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PubMed1983

Epidemiology and genetics of endemic goiter. I. Epidemiological aspects.

This study dealt with approximately 2,000 children and their parents living in a hyperendemic goiter area in Central Brazil, which is bounded by the jungle to the north and by a large plain to the south. The determination of goiter was made according to the methods and classification adopted by WHO. Conspicuous forms of goiter were found in 41% of the children examined. Multiple linear regression analysis showed an increase with age in the frequency of goiter in both sexes. Although data from the literature show that Mulattoes and Negroes have statistically higher frequencies of goiter than do Whites, our multiple linear regression analysis revealed no evidence for an effect of race on the endemism. There was no significant association with socioeconomic level. The presence of goiter in parents was shown to be statistically associated with its occurrence in the children.

Adolescent↗
PubMed1995

[Incidence of endemic goiter--environmental factors and iodine prophylaxis in Southern Poland].

In Southern Poland a well defined endemic goiter area has been known since 19th century. This region was characterized by low level of iodine in the environment. Iodine prophylaxis in Carpathian endemic area was introduced as early as 1935 at the level of 5 mg/kg of table salt. The goiter prophylaxis programme was interrupted during the Second World War. After the war in the years 1945-1946 epidemiological studies held in Southern Poland paid attention to high percentage of goiter in the population. As the result, potassium iodide salt supplementation started in 1947, but goiter incidence in subsequent years was still noted. As an effect of these observations, since 1956 potassium iodide salt supplementation was increased from 5 to 12 mg/kg of salt--in Carpathian and Subcarpathian regions. During over 30 years of iodide prophylaxis the severe symptoms of iodine deficiency disorders disappeared and endemic goiter in Southern Poland became mild. In 1980 the supplementation of kitchen salt was discontinued due to technical reasons. In 1985 an increase of goiter incidence in adults and children, as well as iodide deficiency disorders in newborns was noted. That is why in 1986 the salt supplementation was reintroduced at the level of 20 mg KJ/kg of kitchen salt. The potassium iodide content assessment in salt for human consumption in Krakow region was carried out in the years 1989-1994. The percentage of salt samples with the proper content of potassium iodide was 50, so it meant that the technological process of salt iodination was done incorrectly. Medical investigations are necessary to establish the optimal preventive dose of KJ.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The medical treatment of non-toxic goiter: several questions remain.

In this review it is concluded that thyroxine (T4), triiodothyronine (T3) and iodine (KI), singly or in combination, are all effective in reducing the goiter size, but there is insufficient evidence to prove which is the best (possibly the combination of T4 + KI?). Higher doses are more effective than smaller, but also lead to more side-effects. Thus, the optimal dose has yet to be found. The suppression of the pituitary thyroid axis plays a major role in the treatment of non-toxic goiter, but it is not definite that this is the only mechanism responsible for the beneficial effect of the agents mentioned. In view of the lack of better evidence, it is simply suggested that non-toxic goiters in young persons should be initially treated aggressively with 200 micrograms of T4/day or more for some months. If the goiter shrinks then the dose should be gradually decreased. If the goiter persists, it is futile to continue with large doses for more than 6-12 months. One may continue with smaller doses, maintaining the serum TSH in the low-normal range. The treatment of benign thyroid nodules with thyroxine is controversial. Probably thyroxine is beneficial in about a third of the cases. For both non-toxic goiters and nodules, autonomy should be excluded before starting thyroxine treatment, and old age, cardiac disease and a poor general condition are contraindications.

Drug Therapy, Combination↗
PubMed1995

Surgical management of substernal goiter: analysis of 237 patients.

Between 1968 and 1991, 237 patients underwent thyroidectomy for substernal goiter. Sixteen of them presented malignancies (6.8%). Mean age of the 159 women and 78 men was 57.7 years. Twenty-five patients had undergone previous thyroid surgery. The initial symptoms were cervical mass (72%), compression (16.2%), hyperthyroidism (13.1%), hypothyroidism (1.3%), and 5.5 per cent were asymptomatic. Most patients had long-standing goiter (mean duration: 12.9 yrs). All but eight operations were performed through a cervical incision. There were two postoperative deaths (0.8%), both in patients with advanced neoplasms. Early postoperative complications were hemorrhage (0.8%), dysphonia (4.6%), and transient hypocalcemia (2.9%). Five patients (2.1%) required tracheotomy. Complications were more frequent after total thyroidectomy than partial resection (P < 0.05), after surgery for malignancy than for benign disease (P < 0.05), and in complex than in simple forms (P < 0.05). One hundred ninety-four patients were followed after surgery; dyspnea was found in two patients (1.0%), dysphonia in seven (3.6%), and hypoparathyroidism in one. Analysis of our data indicates that 1) substernal goiter arose in elderly patients more than a decade later than cervical goiter; 2) goiters with a "complex" endothoracic development had an increased rate of short and long term complications; 3) cancer occurred in a significant number of patients, without any specific symptoms of malignancy; 4) the group of patients with hyperthyroidism was characterized by a significantly longer clinical history than euthyroid patients; 5) nearly all substernal goiters could be approached through a cervical collar incision; 6) the morbidity and mortality were low also after sternotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Features of adaptation of newborns born to mothers with endemic goiter].

Relationships between chronic iodine deficiency and, among other things, endemic goiter in women and adaptation of their babies in the early neonatal period were studied. A total of 125 women with endemic goiter of the Ist-IInd degrees and their newborns were examined. The diagnosis of endemic goiter was verified by the findings of an objective examination, ultrasonic examination, and puncture biopsy of the thyroid. Blood levels of triiodothyronine and thyroxin were measured in the women on days 3-4 postpartum. In the newborns Apgar score, body mass and length at birth, degree of maturity, physiologic body mass loss, duration of the icteric syndrome, time of umbilical cord drop off, and immunity status from the data of NBT test were assessed. Forty-five women without goiter and their newborns were controls. Postpartum measurements of triiodothyronine and thyroxin levels in the blood of patients with endemic goiter brought the authors to a conclusion that subclinical hypothyrosis was characteristic of them. Adaptation processes in the early neonatal period were found disordered in the newborns of mothers with endemic goiter. This manifested by a higher, vs. controls, incidence of asphyxia, hypotrophy, signs of the CNS involvement, and respiratory distress syndrome. Initial body mass recovery, disappearance of the icteric syndrome, umbilical cord loss were delayed in these newborns in comparison with the controls, and statistically reliable deviations in their immune status were revealed.

Adaptation, Physiological↗
PubMed1994

Influence of smoking on Graves' disease with or without ophthalmopathy and nontoxic nodular goiter in Taiwan.

The effect of smoking habits on Graves' disease with or without ophthalmopathy and nontoxic nodular goiter has been discussed for more than 10 years in Western countries, but there are no published reports from Oriental countries, where the prevalence of cigarette smoking among women is lower than in Western women. The purpose of this study was to determine the relationship between smoking and Graves' ophthalmopathy, Graves' disease without ophthalmopathy, and nontoxic nodular goiter in Taiwan. The study included 349 patients with thyroid disease from endocrinologic clinics, including 116 patients with Graves' ophthalmopathy (92 women, 24 men), 108 patients with Graves' disease but without ophthalmopathy (96 women, 12 men), and 125 patients with nontoxic nodular goiter (114 women, 11 men). Information on smoking habits at the time of onset of the disease was obtained by a self-administered structured questionnaire. Since women generally smoke less than men, female and male smoking habits were compared separately with those of controls matched with patients on the basis of age. There was a significantly higher prevalence of cigarette smoking in women with Graves' ophthalmopathy and nontoxic nodular goiter than for healthy female controls, showing an odds ratio of 8.15 and 6.48, respectively, despite a lower prevalence of cigarette smoking in Taiwan (7.6% in women with Graves' ophthalmopathy, 6.1% in women with nontoxic nodular goiter) than in the West (64.2% in women with Graves' ophthalmopathy, 30% in women with nontoxic nodular goiter). Men in these three disease groups and women with Graves' disease without ophthalmopathy showed no significant association with cigarette smoking.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Studies on goiter occurrence and iodine deficiency in Lublin Upland (Lublin coordinating center).

Questionnaire, clinical, ultrasonographic and biochemical studies (determination of urinary iodine concentration) have been carried out in 1686 children of age between 7 and 13 years living in the Lublin Upland region. The presence of goiter was found in 368 children (21.8%). A gradual increase in the incidence of goiter with age of children was observed. Ultrasonographic examinations carried out in children with goiter and in those without goiter detectable by physical examination revealed considerable variation in the volume of the thyroid there was an increase in the thyroid volume with age both in rural and urban children. The values of urinary iodine concentration were lowered; mean value in children without goiter was 56.8 micrograms/l, and in children with goiter 52.6 micrograms/l. The query concerning the consumption of iodized salt revealed that only 22.6% of the families studied use iodized salt.

Adolescent↗
PubMed1993

[Usefulness of ultrasonic examination for evaluating the functional and morphologic state of the thyroid in patients with nontoxic and toxic parenchymal goiter].

Ultrasonographic examination of the thyroid was carried out in 150 patients of mean age 37 +/- 11 years, including 100 patients with nontoxic parenchymal goiter and 50 patients with toxic parenchymal goiter associated with the Graves' disease. Ultrasonograph Siemens Sonoline LM with 7.5 MHz head was used in the study. The study was aimed at the evaluation of functional and morphological state of the thyroid in patients with nontoxic and toxic parenchymal goiter. In the case of nontoxic goiter, heterogeneous (100%) and normoechogenic (100%) structure of the parenchyma was visualized by ultrasonography. In toxic parenchymal goiter (Graves' disease), on the other hand, hypoechogenic (92%) and marginally pseudo-cystoid structure of parenchyma was observed. In this group of patients, high values of thyroid hormones (100%) were associated with high level of thyroid antibodies (92%). It can be concluded that ultrasonography is an useful tool for evaluation of functional and morphological state of the thyroid in patients with nontoxic and toxic parenchymal goiter.

Adult↗
PubMed1976

[Regression of endemic goiter in South Baden (author's transl)].

The incidence of goiter and its dependence on the size of the locality are examined in a cross-section of 3.933 people living in South Baden (2.202 natives, 1.731 immigrants) and the results compared with our findings in 1963 obtained under the same conditions. In 1973 only 24.3% of the native population examined had a euthyroid goiter compared with 47.0% in 1963. The incidence of goiter has also decreased by about half among the immigrant population. In 1973 9.4% more people with goiter could be found among the native population than among the immigrants. In the larger towns, the frequency of goiter among the native population fell between 1963 and 1973 from about 40% to less than 20% and in country areas from about 60% to 40%. The total frequency of goiter cases among the immigrant population in country areas fell from about 40% to 30% and in the immigrants to towns from 20% to 10%.

Disease Reservoirs↗
PubMed1993

[Does goiter constitute basically a surgical process?].

Goiter is usually a clinical manifestation present almost in all the thyroid processes. The over-simple idea of a thyroid tumoration demanding surgical resection is, unfortunately, deeply implanted in many medical and, above all, surgical environments. We tried to estimate the incidence of goiter in a series of thyroid processes and how many of them required surgery. We reviewed the surgical indications in several thyroid entities. In a series of 377 thyroidopathies, goiter was present in 345 (91.5%), 50 of which underwent surgery (12.26% of the total and 14.49 of goiters). Some of the patients were operated in other hospitals without adjusting to the aforementioned criteria and, in theory, just 36 of then should had undergone surgery (9.54% of the total and 10.43% of goiters). In conclusion, surgery has a very secondary role in the treatment of goiter.

Female↗
PubMed1976

[The importance of sociomedical factors for the regression of endemic goiter in South Baden (author's transl)].

The further regression of endemic goiter between 1963 and 1973 was investigated with regard to its dependence on social factors and age in representative cross-section of 3933 persons living in South Baden. 2202 of them were natives and 1731 were people who had moved into South Baden. The regression of endemic goiter observable since 1950 included all occupational groups. But if the group of farmers and smallholders (goiter frequency: 1963 = 62.0%, 1973 = 38.6%) is compared with professional people living a town life (goiter frequency: 1963 = 30.0%, 1973 = 15.5%) a noteworthy dependence of goiter attacks on the living habits is even now to be seen. Nodular goiter is more frequent among people living the life of a smallholder (1963: 6.8%, 1973:5.4%) than among native professional people (1963: j.0%, 1973: 3.4%).

Female↗
PubMed1976

[Incidence of goiter and tracheal constriction among outpatients of a Munich hospital (author's transl)].

With a goiter incidence of 55%, 6.5% of the 495 patients examined showed constriction of half or more of the trachea, most frequently in the 10% of larger goiters in stages II and III. But also in the 45% of the stage I goiters occurring in the Munich ambulant patients, distinct tracheal constriction is already found, and in stage lb 9% of the stenoses involved half of the lumen. Because of the high goiter rate and the often already considerable tracheal stenoses even in the smaller goiters, the earliest possible diagnosis and treatment of small goiters with iodized salt or thyroid hormones should follow as a consequence, after exclusion of autonomic adenomata, thyrotoxicosis, cold nodules and malignant struma. The prophylaxis of struma with fully iodized salt is referred to.

Adult↗
PubMedDate not supplied

[Surgical treatment of cervico-mediastinal goiter].

Over the last decades definitions and classifications of cervico-mediastinal goiters have been proposed. According to the definition of Valdoni and Tonelli, from 1968 to 1991 237 patients were operated on for cervico-mediastinal goiter. There were 168 simple forms (141 anterior and 27 posterior) and 69 complex forms according to Borrelly's classification. We analyse and discuss the clinical presentation, the diagnostic procedures and the surgical technique in relation to post-operative complications and long term results. The mean duration of symptoms before surgery in patients with cervico-mediastinal goiter was longer than in subjects with cervical goiters. All but 8 operations were performed through a cervical incision. Two patients, both with advanced tumor, died postoperatively. Post-operative complications were: hemorrhage 0.8%, dysphonia 4.6% and transient hypoparathyroidism 2.9%. A clinical follow-up was available for 194 patients. Permanent dyspnea was observed in 1.0%, dysphonia in 4.6% and transient hypoparathyroidism in 2.9%. Tracheotomy was necessary in 5 cases. Complications were more frequent after total thyroidectomy than after partial resection (p < 0.05), after surgery for malignancy than for benign disease (p < 0.05) and in complex than in simple forms (p < 0.05). Almost all cervico-mediastinal goiters can be treated by a cervical incision. Sternotomy, when required, does not influence mobility and mortality. The lacking of an alternative treatment, the relatively high incidence of malignancy and the risk of acute airway obstruction should induce the early removal of all substernal goiters.

Adult↗
PubMed1997

[Nodular goiter and thyroid cancer].

The author analyzes 151 cases of differentiated carcinoma of the thyroid gland and 112 cases of nodular nontoxic goiter. In 83.5% of patients with carcinoma of the thyroid gland there was no "goiter anamnesis", in 71.5% of the carcinoma patients the tumoral node was located in the unchanged tissue of the thyroid gland, in 28.5% the nodular goiter was found in the contralateral lobe and only in 10% of observations carcinoma took place against the background of the nodular goiter and adenoma. There is no reason to consider the nodular goiter as pre-cancer, and the surgical treatment of the nodular goiter as prophylaxis of carcinoma of the thyroid gland. The indications to operation for benign nodular formations of the thyroid must be restricted.

Adenocarcinoma, Follicular↗
PubMed1996

[Prevalence of goiter in school-age children in the Pirque Zone. Effects of salt iodination].

BACKGROUND: Twenty years ago, Pirque was a zone with a goiter prevalence of 39%. AIM: To assess the effects of salt iodination on the prevalence of goiter in school-age children of this zone. SUBJECTS AND METHODS: School age children from four public schools in Pirque were examined, following WHO criteria for the diagnosis of goiter. Urinary iodine excretion was also measured. RESULTS: Five hundred ninety one males and 298 females aged 12.1 +/- 2.5 years were examined. Fifty seven children (9.6%) bad goiter. In 53 the goiter was grade I and in 4, grade II. No sex differences were observed. Minimal and median urinary iodine excretion values were 12.6 and 57.6 micrograms/dl respectively. CONCLUSIONS: Goiter prevalence dropped from 39 to 10%. The fact that iodine intake is over minimal recommendations, underscores the effectiveness of salt iodination.

Adolescent↗
PubMed1989

Goiters and airway problems.

Even though thyroid enlargement occurs commonly, the incidence of goiter has decreased in the United States due to the routine use of iodized salt. We continue to see a large number of patients with neglected goiters that cause airway compression. The progressive nature of this disease occasionally results in severe tracheal compression and acute airway distress. We treated 120 patients with airway compression secondary to goiters during a 7-year period. Thirty patients presented initially with acute airway distress requiring either intubation or semiemergent surgery. The decision to operate was based primarily on clinical evaluation and airway films. Ninety patients had substernal goiters. Only one patient required sternal splitting. If one lobe was enlarged causing tracheal deviation, lobectomy was performed; if both lobes were enlarged, subtotal thyroidectomy was performed. Two patients required tracheostomy. There were no operative deaths, and morbidity was limited to minor wound problems. It is important to consider early surgical decompression whenever tracheal compression is caused by goiters, especially if the patients are symptomatic or there is mediastinal extension.

Adult↗
PubMedDate not supplied

[Diffuse toxic goiter associated with autoimmune thyroiditis].

A study of 190 patients with diffuse toxic goiter combined with autoimmune thyroiditis has revealed some clinical features: a torpid course and a solid-elastic consistency of the thyroid. In 37.4% of the cases autoimmune thyroiditis was combined with a severe form of thyrotoxicosis. The combined form of diffuse toxic goiter correlated with a greater frequency of the detection of thyroid autoantibodies to thyroglobulin and microsomal antigen (in 83 and 78.3% of the patients respectively) as compared to the common form of diffuse toxic goiter (in 47.3 and 48.1%). A study of the hormonal thyroid status of 43 patients with diffuse toxic goiter combined with autoimmune thyroiditis showed that T3, T4 and TTH levels in patients with the presence of autoantibodies to thyroid antigens did not differ from the levels of these hormones in the common form of diffuse toxic goiter, and in the group of the patients with the absence of autoantibodies there was a tendency to the development of T3-toxicosis. The absence of pathognomic symptoms in combined forms of diffuse toxic goiter makes their preoperative diagnosis difficult. Interrelationship of the hormonal thyroid status and humoral antithyroid immunity was noted.

Adolescent↗
PubMed1981

Hypercalcemia in hyperthyroidism. Role of age and goiter type.

Hyperthyroidism is often associated with hypercalcemia which is provoked by osteoclastic activity of the thyroid hormones. These data show that hypercalcemia develops with increasing age and in the presence of a special type of hyperthyroid goiter. Total serum calcium, total protein, and albumin as well as different parameters of thyroid function, namely T3 RIA1, T4 test, ETR and TRH test were determined in a group of 147 patients. The ionized calcium level was estimated from total calcium and albumin. 211 measurements were performed. Hyperthyroidism existed in 92 cases. Total calcium was not significantly elevated in hyperthyroidism. Hyperthyroid patients under 61 years of age showed elevated ionized calcium levels in only 2.3% and patients over 60 years of age in 18.8% of cases. Elevated ionized serum calcium levels were observed in 43.8% of hyperthyroid patients with multinodular goiters. The linear correlation between ionized calcium levels and different parameters of thyroid function is much more pronounced in the older group and it was found to be highly significant. 7 of 9 hyperthyroid patients with elevated ionized calcium levels showed multinodular goiters, though no autonomous adenoma. In the hyperthyroid group of patients of over 60 years of age with multinodular goiters the incidence of hypercalcemia was 43.8%. Direct action of thyroid hormone on calcium turnover as well as increasing age and special goiter type seem to be responsible for disturbances in calcium metabolism. A possible calcitonin deficiency in the above mentioned conditions is discussed.

Age Factors↗