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PubMed2002

Diagnostic utility of cytokeratin 19 expression in multinodular goiter with papillary areas and papillary carcinoma of thyroid.

The most common benign lesion of thyroid, multinodular goiter, may mimic papillary carcinoma if it contains papillary areas. Although it is usually not very difficult to distinguish between these benign and malignant lesions, some cases may be problematic in differential diagnosis. In these cases, we decided to use cytokeratin 19 (CK19), which is shown to be effective in discriminating papillary carcinoma from follicular carcinoma of thyroid, and we also evaluated the immunoreactivity of CK19 in follicular adenomas. Twenty-five cases of multinodular goiter showing papillary formations, 25 cases of papillary thyroid carcinoma, and 15 cases of follicular adenoma were selected from archives of our institution. Immunohistochemical staining for CK19 was performed on deparaffinized sections. Diffuse and intense CK19 positivity was found in the cells of all papillary carcinomas. In the multinodular goiter group, 20 of 25 cases showed no staining while the remaining 5 were focally reactive with CK19. Three of the five were thought to be false positive owing to hemorrhage. Weak and focal CK19 staining was seen in some follicular adenomas. Our observations suggest that the staining features of CK19 may be helpful in differential diagnosis between papillary carcinoma and multinodular goiter showing papillary areas. Focal and pale staining for CK19 may be seen in multinodular goiter with papillary formations, and this feature should be considered in evaluation.

Adenocarcinoma, Papillary↗
PubMed1998

Effects of octreotide on propylotiouracil-induced goiter in rats: a quantitative evaluation.

To evaluate the possible antigoitrogenic effect of somatostatin, the influence of long-acting somatostatin analog--octreotide--on experimental goiter developed in rats treated with propylthiouracil was examined. Goiter formation was assessed by measurement of the main histological compartments of the thyroid as well as by morphometric analysis of the vascularization and blood supply of the gland. Although treatment with octreotide did not prevent the goiter formation, it clearly reduced blood supply and vascularization of the thyroid and counteracted propylthiouracil-induced increase in the relative volume of follicular epithelium. To conclude, the somatostatin analog--octreotide--is effective in reduction of goiter vascularisation. This finding provides a rationale for the clinical trials of the treatment of hypervascular goiter by somatostatin analogs.

Animals↗
PubMed1992

[Identification of a 3' splice site mutation in the thyroglobulin gene in a case of congenital familial goiter].

A case of congenital familial goiter with impaired thyroglobulin (Tg) synthesis has been reported. The patient is the fifth in a family of six children, three of whom have a goiter. The parents are cousins. The patient's thyroid function tests showed low T4 (1.0 microgram g/dl) and free T4 (0.2 ng/dl), normal or slightly increased T3 (1.8 ng/ml) and free T3 (7.4 pg/ml), and high TSH (57 micrograms U/ml). Serum Tg was 5.1 ng/ml (normal less than 30). The thyroidal 123I-uptake was 59.8% before and 54.5% after perchlorate test. Gel filtration with Bio-Gel A 5m demonstrated the presence of albumin-like protein probably iodinated as a major protein in the thyroid and very low content of Tg which was smaller than the normal 19S Tg. Histologically microfollicular adenoma and negative Tg immunostaining were the dominant findings. Segregation of Tg alleles in the family was studied by Southern blotting with a probe revealing a diallelic RFLP. The results demonstrated that the affected siblings had received the same alleles from both parents and were homozygous for the RFLP. Northern blotting analysis of the goiter RNA with a Tg probe revealed that, whereas the amount of Tg mRNA was normal, its size seemed slightly reduced. PCR amplification of Tg mRNA as six overlapping cDNA fragments demonstrated that a 200bp fragment was missing from the 5' region of the goiter mRNA. Subcloning and sequencing of the cDNA fragments, and of the patient's genomic DNA amplified from this region, revealed that this aberrant splicing is due to a cytosine to guanine transversion at position minus 3 in the acceptor splice site of intron 3. The presence in exon 4 of a putative donor tyrosine residue (tyr 130) involved in thyroid hormone formation provides a coherent explanation of the hypothyroid status of the patient. To our knowledge, this is the first identified mutation responsible for congenital familial goiter in humans.

Adult↗
PubMed1994

[The prevalence of antithyroid antibodies and long term follow-up in patients with lipiodol iodine-induced goiter].

We have carried out a follow-up study on iodine-induced goiter to clarify whether or not iodine could be a factor in the progression as well as the promotion of thyroid autoimmunity. We selected 143 women of child-bearing age without any previous thyroid disorders who had received hysterosalpingography (H.S.G.). 45 Sex and age-matched healthy subjects were chosen as controls. Serum nonhormonal iodine (S.N.I.) levels, frequency of goiter and antimicrosomal antibody (MCHA) in all the Lipiodol-cases were significantly higher than those in the controls (p < 0.001, < 0.01 and < 0.01), respectively. When the subjects were divided into 9 groups according to the duration of each 5 months after H.S.G., serum TSH and S.N.I. levels, incidence of goiter and MCHA in the initial group were significantly higher than those in the other groups (p < 0.05). The S.N.I. levels became normalized in 30 months after H.S.G. and the goiters disappeared in almost the same duration, while the incidence of higher MCHA titers declined gradually but significantly around 40 months after H.S.G. compared with that in the first 5 months after H.S.G. (p < 0.05). The frequency of goiter and MCHA in 44 cases after a 6-39 month follow-up decreased significantly compared to that in the initial group (p < 0.05). Therefore, we tried an individual longitudinal follow-up study on MCHA titer in 12 cases for 35-103 months, resulting in a significant reduction or negativeness of the titer in 6 cases. Likewise, MCHA titers in all cases decreased significantly (p < 0.05) on later evaluation. The present data suggest that iodine in Lipiodol administered via the vagina will act not only as the promoting factor, but as an aggravating agent for thyroid autoimmunity.

Adult↗
PubMedDate not supplied

The natural clinical course of children with an initial diagnosis of simple goiter: a 5-year longitudinal follow-up.

A total of 154 children initially diagnosed as simple goiter were evaluated annually for 5 years. The mean age at diagnosis was 12.8 +/- 1.8 years. The annual evaluation consisted of clinical assessment for height, weight, pubertal status, goiter size, and laboratory measurements for free thyroxine (FT4), thyrotropin (TSH), anti-thyroglobulin and anti-microsomal antibodies. At initial diagnosis, goiter was grade I in 117 children (76%) and grade II in 37 children (24%). All children had normal FT4, TSH and negative thyroid antibodies. After 5 years of follow-up, there were 6 children who later had positive thyroid antibodies in the 3rd and 4th year and the diagnosis was changed to chronic lymphocytic thyroiditis. In one patient TSH level was elevated in the third year and later increased which is strongly suggestive of compensated hypothyroidism. All children had normal growth as shown by the average final adult height of 2.67 +/- 1.25 cm above the midparental height. In girls the average age at menarche was 12.5 +/- 1.4 years which was not different from normal children. The goiter decreased in size in 36 children (23.4%) and remained the same size in 113 children (73.4%) without any medication. We concluded that 1) children who were initially diagnosed as simple goiter need to be followed annually for at least 5 years, and 2) the minimal annual laboratory evaluation should be TSH and thyroid antibodies to detect the early stage of chronic lymphocytic thyroiditis and compensated hypothyroidism.

Adolescent↗
PubMed2002

[Endemic goiter prevalence survey in Brazilian schoolchildren 6 to 14 years old, 1994-1996].

OBJECTIVE: To determine the national and state-level prevalence of endemic goiter associated with iodine deficiency in schoolchildren between 6 and 14 years of age in Brazil, based on data from a national survey carried out from 1994 to 1996. MATERIALS: Thyroid inspection and palpation were performed on 178,774 schoolchildren between 6 and 14 years of age, in all the states of Brazil. A subsample was selected to measure the iodine content in their urine as well as the iodine content of the table salt used for cooking in their homes. RESULTS: The last survey before this one was carried out in 1975. We found an 86% decrease in the median prevalence of grade 1 and 2 grade 2 goiter, from 12% to 1%. In 21% of the municipalities, the observed prevalence was zero. From the 16,803 urine samples collected for iodine measurement, 7,702 were matched with the corresponding clinical record (a loss of 54%). The median urinary iodine level was 14.0 micrograms/dL, and without a significant correlation with the clinical data on goiter. The median iodine excretion level for the population in the states of Acre, Amapá, and Tocantins was equal to or below 9.0 micrograms/dL. In three municipalities, urinary iodine was below 2.5 micrograms/dL in all the samples: Paranã (in the state of Tocantins), Conceição (Paraíba), and Nova Roma (Goiás). The supplementary iodine found in the salt collected from households (458 samples collected) was below recommended levels, with 50% of them below 20 mg/kg (20 ppm). In 7% of the samples, the level of iodine was below 10 mg/kg of salt, even in salt-producing states such as Rio Grande do Norte. CONCLUSIONS: There is evidence goiter is expanding to parts of Brazil that more recently have been opened up for agriculture, with children in those areas being exposed to low levels of supplementary iodine in the salt used for cooking. We found an increased risk of goiter in areas with deficient iodine supplementation (< 10 mg/kg) (odds ratio = 1.85; Cornfield 95% confidence interval: 1.68-2.03).

Adolescent↗
PubMed1982

Follicular reconstruction and hormone production by human adenomatous goiter cells in culture.

Morphological and functional properties of dispersed cells of human adenomatous goiter and those of the thyroid tissue adjacent to and distant from the nodular lesion (normal control) were investigated. In the presence of TSH, reconstructive arrangement of adenomatous goiter cells into a three-dimensional follicular structure occurred in a similar manner to that of normal controls. An addition of thyrotropin (TSH) to culture resulted in the secretion of thyroid hormones in control cells, but adenomatous goiter cells showed no response to TSH. It was found that the ratio of rT3, T3, the ratio of an inactive to an active form, was about three times higher in adenomatous goiter than in normal control. These findings suggested that conversion from T4 to rT3 is increased in adenomatous goiter.

Adenoma↗
PubMed1995

Ten-year follow-up study of thyroid function in euthyroid patients with simple goiter or Hashimoto's thyroiditis.

In an attempt to study the natural course of Hashimoto's thyroiditis and simple goiter, 74 euthryroid patients with Hashimoto's thyroiditis and 212 patients with simple goiter were followed for 10 years. In 204 patients with simple goiter (96.2%) it remained as a simple goiter throughout the observation period, whereas 8 patients (3.8%) later had Hashimoto's thyroiditis as evidenced by the appearance of circulating thyroid autoantibodies. These 8 patients had HLA typing significantly different from that of control subjects. None of the patients with simple goiter had hyperthyroid Graves' disease despite the fact that 17.5% of those patients had mild to moderate exophthalmos with either Moebius' sign or von Graefe's sign. In contrast, 12 patients with Hashimoto's thyroiditis (16.2%) had exophthalmos with Moebius' sign and/or von Graefe's sign, and 4 of 12 such patients later had hyperthyroid Graves' disease. TSH binding inhibitory immunoglobulin was detected in 3 of 4 such patients with hyperthyroid Graves' disease. Forty-nine patients with Hashimoto's thyroiditis (66.2%) still remained euthyroid but 20 of those (27.0%) turned into hypothyroidism during the 10-year follow-up.

Adolescent↗
PubMed1989

Abnormal oesophageal function in patients with non-toxic goiter or enlarged left atrium, demonstrated by radionuclide transit measurements.

In 10 patients with enlarged atrium and in 29 patients with goiters and neck discomfort dynamic oesophageal scintigraphy was performed. The passage of water and capsules, containing 99mTc-pertechnetate, was studied with the patients in the supine and in the sitting positions. As a reference group we examined 35 healthy, age-matched volunteers. Mean transit time (MTT) was calculated, residual activity was expressed as a percentage of maximum activity, and the number of spikes in the curves was defined by visual analysis. Both in patients with enlarged left atrium and in those with large goiters the studies showed significantly prolonged MTT, increased residual activity, and a higher frequency of spikes, compared with healthy volunteers and with patients with small goiters. There was no relationship between symptoms and abnormal scintigraphic results. The passage of capsules was impaired only in cardiac patients. It is concluded that abnormal oesophageal function is often present in patients with enlarged left atrium and in patients with large, but not with small, goiters. Inhibition of oesophageal transit appears to be dependent on mechanical compression, but the nature of oesophageal impairment may vary with the level of compression. The frequent complaints of neck sensations in patients with goiters are probably not of oesophageal origin.

Adult↗
PubMedDate not supplied

Prevalence of differentiated thyroid cancer in 810 cases of surgically treated goiter in Yemen.

BACKGROUND: In 1990, the World Health Organization (WHO) suggested that severe iodine deficiency exists in Yemen. Therefore, we looked at the prevalence of differentiated thyroid goiter in 810 cases consecutively treated by surgery for goiter. METHODS: This was a retrospective study of 810 surgically operated cases of goiter over a 5-year period (1999-2003). All cases were evaluated on H&E stained sections from embedded, 10% buffered formalin fixed tissue blocks. Special stains and immunohistochemical analysis were done in Yemen and abroad. Most patients were older than 20 years of age and were from the high altitude areas (2000 to 2600 meters above sea level), where iodine deficiency disorders (IDD) are well documented. RESULTS: In the 810 cases, 729 (90%) were females and the remaining 81 (10%) were males, with female-to-male ratio of 9:1. Differentiated thyroid cancer (DTC) was found in 170 (21%) cases, including 148 (86.4%) females and 22 (13.6%) males. Nearly 60% of the cases were in the age group of 21-40 years. Papillary carcinoma was the most common type of DTC (164 cases, 96.5%). CONCLUSIONS: In a Yemeni population, which has a high prevalence of iodine deficiency, 21% of patients operated on for nodular goiter without pre-operative fine needle aspiration biopsy had thyroid cancer, mostly of the papillary type. In this study, males and elderly patients with goiter had a higher chance of having malignancy.

Adolescent↗
PubMed1998

[Epidemiology of endemic goiter in Italy].

Epidemiological surveys on goiter endemia carried out in Italy in the two last decades were recently reviewed. Iodine deficiency and endemic goiter were documented in the entire country. In recent studies, urinary iodine excretion was higher and prevalence of goiter was lower than that documented in the past, in absence of a national program of prophylaxis. Nevertheless, in a recent study carried out in Basilicata, in schoolchildren a goiter prevalence of 16% was documented. In conclusion, iodine deficiency and endemic goiter are still present in Italy; despite the beneficial effects of "silent prophylaxis", a iodine prophylaxis program is mandatory.

Adolescent↗
PubMed1998

[Endemic goiter in Latium: environmental and genetic factors].

Most studies on the pathogenesis of endemic goiter focus above all on iodine deficiency. In some endemic goiter areas (i.e. Nigeria) there is no evidence of iodine deficiency; therefore, we suggest the taking into account of various factors, both environmental and non-environmental. We report the results of two studies carried out in three different areas in Latium: one of them (Cerveteri, RM) could be classified as high prevalence of goiter area, while the two others (Roccasecca dei Volsci, LT and Castel San Pietro Romano, RM) are true endemic goiter areas. The role of environmental factors, radioactivity and electromagnetism, foodstuff, the hydrogeological and chemical composition of natural water and the importance of genetics are here discussed, assuming that the endemic goiter could have a multifactorial pathogenesis.

Adolescent↗
PubMed1999

[Management strategies for endemic goiter in developing countries].

Despite significant progress in the last decades, endemic goiter remains a serious public health problem in the developing world, especially in Africa. Even in countries that have successfully reduced overall incidence to acceptable levels, endemic areas often remain. This persistence is due to the inadequacy of preventive measures and poor follow-up of control programs. The main etiologic factor in endemic goiter is inadequate dietary intake of iodine. This commonly occurs in communities depending exclusively on local produce grown on iodine-poor land, especially in mountain areas. Endemic goiter is epidemiologically associated with cretinism, deaf-mutism, and mental retardation. Even mild iodine deficiency leads to clinical hypothyroidism and moderate myxoedema with significantly reduced intellectual performance. Prevention of endemic goiter depends mainly on increasing the iodine intake of people in endemic areas. When iodine intake reaches the estimated adult minimum requirement (100 to 150 micrograms per day), the prevalence of goiter decreases. Two approaches have been used to increase iodine intake. The first consists of adding iodine to food staples such as table salt. The second consists of medical treatment using agents such as iodized oil. Iodization or iodination of salt is the most widespread and cost-effective method of prevention. Administration of iodized oil has been used only in severely endemic areas and in regions where reliable provision of iodinized salt is prevented by geographical barriers or political factors. However, iodized oil has been helpful in the start-up phase of prevention programs using iodized salt, either as an emergency measure or as a mean of convincing officials of the efficacy of iodine prophylaxis.

Adult↗
PubMedDate not supplied

[Characteristics of goiter endemic in Kuzbass].

The purpose of the present study was to comprehensively assess goiter endemia in Kuzbass. The spread of goiter was examined in its population. The severity and intensity of goiter endemia were assessed. Its causes and risk factors were revealed. The Kemerovo region was found to be an area of moderate goiter endemia with a tendency for its severity. The wide spread of iodine deficiency in the population, which is associated with low dietary iodine intake, is a cause of goiter endemia in Kuzbass.

Adolescent↗
PubMed2001

[Long-term results of the surgical treatment of patients with multinodular euthyroid goiter].

Long-term results of treatment of 280 patients operated for multinodal euthyroid goiter (MNEG) in surgical department of Endocrinology Research Center RAMS from 1983 to 1997 were studied. Hormonal examination of peripheral blood, ultrasonic examination of thyroid gland (TG) and zones of regional lymph outflow, thin-needle punch biopsy were used as special methods of investigation. Correlation between recurrence and histological form was studied. In cystic-colloid goiter with adenomatosis the recurrence of MNEG was revealed in 15 (34.1%) cases. In primary multiple TG adenomas of different types the number of recurrences was smallest--1 (3.3%) cases. There were no recurrences in cancer of TG in combination with cystic-colloid goiter or adenomas of TG. Recurrence of cystic-colloid goiter was revealed in 5 (5.7%) cases, different types of adenomas--in 5 (5.7%) cases. The smallest number of recurrences of MNEG was seen after maximum subtotal resection of TG--in 4 patients (7.7% of the patients with this volume of operation). In all the 12 cases of partial resection of TG the recurrence of different morphological forms of MNEG was revealed. Influence of thyroid therapy on remote recurrence rate in different form of MNEG was also studied. In cystic-colloid goiter (CCG) of different proliferation degree with adenomatosis the recurrence rate was not significantly different irrespective of hormonal therapy--29.4%, 37.5% and 36.4%, respectively, in adequate therapy, inadequate therapy and its absence, that testifies to small influence of thyroid therapy on reduction of recurrence rate in this group of patients. The highest recurrence rate in CCG and CCG with adenomas of TG was revealed in the group without thyroid therapy--30.8% and 35.7%, respectively.

Adenocarcinoma↗
PubMed2001

[The Swiss Commission of Goiter of January 21, 1922].

The Swiss Commission of Goiter met for the first time the 21st of January, 1922 and has been the first step of an historical event in terms of Public Health: the first requirement for salt iodination for the prevention of goiter. The minutes of this commission as well as the following scientific publications until 1930 indicate that the debate was still very vigorous about this recommendation but mainly about the origin of goiter and the iodine dose to be used. This dose went progressively from less than 10 mg of iodine per kilo of salt to the present WHO recommendation of 20 to 40 mg of iodine per kilo of salt. Another key point was the strategy of implementation of iodine. Two complementary approaches were proposed and implemented: iodine supplement to children at school and iodized salt available for the whole population. One point seemed clear for everyone at that time: iodine was not the source of goiter. Later scientific studies have shown that iodine deficiency was indeed the origin of goiter and associated pathologies.

Goiter↗
PubMed2002

Difference in goiter rates between two areas in Mae Hong Son Province despite an equally sufficient iodine supply.

The study was designed to investigate the problem of endemic goiter and iodine supplementation in Mae Hong Son, Thailand. Routine school data still showed high goiter rates in many areas. Six such schools and five schools with declining prevalence of goiter were selected. A single examiner examined all the children. Their weight, height, body mass index, ethnicity, history of iodine intake and migration were recorded. Urine samples were collected for measuring iodine and thiocyanate levels. From 653 children, 105 and 13 were found to have grade 1 and 2 goiter status, respectively. Median values of urine iodine level in children from all schools suggested sufficient iodine supplementation. Multivariate analysis showed that hilltribe minorities had a 2.09 times higher risk of endemic goiter than Thai children. Urine thiocyanate levels among children from high prevalence schools were significantly higher than those from low prevalence schools. No other significant correlation was found. Possible roles of other known and unknown goitrogens should also be investigated.

Child↗
PubMed2003

[Occurrence of goiter, urinary iodine excretion and TSH in neonates in the Tuzla Canton].

Goiter frequency and urinary iodine excretion levels were assessed in schoolchildren, aged 7-15 years, living in Tuzla Canton. Goiter frequency was evaluated by clinical examination and ultrasound of the thyroid gland. Goiter by inspection and palpation was found in 19.1% of all subjects, in 19.8% of girls and 18.4% of boys. With regard to updated reference values for thyroid volume reported by WHO and ICCIDD, goiter by ultrasonography was found in 12.9% (n = 62) of all subjects (n = 480). Median urinary iodine was 71.0 micrograms/L. Mild iodine deficiency is observed in Tuzla Canton, based on goiter frequency and urinary iodine excretion. Neonatal TSH results, obtained in the programme of the neonatal thyroid screening, were also analyzed. The frequency of neonatal TSH above 5 mU/L was 12.0% indicating, as two other indicators, mild degree of iodine deficiency in this region. The results underline the inefficacy of iodine prophylaxis with 10 mg K1 per kg of salt in correcting iodine deficiency. On the basis of the study, carried out in the rest of the Federation of Bosnia and Herzegovina, the new regulation was proclaimed in 2001 requiring 20-30 mg of iodine per kg of salt.

Adolescent↗