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PubMed1995

Retrosternal goiter.

BACKGROUND: Retrosternal goiter is a common cause of compression of adjacent structures, and it may harbor cancer. METHODS: During a 22-year period, we treated 44 patients with intrathoracic multinodular goiter. RESULTS: The goiter was resected in 40 patients; 4 patients were rejected because of prohibitive risk. There were three minor complications and no deaths. CONCLUSIONS: The specific indications for resection include compression of adjacent structures, prevention of future complications, and obtaining a diagnosis. Fine-needle aspiration for diagnosis is not always possible and rarely reliable, and there is no effective medical therapy. Cervical incision is nearly always adequate, with few exceptions, such as very large posterior goiter, mediastinal blood supply, or carcinoma necessitating mediastinal dissection.

Aged↗
PubMed2004

C-cells in colloid goiter.

PURPOSE: The aim of this investigation was to quantitatively evaluate C-cells in colloid goiters, analyzing 36 thyroids that were obtained through thyroidectomy from 24 patients with goiter and 12 normal glands from adult patients without thyroid disease, which were used as the control group. MATERIAL AND METHODS: On average, 6 different thyroid areas were sampled and labeled by immunohistochemistry with a monoclonal anticalcitonin antibody, utilizing the avidin-biotin-peroxidase complex. C-cells were counted in fields measuring 1 square centimeter, and the mean number of cells per field was then calculated. Data were statistically analyzed using the Mann-Whitney test. RESULTS: In the colloid goiter group, the number of C-cells ranged from 0 to 23 per field, while in normal controls they ranged from 20 to 148 per field. CONCLUSIONS: These results demonstrate a significant decrease of C-cell number in the colloid goiter group compared with control group, indicating that the hyperplastic process is restricted to follicular cells, to the detriment of C-cells, which probably cease to receive trophic stimuli.

Colloids↗
PubMed2004

[Diagnosis and treatment of benign goiter].

Although the German population is now appreciably better supplied with iodine, this is still not adequate in all regions and in all situations, e.g. during pregnancy and breast feeding. As a result, more than 20 million Germans have an iodine-deficiency goiter that requires treatment. Investigation of a goiter is effected with sonography and the determination of serum TSH. If the results indicate euthyroid diffuse goiter, medical treatment should be initiated. In recent years, the combination of thyroid hormone and iodine has proved particularly effective. In contrast to monotherapy with levothyroxine goiter recurrence after discontinuation of treatment is less common, and the combination is usually tolerated better.

Adolescent↗
PubMed2004

[Medical treatment of nodular goiter].

An optimal supply of iodine--150-200 microg/day--has not yet been secured in all regions and in all phases of life. The appreciable diminishment in thyroid gland mass in children and adolescents is, however, indicative of an improvement in this situation. In elderly persons, however, prophylactic measures do not result in struma or nodule regression. Nodules are found in some 40% of women and 28% of men older than 45. Medical treatment of nodular goiter is aimed at achieving a reduction in size or preservation of the status quo. Depending on the size of the goiter, iodine-deficiency goiter is treated with iodine or a combination of iodine and levothyroxine. In view of the pathogenesis and the marginal alimentary lack that still persists, there are no adequate arguments for L-thyroxine monotherapy of uncomplicated iodine-deficiency goiter.

Adolescent↗
PubMed1989

[Results of the definitive treatment of autonomy in iodine deficiency goiter].

In order to evaluate the efficacy of, and the risk associated with, the definite treatment of euthyroid goiter with autonomy, the data of 88 patients treated between 1982 and 1986 (50 by subtotal thyroidectomy; 38 by 131I-treatment, mean radiation dose 200 Gy without protection by thyroxine) were analyzed in a retrospective study. The following criteria were used before and after treatment: the results of scintigraphy under suppression qualitatively (in focal autonomy) and quantitatively (global thyroid uptake) (TcUs), the means of FT4I, FT3I and delta TSH after TRH, the improvement of mechanical signs and symptoms and the decrease of thyroid volume. Measured by TcUs and delta TSH, autonomy could be removed completely in 85-90% of all patients. Surgery was slightly more successful (100%) compared to treatment by 131I (75-80%). This was also true for removal of mechanical symptoms and reduction of the goiter. The incidence of manifest hypothyroidism was greater after surgery (16%) than after 131I treatment (3%). At a higher grade of autonomy (TcUs greater than 3.2%) surgery was more effective (95-100%) than treatment with 131I (60-70%) but at a higher risk of hypothyroidism (24 vs 0%). It is imperative to improve the methods of estimating the amount of 131I to be administered in euthyroid goiter with autonomy. Selection of patients with autonomy in euthyroid goiter for definite treatment is difficult, since until now their risk to become hyperthyroid cannot be predicted properly.

Adult↗
PubMedDate not supplied

[Diagnosis and treatment of substernal and mediastinal goiter].

Clinical picture, methods of diagnosis and treatment of 42 patients with retrosternal (23), "diving" (6), and mediastinal (13) strumas were studied. A conclusion was drawn that these goiters had no specific signs. In the absence of thyrotoxicosis the clinical picture is conditioned by the compression and displacement of the mediastinal organs, and in its presence symptoms characteristic of thyrotoxic goiter are added. The most important method of diagnosis of retrosternal and mediastinal goiters in considered to be polypositional roentgenotomography, pneumomediastinography, contrast examination of the esophagus, trachea, vessels, and, in a number of patients, radioiodinediagnosis. Surgical treatment of retrosternal and mediastinal goiters is recommended.

Adult↗
PubMedDate not supplied

[Collagen content of the thyroid tissue and/urinary hydroxyproline in various forms of goiter].

Chemical composition of the thyroid tissue, removed by surgery, was studied in 72 patients with goiter. Thyrotoxicosis of different severity was found out in 42 and euthyrosis in 30 subjects. The water and dry residue contents, the amounts of extracted and insoluble tissue, collagen level in the thyroid normal tissue and that of different goiter forms were detected. The urine hydroxyproline concentration was determined before surgery. The study of the thyroid tissue chemical composition in modular euthyroid and diffuse toxic goiter has shown a fall in the dry residue and collagen contents, a rise in the water and insoluble tissue levels, an enhancement of the soluble to insoluble tissue ration in comparison with the control. Hyperoxyprolinuria, most pronounced in severe thyrotoxicosis, was seen in patients with various goiter forms versus healthy subjects.

Adolescent↗
PubMed1980

Antenatal diagnosis and treatment of a fetal goiter.

The sonographic diagnosis of a fetal goiter, confirmed at delivery, is described in a fetus exposed to large doses of propylthiouracil, which was administered to the mother. The pregnancy was also complicated by recalcitrant premature labor secondary to polyhydramnios. The intraamniotic instillation of thyroxine decreased the size of the fetal goiter, and numerous therapeutic amniocenteses permitted continuation of the pregnancy, so a mature infant with a goiter but no airway obstruction was delivered. Amniotic fluid reverse-T3 assays confirmed fetal utilization of the thyroxine. Fetal thyroid physiology is discussed briefly along with the benefits of the antenatal sonographic diagnosis of fetal goiter.

Adult↗
PubMed1995

[Goiter: from epiphenomenon of iodine deficiency to benign tumor. A 30-year long guided story].

Thirty years ago, iodine deficiency was highly prevalent in Switzerland and, consequently, few people doubted that shortage of this element fully accounted for the very high incidence of nodular goiters. Most research efforts were aimed at unraveling the mechanisms that allowed the thyroid to maintain adequate hormone production - at the expense of goiter formation - despite insufficient iodine supply. In 1982 iodine deficiency was eradicated in this country, a remarkable achievement of preventive medicine. Although the incidence of goiter dramatically decreased thereafter, this thyroid disease has remained and still is a common problem. Only now has it become clear that factors other than or in addition to iodine shortage must be operative in goitrogenesis and that classical features, such as the tremendous functional and morphological heterogeneity of goitrous tissue, and, in particular, the growth of nodules, must result from causes and mechanisms that are common to the pathological growth of other tissues too. Subsequently, the thyroid has become a rewarding source of information about cellular and - more recently - molecular events that accompany and might possibly cause pathological growth. Today, thyroid nodules are considered to be true monoclonal and polyclonal tumors. Hence, we no longer wonder why eradication of iodine shortage cannot totally prevent or reverse goiter growth. - While modern molecular biology unravels - at an amazing pace - the mechanisms that cause heterogeneity between individuals of a single species, goitrogenesis offers a unique opportunity to go one step beyond, which is the inborn and acquired heterogeneity between the individual cells of the same tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1999

Radioiodine therapy for multinodular toxic goiter.

BACKGROUND: Radiolabeled iodine 131 therapy is used for treatment of multinodular toxic goiter, but long-term follow-up studies are lacking. METHODS: A prospective study of 130 consecutive patients (115 women) treated with 131I for multinodular toxic goiter and followed by evaluation of thyroid volume (determined using ultrasound) and thyroid function variables. RESULTS: The patients were observed for a median of 72 months (range, 12-180 months). Sixty-six patients received antithyroid drug pretreatment; 64 did not. Iodine 131 treatment (3.7 MBq/g thyroid tissue corrected to a 100% 24-hour 131I uptake) was given as a single dose in 81 patients, 2 doses in 38, and 3 to 5 doses in 11. One or 2 treatments cured 119 patients (92%), and 68 (52%) became euthyroid within 3 months after 131I treatment. The median 131I dose was 370 MBq (range, 93-1850 MBq). Forty-nine patients needing more than 131I dose had a reduction in median thyroid volume from 56 mL (range, 21-430 mL) to 44 mL (range, 15-108 mL), representing a 24% reduction related to the insufficient 131I dose. In all patients, the initial median thyroid volume of 44 mL (range, 16-430 mL) decreased to 25 mL (range, 8-120 mL) (P<.005), representing a median reduction of 43%, 24 months after the last 131I dose. Hypothyroidism evaluated using life-table analysis developed in 6% of patients who did not receive antithyroid pretreatment and 20% who did (P<.005) after a median of 42 months (range, 3-60 months), the total hypothyroidism frequency being 14% within 5 years of treatment. CONCLUSIONS: Ninety-two percent of patients with multinodular toxic goiter were cured with 1 or 2 treatments. The thyroid volume was reduced by 43%, with few side effects. Iodine 131 should be the choice of treatment in patients with multinodular toxic goiter.

Adult↗
PubMed1999

Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice.

HYPOTHESIS: That changing practices in a single institution toward performing total thyroidectomy as the preferred option for the treatment of bilateral benign multinodular goiter (BMNG) can alter attitudes and practice within an entire region (Australia and New Zealand). DESIGN: (1) Single-institution study of patients with bilateral BMNG treated by thyroidectomy over a 40-year period, examining the changing pattern of use of bilateral subtotal thyroidectomy and total thyroidectomy in the initial surgical treatment of nodular goiter. (2) Mail survey of all endocrine surgeons (n = 75) in Australia and New Zealand, seeking information on their changing practice in the surgical treatment of BMNG. SETTING: Tertiary academic referral center. PATIENTS: A group of 3468 patients who underwent thyroidectomy for bilateral BMNG during the study period. Of these, 1838 had a subtotal thyroidectomy performed and 1251 had a total thyroidectomy as the primary surgical treatment. MAIN OUTCOME MEASURES: The changing incidence of each type of thyroid procedure each year over the study period. RESULTS: Within our unit, bilateral subtotal thyroidectomy was the principal procedure performed until 1984, when total thyroidectomy became the preferred procedure. Our unit now treats 94% of these patients with total thyroidectomy. Secondary thyroidectomy for recurrent goiter initially increased over the years (with a lag period of 13 years), reflecting the numbers of subtotal procedures previously performed, and is now declining. This pattern has been reflected throughout Australia and New Zealand; 60% of practicing endocrine surgeons now perform total thyroidectomy as the preferred treatment for bilateral BMNG. CONCLUSIONS: Total thyroidectomy is a safe and effective treatment for bilateral BMNG, and it is now the routine procedure throughout Australia and New Zealand. Its use has corresponded to a reduction in the need for secondary thyroidectomy for recurrent goiter.

Adult↗
PubMed2005

Preoperative technetium Tc 99m sestamibi SPECT imaging in the management of primary hyperparathyroidism in patients with concomitant multinodular goiter.

HYPOTHESIS: Preoperative parathyroid and thyroid imaging using technetium Tc 99m sestamibi scintigraphy-single-photon emission computed tomography (Tc 99m MIBI SPECT) and technetium Tc 99m sodium pertechnetate, respectively, in patients with parathyroid adenomas and concomitant multinodular goiters enables the selection of those suitable for minimally invasive radio-guided surgery. DESIGN: One hundred thirty patients with primary hyperparathyroidism were treated surgically during a 30-month period. Forty-one of these 130 patients had an associated multinodular goiter. All patients underwent planar and SPECT parathyroid scintigraphy using Tc 99m MIBI, and thyroid scintigraphy with technetium Tc 99m pertechnetate 2 to 5 days before surgery. On the morning of surgery each patient was reinjected with Tc 99m MIBI for intraoperative localization and validation. Minimally invasive radio-guided parathyroidectomy was performed using a handheld gamma-detection device with a thyroid probe. Removed glands were submitted for histopathologic examination for comparison with the scintigraphic results. Quantitative analysis of parathyroid activity was performed. RESULTS: Minimally invasive, radioguided parathyroidectomy was successfully performed in 21 (51%) of 41 patients who had a concomitant multinodular goiter. The remaining 20 patients underwent standard neck exploratory surgery because of associated thyroid disease; 5 of them had malignant thyroid disease. Among the 41 patients planar scintigraphy correctly identified 28 adenomas (68%). Single-photon emission computed tomographic imaging identified an additional 11 adenomas for a sensitivity of 95% and a specificity of 100%. Moreover, SPECT imaging correctly identified malignant thyroid nodules in 4 of 5 patients. Technetium Tc 99m MIBI retention was noted in only 25 adenomas (61%) while the remaining adenomas demonstrated a rapid washout. The average uptake ratio of parathyroid counts to maximum thyroid activity was significantly correlated with parathyroid hormone levels before surgery (P = .04). CONCLUSIONS: Our data encourage the use of preoperative SPECT imaging of parathyroid adenomas in patients who have multinodular goiters to select those suitable for minimally invasive radioguided surgery. This technique also offers important information regarding thyroid nodules that are suspicious for malignancy. The intraoperative gamma-probe technique enables the surgeon to focus his or her search, provides instant feedback regarding the progress of the operation, reduces surgical trauma and complications, and yields better cosmetic results. Patients with higher presurgical parathyroid hormone levels may especially benefit from radioguided surgery.

Adult↗
PubMed2006

Increased mortality and morbidity associated with thyroidectomy for intrathoracic goiters reaching the carina tracheae.

HYPOTHESIS: Complications associated with thyroidectomy for intrathoracic goiters have been underestimated because of the lack of a precise definition of high-risk patients. DESIGN: Retrospective multicenter multinational review of medical records and radiographic images of patients who underwent thyroidectomy for intrathoracic goiters reaching the carina tracheae. Demographic, clinical, operative, anatomical, and pathological data were recorded. RESULTS: There were 35 patients (mean +/- SE age, 63 +/- 11 years) included in the study. In 4 patients, the goiter was asymptomatic; 10 patients had dysphagia, 24 patients had dyspnea, and 3 patients had superior vena cava syndrome. A median sternotomy was required in 12 patients and a right-sided thoracotomy in 1 patient. The mean +/- SE operative time was 145 +/- 72 minutes (range, 50-360 minutes). Transient hypoparathyroidism developed in 13 patients. Four patients experienced transient hoarseness, and 1 patient had permanent vocal cord paralysis. There were no significant differences between the proportion of patients who underwent or did not undergo sternotomy or thoracotomy regarding vocal cord dysfunction (2 [15%] of 13 patients vs 3 [13%] of 22 patients) or hypoparathyroidism (5 [38%] of 13 vs 6 [28%] of 22 patients). The mean postoperative hospital stay was 10 days (range, 2-84 days). Four patients required reoperation. Two patients died. Nine of 14 patients with thyroid glands weighing at least 260 g required sternotomy vs 3 of 14 patients with thyroid glands weighing less than 260 g (P = .02). Overall, 18 [52%] of 35 patients were discharged without any complication. CONCLUSION: Intrathoracic goiters reaching the carina tracheae carry a high unreported risk of sternotomy, postoperative complications, reoperation, and death.

Adult↗
PubMed1992

Mediastinal goiters. The need for an aggressive approach.

We reviewed the cases of 52 patients with substernal goiters to examine clinical presentation, workup, technique of removal, malignancy, and outcome. Half of the patients were asymptomatic; half had at least one compressive symptom. Chest film was the most used; computed tomography or magnetic resonance imaging was by far the most useful study. Thyroid scans often failed to show the intrathoracic goiter. Fine-needle aspiration was not helpful because of the gland's inaccessibility. Seventeen percent (nine) of the thyroids showed malignancy, 21% (11) including incidental papillary carcinomas. These were not identified by duration of goiter, symptoms, or fine-needle aspiration. Except for lymphomas, prognosis was good after resection. Removal was almost always accomplished via cervical incision, with low morbidity and no deaths. The threat of compression, the substantial chance of malignancy, and the safety of resection mean that the presence of substernal goiter is an indication for surgery.

Academic Medical Centers↗
PubMed2004

Doppler evaluation of the thyroid in pediatric goiter.

PURPOSE: The aim of this study was to identify any changes in Doppler parameters in the thyroid arteries of pediatric patients with a clinical diagnosis of goiter living in an area where goiter is endemic. PATIENTS AND METHODS: In this prospective study, 20 pediatric patients with simple endemic goiter and 20 age-matched healthy subjects underwent sonographic examination. The resistance index (RI) and peak systolic velocity (PSV) on duplex sonography were measured from the inferior thyroid arteries, and the thyroid gland volume was recorded. Serum thyrotropin, free T3 hormone, and free T4 hormone levels were measured in both groups. RESULTS: The mean thyroid volume (+/- standard deviation) was significantly higher in the patients than in the healthy subjects (7.2 +/- 1.4 ml versus 3.2 +/- 1.1 ml; p < 0.01). The mean RI values for the thyroid arteries were significantly lower in the patient than in the control group (0.58 versus 0.70, respectively; p < 0.05). The mean PSV of the thyroid arteries was significantly higher for the patients than for the healthy subjects (mean, 36.7 cm/second versus 18.3 cm/second, respectively; p < 0.05). There was no correlation between the Doppler parameters and any of the hormone levels evaluated. CONCLUSIONS: In the arteries supplying the thyroid gland in a pediatric population, RIs were lower and PSVs higher in the patients with diffuse goiter than in the healthy control group. We discuss iodine deficiency as a possible mechanism for these changes.

Adolescent↗
PubMed1997

Thyroid cancer associated with adenomatous goiter: an analysis of the incidence and clinical factors.

We evaluated the incidence of thyroid cancer in patients with adenomatous goiter and investigated the clinical factors distinguishing patients with occult thyroid cancer, defined as a tumor size smaller than or equal to 10 mm, from those with clinical thyroid cancer, defined as a tumor size larger than 10 mm. Of 835 patients with histologically confirmed adenomatous goiter, 256 (30.7%) also had thyroid cancer, being occult in 137 patients and clinical in 119 patients. There was no correlation between the maximum size of the thyroid cancer tumor and the age of the patient, and the percentage of patients with thyroid cancer in each group was not influenced by age. There were no significant differences in age, sex, the serum concentrations of free triiodothyronine, free thyroxine, thyrotropin, and thyroglobulin, or the urinary iodine creatinine ratio. The frequency of calcified lesions being detected by ultrasonography (US) and/or neck X-ray in the patients with clinical thyroid cancer was significantly greater than that in those with occult cancer at 83% vs 57%, respectively (P < 0.0001). This study disclosed a high prevalence of thyroid cancer associated with adenomatous goiter, and the results suggest that a considerable number of associated carcinomas remain occult. The detection of calcification in the thyroid gland is one of the surgical indications for patients with adenomatous goiter.

Adenocarcinoma, Follicular↗
PubMed2002

Iodine status and goiter prevalence in Turkey before mandatory iodization.

Endemic goiter is an important public health problem in Turkey. Legislation for mandatory iodization of household salt was passed in July 1999. Current study is aimed at ascertaining the goiter prevalence and iodine nutrition in school-age children (SAC) living in known endemic areas of Turkey. Sonographic thyroid volumes (STV) and urinary iodine concentrations (UIC) of 5,948 SAC from 20 cities were measured between 1997-1999. STV of 31.8% of the SAC examined stayed above the upper-normal limits for the same age and gender recommended by the World Health Organization (WHO). Goiter prevalence ranged between 5 to 56% and median UIC ranged between 14 to 78 microg/l, indicating severe to moderate iodine deficiency (ID) in 14 and mild ID in 6 of the cities surveyed. Neither of the cities was found to have sufficient median UIC levels. The current study shows that endemic goiter is an important public health problem and iodine nutrition is inadequate nationwide. It also provides reliable scientific evidence and shows the need for a controlled and effective iodine supplementation program nationwide. Mandatory iodization of household salt seems to be the essential measure taken for the moment, additional measures may be needed in the near future.

Child↗
PubMed2002

The influence of parity on multinodular goiter prevalence in areas with moderate iodine deficiency.

Despite the observation that parity may increase the risk of thyroid carcinoma, very few studies have investigated the possible repercussion of parity on thyroid benign pathology. Recently, parity has been identified as one of the factors contributing to a larger thyroid size in healthy females. The aim of this work was to investigate a possible role for parity on the prevalence of multinodular goiter in iodine deficient areas. For this purpose, the reproductive histories of 2 cohorts of women, normal (Group I, 235 cases) and non-toxic multinodular goiter (NTMNG) affected (Group II, 274 cases) were compared. All subjects were euthyroid and had no previous history of thyroid function abnormalities. The number of full-term previous pregnancies (2.55+/-0.11 vs 1.77+/-0.10) and age (47.7+/-0.76 vs 42.3+/-0.83 yr) were found significantly higher (p<0.001) in multinodular goiter (MNG) patients than controls. Parity and age were found to be directly correlated (p<0.001), nevertheless the partial correlation coefficients demonstrated an independent and statistically significant difference for both variables between normal and NTMNG. Therefore, the independent effects of parity and age were further investigated. The effect of age on NTMNG prevalence seems to be weaker, in fact significant differences (p<0.001) for age between patients and controls were detected only when the effect of parity was absent (nulliparous), while with increasing gestations the effect of age disappeared. Our results indicate that age plays a minor role compared to parity which can therefore be considered as a stronger risk factor. In conclusion, the present study shows that, at least in iodine deficient regions, non-toxic multinodular goiter women show a statistically significant higher parity rate than healthy controls. Age may play a certain role but only when additional stronger risk factors are absent.

Adult↗