 case histories of patients operated on for different thyroid diseases, has shown that the frequency of adenocarcinomas in lymphadenoid goiter is almost like in nodular and multinodular goiter however they are detected usually in the form of microfoci. Thyroid cancer in patients with lymphadenoid goiter combined with nodular goiter and/or adenoma is detected twice as more frequently than in patients with (multi)nodular goiter. Routine methods of investigation do not permit preoperative detection of malignancy against a background of lymphadenoid goiter.

Adenocarcinoma↗
PubMed1989

Changes in serum thyroid hormone and thyroglobulin levels after surgical treatments for toxic and non-toxic goiter.

We assessed changes in serum total tri-iodothyronine (TT3), total thyroxine (TT4), free thyroxine (FT4), reverse tri-iodothyronine (rT3), thyroid stimulating hormone (TSH), and serum thyroglobulin (hTg) levels in 20 patients with toxic diffuse goiter who received subtotal thyroidectomy after metabolic control with antithyroid drugs and 22 patients with non-toxic solitary nodular goiter who received lobectomy only. In the first 2 days postoperatively the toxic diffuse goiter group had approximately a 50% decrease in the mean serum TT3 concentration, and a 28% decrease in the mean serum TT4 concentration. In the same period, the non-toxic nodular goiter group had approximately a 30% decrease in mean serum TT3 concentration, and a 15% decrease in mean serum TT4 concentration. The toxic diffuse goiter group and the non-toxic nodular goiter group each had transient elevations of the mean serum rT3 concentration, amounting to 34% and 48% respectively. Neither group had any change in the mean serum FT4 level, while both showed a several-fold elevation of serum hTg. At the 6th week postoperatively in both groups, the mean serum TT3 level had returned to the preoperative value, the mean serum TT4, rT3 and hTg levels were significantly lower than preoperative values, and the mean serum FT4 level remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Circadian and seasonal variations in iodine excretion in children with and without endemic goiter.

The urinary iodine excretion was measured in 193 children 11 +/- 1.5 years of age living in the endemic goiter area of Dîmboviţa, Romania. One hundred and thirty four of the children showed some degree of endemic goiter, 59 showed none. All children followed a diurnal activity pattern with rest during the night. They received their usual iodine supplement of 1 gm potassium iodide once a week during the school year (which included the time of all measurements made). Urine was collected in six 4-hour samples over a 24-hour span. The examinations were conducted during the months of March, June, September and December. Iodine was determined by an automated ceric ion arsenic acid method using a Technicon Autoanalyzer. Circadian and seasonal variations of urine volume and iodine excretion were statistically verified by the cosinor technique and the seasonal variations also by one way analysis of variance using the circadian means as input. A comparable circadian rhythm of iodine excretion was found in the children with and without endemic goiter, with an acrophase during the evening (20:16 with a 95% C.I., from 19:32 to 21:04). The circadian rhythm in iodine excretion has to be taken into account whenever an estimate of the 24-hour excretion is attempted from a sample covering less than the entire 24-hour span. There was a statistically significant seasonal variation of the 24-hour iodine excretion in the boys with and without endemic goiter and in the group as a whole. The 24-hour iodine excretion during March was 102 +/- 6 mcg, during June 81 +/- 4 mcg, during September 79 +/- 3 mcg and during December 102 +/- 7 mcg. The average 24-hour iodine excretion pooled over all seasons was 91 +/- 3 mcg/24 hrs in the children with and 91 +/- 5 mcg/24 hrs in the children without endemic goiter. During March and December the iodine excretion indicates an iodine intake not usually associated with a high prevalence of endemic goiter. However, during the months of June and September (and presumably even more during the months of July and August when during summer vacation no iodine supplementation was given in school) the 24-hour iodine excretion indicates some degree of iodine deficiency. The seasonal variation in urinary iodine excretion thus points to a time when increased iodine prophylaxis may be of value.

Child↗
PubMed1988

Goiter with severe respiratory compromise: evaluation and treatment.

Goiter with major respiratory compromise is uncommon but troublesome. Evaluation and treatment of this condition are controversial. Of a total of 2,908 goiters operated on over a 17-year period, 58 cases with this particular complication were studied retrospectively to define optimal management. Twenty-two patients had severe or acute dyspnea, and four of them required immediate tracheal intubation. Thirty-six patients had chronic dyspnea without cyanosis. Carcinoma was present in these two groups in 50% and 11% of patients, respectively. Results of our retrospective study are as follows: long-standing tolerance of goiter did not preclude the possibility of compressive respiratory distress or carcinoma. Optimal management of goiter with respiratory compression was obtained when surgery was delayed until satisfactory operating room conditions and adequate possibilities of interpretation of pathologic conditions were united. In case of respiratory distress, tracheal intubation allowed to abide without risks. In other patients preoperative investigations were kept to a minimum. Technical artifices facilitated the extraction of the goiter via cervicotomy without sternotomy in 92% of patients with minimal morbidity. Whenever necessary, endotracheal intubation obviated the need for tracheostomy. These data suggest preventive removal of all large or substernal goiters.

Adolescent↗
PubMed1986

Thyroid autoimmunity and endemic goiter.

The goitrogenic role of autoimmune phenomena in endemic goiter is still uncertain. Scanty and discrepant results have been reported in different areas of the world. This prompted us to evaluate the prevalence of circulating thyroid antibodies in an area of northwestern Tuscany during a survey for endemic goiter. The survey was carried out according to the P.A.H.O. criteria in a stable community. In all schoolchildren (n = 142; age range 7-15 years) and in most of their parents (n = 159), thyroid size was evaluated and urine was collected for iodine determination. Blood was drawn for determination of circulating thyroid microsomal (MAb) and thyroglobulin antibodies (TgAb). TSH binding-inhibiting (TBIAb) and thyroid growth-stimulating antibodies (TGSAb), TT3, TT4 and TSH. Prevalence of goiter in schoolchildren was 77.9% and 94.8% in their parents. Mean (+/- S.D.) urinary iodine excretion was 55.0 +/- 2.1 micrograms/24 h. The overall frequency of TgAB and MAB in the adult population was 14.4, statistically higher than of control subjects matched for sex and age. The frequency in schoolchildren was 4.3%. TBIAb and TGSAb were undetectable in all tested cases. The presence of goiter in children was unrelated with the presence of thyroid antibodies in parents, whether goitrous or non-goitrois. A higher prevalence of goiter was found in children with goitrous parents as compared to children with non-goitrous parents (P less than less than 0.005). In conclusion, the frequency of thyroid autoantibodies in the adult population of the endemic area studies was increased, but showed no relation with the presence of goiter.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

The incidence of thyroid carcinoma in solitary cold nodules and in multinodular goiters.

The incidence of carcinoma in patients with multinodular goiters has been reported to be considerably lower than in patients with a single cold nodule. However, the definition of a "single cold nodule" is highly subjective and has therefore been modified by qualifiers such as "clinically solitary" or "clinically dominant." In this retrospective study, we find no significant difference in the incidence of carcinoma in patients with multinodular goiters compared with patients with a solitary cold nodule confirmed by operation and histopathologic examination. In a consecutive series of thyroidectomies over a 22-year period, all patients with factors predisposing them to neoplasia, such as a history of radiation exposure and thyroiditis, were eliminated. Furthermore, all patients thought to have additional nodules documented by gross examination at operation or subsequently by histopathologic examination were also eliminated. The remaining 69 patients with clinically evident multinodular goiters were compared with the remaining 96 patients with a solitary cold nodule. The incidence of carcinoma in the 96 patients with a solitary cold nodule was 17%. In the 69 patients with clinically evident multinodular goiters, the incidence of carcinoma was 13%. The difference is not significant. It is of interest that male patients with multinodular goiters had the highest incidence of carcinoma at 29%, whereas, males with a solitary cold nodule had an incidence of only 13%. In conclusion, once known factors that predispose patients to neoplasia are eliminated, there does not seem to be a significant difference in the incidence of thyroid carcinoma between patients with operatively and histopathologically proved solitary cold nodules and those with multinodular goiters.

Carcinoma↗
PubMed1985

[Familial goitrous cretinism with giant goiter and hyperthyroglobulinemia: report of two siblings].

A 39 year-old-man and a 44 year-old-woman who was his elder sister were admitted to our hospital for study and treatment of goiter and hypothyroidism. Both had giant goiters. When he was about 3 years old goiter was first noticed since then the goiter slowly increased in size until the time of admission, while her goiter increased in size from when she was about 30 years old. Though both cases were already recognized as cretinism, they had not been treated. Perchlorate discharge test showed impaired iodide organification in both cases. Their serum thyroglobulin concentration was extremely high (1800 ng/ml). To our knowledge, there have been no case reports of goiterous cretinism due to impaired iodide organification with hyperthyroglobulinemia except the report by Hirota, Y. et al.

Adult↗
PubMed1975

[The effectiveness ot thyroid-hormone therapy following goiter-resection].

The effectiveness of a postoperative thyroid-hormone therapy in preventing a goiter-recidiv was investigated two years after goiter-resection. Of 3381 patients with goiter, who were operated on in the years 1964 to 1973 in the Surgical Department of the Krankenhaus Nordwest in Frankfurt/Main, Germany, 129 patients who were operated on in the first six months of 1969, were questioned and examined in a follow-up study. A rezidiv-goiter was found in 4, 6 p.c. of patients. If only palpable recidiv-goiters are taken into consideration 2, 3 p.c.), patients without postoperative thyroid-hormone therapy developed a recidiv goiter twice as often as patients with thyroid-hormone therapy.

Adolescent↗
PubMed1977

[Electron microscopic and morphometric study of the cellular composition of several forms of goiter in man].

According to the ultrastructural patterns four varieties of follicular cells are recognized in the cell population of the human goiter. The parenchyma of different goiters is composed of the same cell types and varieties. Goiters differ in percentages of these cells. The ultrastructure of the main cell form is correlated with the functional activity of the goiter. The "map" of cell composition of some forms of goiter is given, which may be used for a more exact diagnosis of the goiter, especially in the cases of discrepancy between the light microscopical morphological data and clinical picture of the desease.

Adult↗
PubMed1981

Nonfunctional thyroglobulin messenger RNA in goats with hereditary congenital goiter.

A goat strain with congenital goiter was studied as a model for human thyroid disoders. These goats were deficient in thyroglobulin (Tg), the precursor protein of the thyroid hormones T3 and T4. RNA coding for Tg (Tg-RNA) was detected in reduced amounts in the goiters and was almost absent from the membranes, where Tg is normally synthesized. This paper describes the preparation and characterization of a goat Tg cDNA plasmid and its use in the study of thyroglobulin gene expression in the goiter. We found that the goiter Tg-RNA is polyadenylated and has the same size as normal 33S goat TG mRNA. Thus, there are no major defects in the mRNA processing. However, in contrast to normal Tg mRNA, the goiter Tg-RNA was not translated into immunoprecipitable Tg subunits when injected into Xenopus oocytes. We conclude therefore that the goiter Tg-RNA has one or more alterations causing a lack of proper translation and/or a decreased cytoplasmic stability.

Animals↗
PubMed1984

[Pre- and postoperative thyroglobulin secretion into the blood in nodular goiter].

Serum thyroglobulin was measured in patients with a euthyroid, preclinically hyperthyroid or toxic uni- or multinodular goiter (n = 72) prior to and/or 3-12 months following selective resection of the nodular goiter tissue. A sharp decrease in the mean and individually elevated serum thyroglobulin values was observed postoperatively, with normal or undetectable values in 92% of the patients. The pre- and postoperative thyroglobulin levels in multinodular goiter patients with hyperthyroidism, preclinical hyperthyroidism and euthyroidism were 102 +/- 79 micrograms/l vs. 10 +/- 7 micrograms/l; 77 +/- 62 micrograms/l vs. 16 +/- 22 micrograms/l; and 76 +/- 82 micrograms/1 vs. 18 +/- 26 micrograms/1 respectively. The pre- and postoperative values in uninodular goiter patients with TRH-TSH unresponsiveness and with a normal TSH response were 84 +/- 60 micrograms/l vs. 10 +/- 8 micrograms/l, and 105 +/- 115 micrograms/1 vs. less than 6 micrograms/1 respectively. Thus, the elevation of serum thyroglobulin proved to be unrelated to TRH-TSH responsiveness and to thyroid hormone secretion, but to be related to the presence of nodular goiter tissue. Follicular nodules lack normal TSH dependence with respect to goiter maintenance and growth. The results suggest that serum thyroglobulin may represent a marker of autonomous thyroid growth.

Goiter, Nodular↗
PubMed1980

[Thyreotrophic hypophysial function after surgery for euthyroid goiter or autonomous adenoma].

44 euthyroid patients with nodular goiter and 23 patients with autonomous adenomas were treated by hemithyrectomy or subtotal thyrectomy. Thyroid function was followed over 6 weeks post-operation by TRH tests, which were performed before and at the 5th, 14th, 28th and 42nd day after operation. Bilateral subtotal thyrectomized patients with euthyroid goiter showed a continous increase of basal and TRH stimulated TSH level into the hypothyroid range. 19 of 25 patients were hypothyroid 6 weeks after operation. In contrast, 14 of 19 hemithyrectomized patients with euthyroid goiters remained euthyroid during the time investigated; 5 patients showed a transient TSH increase into the hypothyroid range but were euthyroid again after 6 weeks. TSH levels obtained from patients operated for autonomous adenoma may not yet reflect thyroid function during the time interval investigated here. We conclude that all patients with euthyroid goiter after bilateral subtotal thyrectomy should receive hormone substitution because they are at high risk to develop recurrency. However, we propose that in patients hemithyrectomized for euthyroid goiters the decision of long term hormone substitution should be cased on the result of a TRH-test 3--4 month after operation. Substitution with thyroid hormone should be preferred to iodide because it is unclear yet how far a failure in iodide organification and hormone synthesis is the reason for goiter recurrency.

Adenoma↗
PubMedDate not supplied

High incidence of goiter in patients treated with lithium carbonate.

The effects of lithium carbonate on thyroid was evaluated in 40 consecutive psychiatric patients on long-term treatment with this drug. Five patients had clinical and/or biochemical hypothyroidism. Twenty four (60%) subjects showed goiter of different size, including very large glands. A very high prevalence of goiter (87%) was observed in the 15 patients coming from a moderate endemic area. A lower incidence of goiter (44%) was found in subjects coming from non endemic areas. Goiter was associated with significantly elevated serum thyroglobulin concentration similar to that reported in endemic or sporadic nontoxic goiter. None of 25 psychiatric patients not receiving lithium therapy was hypothyroid and only three (12.5%) of them showed a small size goiter. These data indicate a very high prevalence of thyroid enlargement in patients on lithium therapy and suggest the opportunity to institute a prophylactic thyroid hormone treatment at least in subjects coming from endemic areas.

Adolescent↗