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PubMed1986

[New area of endemic goiter : the northeast Bénoué, (North Cameroon)].

Endemic goiter was thought to essentially spread in the southern part of Cameroun. In fact the North-East Benoué (NEB) area also appears to be concerned. We studied 1242 individuals from 5 representative villages. The overall goiter frequency was 28.4%. Study of emigrants showed a spreading of the endemic area towards the boundary part of Tchad. However increase of morbidity was related to the duration of settlement in NEB (18% after 1 year vs 34% after 5 years, p less than 0.01). Samples of urine from one single micturition were kept at 4 degrees C and assayed for iodide within 3 days. The results exhibited marked iodine deficiency (iodide : 9.6 +/- 1.5 micrograms/l; urinary ratio : iodide/creatinine : 17.9 micrograms/l). The way of preserving urine before iodine assay was critical. After 8 days of daylight exposure of the samples at 30 degrees C, the most part of assayable iodine had disappeared. The goitrogenic effect of manioc was weak : there was no relationship between the presence of goiter and the amount of ingested manioc. Concentration of thiocyanates in urine was correlated neither with manioc consumption nor with goiter volume. An automatic classification was obtained by computerization of several parameters. 88% of the patients distributed in 10 groups whose goiter frequencies were markedly different. Because of the well-defined characteristics of each group, it seems possible to perform valid biological or nutritional studies using a limited number of individuals.

Adolescent↗
PubMed1979

[Plunging and intrathoracic goiters].

The authors report 21 cases of cervico-substernal and 9 cases of mediastino-cervical goiters. On the base of their experience they remark that the diagnosis of topographic mediastinal extent of goiter has never been a problem in the mean time that it remains difficult to recognize the possible tumoral nature of the lesion, also utilizing both thyroid angiography and superior caval phlebography. Removal of 27 of 30 goiters was effecuted by cervical approach alone. In two cases a thoraco-lateral approach was added to remove endothoracic neoplastic goiters and in the last case a partial sternotomy was necessary. The authors conclude that the occasional use of sternotomy is not the result of an aprioristic decision, but the consequence of a correct removal obtained through the cervicotomic approach, also for large mediastino-cervical goiters.

Adult↗
PubMed1977

Upper airway obstruction in euthyroid goiter.

Although it is recognized that an enlarged thyroid may occasionally cause tracheal compression, the incidence in euthyroid goiter is unknown. Twenty patients with nontoxic goiter were investigated for upper airway obstruction. Although none of them had dyspnea as a chief complaint, on direct questioning 9/20 had a history of shortness of breath on exertion and choking sensation. Upper airway obstruction was detected in 7/20 (35%) by roentgenography, 12/20 (60%) by flow volume loop (FVL), and in 16/20 (80%) by combined roentgenography and FVL. After therapy for goiter, there was a reduction in the size of the goiter and an improvement in FVL in the whole group. The statistically significant change occurred in peak expiratory flow (P less than .01) and peak inspiratory flow (P less than .05). These findings and the change in configuration of the curve suggested less upper airway compression. We conclude that goiter often causes unsuspected upper airway obstruction, usually slow in onset and not noticed by the patient.

Adult↗
PubMedDate not supplied

[Surgical treatment of endothoracic goiter].

The authors make an analysis of the experience accumulated in the Clinic for Thoracic Surgery of Bucharest as a result of the surgical treatment of 16 patients endothoracic goiters. The authors stress the fact that these goiters should be differentiated from the "plunging goiter" variety, by their symptomatology, and by the different way of approaching their treatment. The diagnostic difficulties are stressed, especially since the uptake of iodine (radioactive iodine) can be negative in the endothoracic goiter of the functional type. The authors prefer thoracotomy, while the sternotomy is reserved only for the endothoracic goiters in the median area. The immediate results have been good in 15 cases. One patient died as a result of toxi-infectious phenomena.

Adult↗
PubMed1982

Pathogenesis of thyroid nodules in multinodular goiter.

Pathogenesis of nodule formation was studied in over 100 nodular goiters from a subendemic area. 60 surgical specimens were autoradiographed. Only one classical, well-encapsulated adenoma was detected. All other nodules were incompletely encapsulated and consisted of follicles that were morphologically and functionally identical to those of nonnodular parenchyma. Most characteristic was the tremendous interfollicular heterogeneity appearing on autoradiographs. Nodular goiters contain multiple foci and strands of fibrous tissue, which result from scarring of multiple hemorrhagic necroses occurring during goiter growth. Therefore, the slowly growing number of newly formed follicles has to squeeze into the meshes of an inelastic network of connective tissue. Nodular growth pattern is the inevitable consequence. Some particular nodules expand because of excessive accumulation of colloid. We conclude that most thyroid nodules in long-standing goiters consist of ordinary, polyclonal goiter follicles which expand in nodular fashion because they replicate within a mold made out of a poorly extensible network of connective tissue.

Autoradiography↗
PubMed1994

[Endemic goiter in three census areas of Chile].

The goal of the present study was to evaluate the current status of endemic goiter in Chile. 3500 students of basic education from public schools in three censor areas of the country were studied: 1000 in Calam (North), 1000 in Temuco (South) and 1500 in Santiago (Center). Socio-economic level was evaluated according to the Graffar scale. Two trained physicians determined body weight, height and size of the goiter through palpation of the thyroid gland (according to W.H.O. classification). Iodine in urine was determined in 20% of the students. Iodine insalt was determined in samples obtained in the three areas. A goiter prevalence of goiter of 11.4% in males and 12% in females was found, with a higher prevalence in females during puberty. A higher prevalence in the medium-low and low socio-economical levels was observed (12.4% and 14.4% respectively). The level of salt iodination was variable in the three areas (1/3 with concentration > than 100 parts per million (ppm), 1/3 between 60-100 ppm and 1/3 with < 60 ppm of iodine content). According to W.H.O. criteria, Chile has presently a low goiter prevalence, but the salt iodine concentration indicate the importance of a permanent surveillance of iodine nutrition.

Adolescent↗
PubMed1994

Endemic goiter in the Lemanak and Ai river villages of Sarawak.

In a survey of 974 villagers (408 males, 566 females; ages = 11-82 years) of the Ai (n = 496; 212 males, 284 females) and Lemanak (n = 478; 196 males, 282 females) rivers in the district of Lubuk Antu in Sarawak's Sri Aman Division during July 1993, goiter was found in 31.8% of the subjects. The goiter prevalence was higher in the more interior Ai river area than in the Lemanak river area (36.9% vs 26.5%). In females aged 15 years and above, the goiter prevalence was 75.4% and 49.1%, respectively, in the Ai and Lemanak river areas. The difference in goiter prevalence between the two areas was related to the degree of iodine deficiency in the two areas. The median urinary iodine excretion in the Ai river villagers was 22.1 micrograms/l compared to 72.9 micrograms/l in the Lemanak river villagers (p < 0.0001). Goitrous subjects tended to have lower urinary iodine concentration than non-goitrous subjects. In the males, smoking of tobacco was associated with a two-fold increase in goiter frequency. Despite on-going distribution of iodized salt by the medical and health services in the State, only 23% of the 135 salt samples obtained from the households in the areas contained detectable iodine.

Adolescent↗
PubMed1976

[Studies on thyroid function by means of TRH tests in simple goiter before and after strumectomy].

In 35 patients with simple multinodular goiter and with normal preoperative TSH reserve, the mean basal TSH and the mean TSH response to TRH increased significantly 5-15 days and 1-15 months following partial thyroidectomy. The postoperative mean TSH values were also greater than the age-related normal mean values. The incidence of postoperative supranormal TSH values and the incidence of postoperative increase in basal and TRH-stimulated TSH did not differ in the early and late postoperative course. In the latter the FTI had decreased significantly in the euthyroid range as compared to the preoperative value, whereas the mean serum T3 had not increased significantly. The patients were divided into two subgroups according to the anatomo-pathological finding and ensuing type of goiter resection (either selective ablation of non-functioning parenchyma with normal remnants, or resection of functioning and non-functioning parenchyma in the presence of goitrous remnants); the postoperative increase in the mean basal and TRH-stimulated serum TSH values was significant only in the non-selective ablation subgroup. Preclinical hypothyroidism was noted post surgery in 6 patients with supranormal preoperative TSH reserve. The results demonstrate a decreased thyroid reserve, as reflected in a persistent increase in thyrotropic function following resection of simple multinodular goiter in patients from a mildly endemic area. Long-term follow-up and thyroid hormone substitution may chiefly be indicated following non-selective goiter resection, in order to eliminate or prevent preclinical hypothyroidism and to prevent development of recurrent goiter.

Adult↗
PubMed1993

[Autoimmune thyroid pathology of pregnancy and puerperium. Prevalence in a zone of endemic goiter and its impact on the newborn].

The aim of this work was to study the prevalence of thyroid disease in pregnant and puerperal women and newborns in Pirque (Chile) and its possible relation to iodine intake or autoimmune disease. Two hundred twenty eight women with 13.4 +/- 3.4 weeks of pregnancy were examined initially and in 223, laboratory tests were performed. Goiter was found in 107 women. Although all women were euthyroid, those with goiter had higher serum levels of T3 and T4. Nineteen women had positive anti-thyroid antibodies and urinary iodine excretion was > 100 micrograms/g creatinine in 87.2%. Within 2 and 57 weeks after delivery (mean 13.5 weeks), 183 women were reexamined and in 175 laboratory tests were performed. Serum T3 continued to be higher in those with goiter. Fifteen women with positive anti-thyroid antibodies during pregnancy continued to have positive titres; of these, two had a post partum thyroiditis and one a graves disease. Two hundred three newborns were examined and no one had goiter or elevated TSH. It is concluded that there is a high frequency of goiter among pregnant and puerperal women from Pirque, that iodine intake is normal and that there is a low frequency of post partum thyroiditis.

Adolescent↗
PubMed1998

[Endemic goiter in the extreme North of West Siberia].

Random examinations covering 8-60-year-old 4345 citizens of 12 settlements of the Yamal-Nenets Autonomic Territory discovered goiter endemia throughout the territory but most evident the endemy manifested in the Far North. The prevalence of endemic goiter among schoolchildren made up 52.8% (enlargement of the goiter of the 1st and 2nd degree), among adults-49.2%. By ultrasound investigation, the above percentages were 29 and 26.4%, respectively. This corresponds to moderate endemia. The median of urinary iodine excretion averaged in the territory 5.1 micrograms%, while overall iodine insufficiency (number of children with urinary iodine < 10 micrograms%) was 81.9%. In the Far North iodine excretion was less but goiter incidence was higher than normal. Thus, in the Far North goiter endemia is rather serious.

Adolescent↗
PubMed1998

[Results of selective goiter resection in functional autonomy].

In the period from 1989 to 1994 a surgical treatment of toxic nodular goiter was performed in 145 patients. An unifocal autonomous adenoma occurred in 69 cases, a multifocal disease 76 times. The operative strategy consisted in a bilateral resection 105 times, and unilateral resection 29 times. An excision of a single node was carried out in ten cases. In one operation a hemithyroidectomy on one side and a subtotal resection of the other lobe was done. In May 1996 an interrogation about the current thyroid function was performed. In 105 (72.4%) patients a re-evaluation was possible. Concerning the postoperative therapy for prevention of recurrent hyperthyroidism or goiter growth, 84 patients (80%) had been treated with thyroxin and/or iodine. Under this therapy, after a mean period of 36 months 94 patients (89.5%) were clinically euthyroid. Nine patients (8.6%) were hypothyroid. Two patients developed a recurrent hyperthyroidism. Both of them belonged to the group of patients with multifocal autonomies, and both had been treated with thyroxin postoperatively. In one case, recurrent goiter growth occurred that did not need a therapeutic intervention. This patient as well had been treated for a multinodular goiter originally. She had not been taking a specific medication postoperatively. We conclude that a functional resection of autonomic tissue in nodular goiters is efficient in controlling the thyroid metabolism. A medical prophylaxis was not able to prevent recurrent hyperthyroidism in two cases.

Female↗
PubMed1998

[Total thyroidectomy in iodine-deficient goiter--an effective treatment alternative?].

It can be difficult to define the extent of struma resection because of large multinodular transformation. The total thyroidectomy of goiter is refused due to a supposed increase in complications. A high rate of goiter recurrence together with higher risks of complications demonstrates the problems of insufficient resection. This study investigates the rate of complications of total thyroidectomy of goiter. 4767 surgical treatments (partial thyroidectomy, hemithyroidectomy or total thyroidectomy) of goiter were investigated. Retrospectively the rate of postoperative complications (hemorrhage, wound infection, recurrent nerve palsy, hypocalcemia) after strumectomy or hemithyroidectomy was analysed in our patients and compared with the data of the literature. Total thyroidectomy (n = 176) did not cause a higher rate of complications (hemorrhage: 0.6%, hypocalcemia: 0.6%; recurrent nerve palsy: 0.6%) compared to the control group and the literature. Thus, total thyroidectomy can offer an efficient therapeutic option in large multinodular goiter.

Adult↗
PubMedDate not supplied

[Immunohistochemical identification of biochemical defect of dyshormonogenetic goiter].

This is a report of two cases of congenital goiter in which it was possible to indicate, through immunohistochemistry method, the disorder in the hormonal synthesis. One of these cases was of a sixteen-year-old woman, with goiter since childhood who used thyroid hormone replacement for ten years. Pathology showed coloid goiter with follicular adenoma. Immunohistochemistry showed strong mainly apical follicular cell thyroglobulin. Thyroglobulin was not found in the coloid. This finding is compatible with a malfunction of thyroglobulin exocitosis. The reaction for thyroid peroxidase was adequate for the age. The other case was a 13 year-old-boy with goiter and thyroid hormone replacement since the age of 1 year. He presented slight mental and growth retardation. Pathology showed coloid goiter with follicular adenoma. Immunohistochemistry study showed a very weak and diffuse reaction for thyroid peroxidase while the reaction for thyroglobulin was adequate. These findings indicate quantitative defect of thyroid peroxidase.

Adolescent↗
PubMed1998

Retrosternal goiter: a six-year institutional review.

Retrosternal goiter is defined as any goiter in which at least 50 per cent of the thyroid resides below the level of the thoracic inlet. The incidence of retrosternal goiter varies from 3 to 20 per cent with respect to thyroidectomy patients. A retrospective chart review from June 1991 to December 1997 found 232 thyroidectomies performed at our institution. Sixteen patients were found to have retrosternal goiters (6.9%). The mean age was 57.8 years (range, 34-92). All were of benign pathology. Symptoms included shortness of breath (68.8%), hoarseness (37.5%), dysphagia (31.3%), and superior vena cava obstruction (6.25%). Thirteen patients were female (81.3%). Fifteen patients had surgical intervention (93.8%). Total thyroidectomy was performed in nine cases (60%), whereas lobectomy was performed in six cases (40%). All treated patients had complete resolution of symptoms. A cervical incision alone was used in 13 cases (86.7%). Complications consisted of one postoperative pleural effusion and in one case a traumatic C5 nerve root compression occurred. There were no instances of long-term vocal cord paralysis or hypoparathyroidism. There was no perioperative mortality. In the majority of patients with retrosternal goiter, surgery can be done expeditiously through a cervical incision with minimal morbidity and mortality.

Adult↗
PubMedDate not supplied

Postural changes of the cervical spine in patients with nontoxic goiter.

PURPOSE: To investigate differences in cervical spine posture and range of motion and self-reported neck pain and headache between patients with nontoxic goiter compared with a matched control group. DESIGN: An observational, controlled, blinded study. SETTING: The ambulatory outpatient facility of a university hospital. PARTICIPANTS: Twenty-five nontoxic goiter patients and 25 matched nongoiterous control subjects from the Department of Endocrinology. INTERVENTION: Participants were X-rayed from a lateral position in neutral, full flexion and full extension, and the radiographs were evaluated by a blinded examiner for anterior head carriage, maximal flexion, maximal extension and the extent and severity of any degenerative changes in the cervical spine. The degree of postural neck muscle tenderness was evaluated by a blinded rheumatologist using a validated Total Tenderness Score system. In addition, the two groups were compared for their self-reported frequency of neck pain and headaches. RESULTS: A significant increase in anterior head carriage was found among the goiter patients (p = .01), together with a corresponding decrease in flexion (p = .01), whereas the corresponding increase in extension was not statistically significant (p = .16). A higher prevalence of headaches was found in the goiter group (p = .06), but there was no difference in neck muscle tenderness (p = .40) or frequency of neck problems (p = .40) between the groups. The severity of degenerative changes in the cervical spine (p = .22) and the number of vertebral levels with degenerative changes (p = .13) were similar in the two groups. CONCLUSIONS: Goiters of > 100 g seem to alter the posture of the cervical spine, possibly resulting in a tendency for more frequent headaches. The changes do not seem to cause more neck pain, muscle tenderness or degeneration of the cervical spine.

Adolescent↗
PubMed2006

Goiter prevalence and urinary iodine status in urban and rural/mountain areas of Piedmont region.

Piedmont region was reported in the 70s as a mild iodine-deficient area with a goiter prevalence > 10%. This study aimed at characterizing the current status of iodine deficiency in Piedmont, with special attention to putative differences between urban and rural/mountain areas. A cross-sectional, observational study was performed according to the surveillance methods for iodine deficiency disorders recommended by the World Health Organization (WHO). Ultrasound local thyroid volume reference values and median urinary iodine concentration were obtained in 2178 schoolchildren aged 11-15 yr, resident in Piedmont region for more than 5 yr to assess both goiter prevalence and iodine intake. Anamnestic and anthropometric data, thyroid volume by both bimanual palpation and ultrasound were assessed, and spot urinary iodine samples were collected. The median urinary iodine concentration was 115.8 microg/l and the prevalence of goiter 3.1%, indicating this area as iodine-sufficient. Nevertheless, 39% of the schoolchild population had urinary iodine levels < 100 microg/l and 6.8% < 50 microg/l. No differences in goiter prevalence and median urinary iodine excretion were observed between urban and rural/ mountain populations. In conclusion, Piedmont is now an iodine-sufficient region. As no programs of salt iodization have been carried out in the last 30 yr, a silent iodine replacement has occurred. Despite a sufficient median urinary iodine excretion, a program of iodine prophylaxis is strongly recommended due to a large part of iodine-deficient population.

Adolescent↗
PubMed1977

Iodinating activity of thyroid tissue in toxic diffuse goiter.

Thyroid tissue obtained from 12 patients with Graves' disease and treated with thionamide drugs for 3-7 mo before subtotal thyroidectomy, from 12 patients with Graves' disease, similarly treated, and given 50 mug of triiodothyronine (T3) for 10 days before surgery, and from 12 euthyroid patients with solitary cold nodules was investigated to compare in vitro iodination of thyroglobulin in toxic diffuse goiter and in normal thyroid tissue. The supernates of the homogenates (105,000g) were subjected to sucrose density gradient centrifugation (5--28%) to separate the thyroglobulin fraction. The precipitates were treated with 1% digitonin and centrifuged to collect the supernate (particulate fraction). When thyroglobulin and particulate fractions obtained from the same patient were incubated with 125I-, iodide, glucose, and glucose oxidase, the amount of iodine bound to thyroglobulin was several times greater in toxic diffuse goiter than in normal thyroid tissue; administration of T3 did not affect iodination in toxic diffuse goiter. When the thyroglobulin fraction from each patient was incubated with a standardized quantity of peroxidase instead of the individual particulate fraction, the amount of iodine bound to thyroglobulin was the same among the three groups of patients. Finally, when bovine serum albumin was substituted for thyroglobulin from each of the patients, iodination of bovine serum albumin was several times greater with the particulate fraction obtained from toxic diffuse goiter tissue than with that obtained from normal tissue. The guaiacol-oxidizing activity oty. These results suggest that in vitro iodination of thyroglobulin is increased in toxic diffuse goiter even when patients are made euthyroid by treatment with thionamide drugs as well as when they are given additional T3 for 10 days before operation. The increase in iodination of thyroglobulin appears to be due to an increase in peroxidase activity in the particulate fraction.

Adult↗
PubMed2000

Melatonin concentrations in patients with large goiter before and after surgery.

OBJECTIVES: Surgical removal of a very large goiter may traumatize adjacent anatomical structures. The manipulations that involve superior cervical ganglia may alter melatonin secretion. To test this hypothesis we decided to study diurnal serum melatonin profiles in patients with a very large goiter before and after the surgery. MATERIAL AND METHODS:The study was performed on 10 women (mean age-46.5+/-1.6 years; mean+/-SEM; range 39-54 years) with very large non-toxic nodular goiter (mean thyroid volume-125.8+/-25.9 cm (3); mean+/-SEM; range 82.6-326.7 cm(3)). Diurnal serum melatonin profiles were estimated two days before the operation and 10 days after the surgery. Blood samples were collected at 08:00, 12:00, 16:00, 20:00, 22:00, 24:00, 02:00, 04:00, 06:00 and 08:00 h. Melatonin concentration was measured using RIA kit. RESULTS: Nocturnal serum melatonin concentrations (at 24, 02, and 04 hours) were significantly higher after the surgery than before the operation. CONCLUSIONS: Very large goiter may compress the superior cervical ganglia altering indirectly the melatonin synthesis. It cannot be excluded, however, that the presence of the large goiter in some other way affects melatonin secretion.

Journal Article↗