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PubMed1987

Increased level of thyroglobulin mRNA in a human familial goiter.

Thyroglobulin (Tg) and its specific mRNA were analyzed in the thyroid gland of two cases of familial goiter. A three-fold increase in the level of stable protein and functional Tg mRNA was found in the goiter of one of the two patients in whom a desiodase defect was demonstrated. Normal concentrations of both Tg and its mRNA were found in the other goiter in which no enzymatic defect could be shown. Our results suggest that the increase of Tg mRNA levels found in the goiter with a desiodase defect was due to a chronic stimulation of the gland by TSH.

Adolescent↗
PubMed1996

Epidemiological survey of goiter and iodine deficiency in Veneto region.

The aim of this paper was to determine goiter prevalence and urinary iodine excretion in the Veneto region. It is known since ancient times that goiter prevalence has affected mainly the mountainous areas in Italy. An extensive epidemiological survey was carried out in school-aged children, visiting 5,439 students and testing 1,883 urinary samples. A goiter prevalence of 8.8% was found in the Region; 7.7% of grade 1A and 1.1% of grade 1B respectively; in the pre-mountainous area the prevalence was higher than 10% (11.7% in the Treviso area and 12.7% in the Vicenza area). Urinary iodine excretion was less than 100 mcg/cr in about 45% of all examined children, with a peak of 20% under 50 mcg/cr in the Vicenza district. According to the WHO criteria, the goiter prevalence in the Veneto area can be considered under the limits of epidemic standards. Nevertheless we feel that in light of the urinary data a prophylaxis with iodine added salt should be recommended in any case.

Child↗
PubMed1987

Intrinsic abnormality of thyroid cells from a patient with a Brobdingnagian goiter.

Thyrocytes from normal and goitrous portions of the thyroid gland from a patient with an enormous (635 gm) goiter were cultured in media, and their relative abilities to uptake thymidine, synthesize DNA, and secrete Tg and T4 were assessed. Tg, T4 and the ratio Tg/T4 in media at 72 h were 120 micrograms/dl, 1.6 micrograms/dl and 75 for normal cells, and 410 micrograms/dl and 273 for goitrous cells. DNA synthesis was 30-100% greater in goitrous than normal cells over a period of 72 h indicating abnormally high rates of cell division and growth, but their thymidine uptake was only 20% of that in normal cells. TSH elicited stimulation of thymidine uptake and DNA synthesis both in goitrous and in normal cells, but to a lesser extent in goitrous cells. No evidence of growth stimulating autoantibody activity was detected in the patient's serum. These data indicate that although the ability of goitrous cells to uptake thymidine was impaired, their DNA synthesis was more active than normal thyroid, which may have led to disordered cell growth as evidenced by the enormous goiter size in this patient. Although goitrous cells secreted more than three times as much Tg into media compared to normal, media T4 levels were similar, indicating an increased synthesis yet low iodination of Tg in goitrous cells. There does not appear to be any support for TGSI mediation of the goiter in this patient, but rather, the goiter may have been due to an intrinsic alteration in DNA synthesis resulting in vigorous cell growth.

Cells, Cultured↗
PubMed1995

Development of hyperthyroidism in nodular goiter and thyroid malignancies in an area of relatively low iodine intake.

A high incidence of toxic nodular goiter has recently been described in areas of relatively low iodine intake. We studied the development of hyperthyroidism in nodular goiter and thyroid malignancies in an area of relatively low iodine intake (median 87 micrograms/h). The material comprised a total of 557 patients admitted to our department in the period 1978-88. The follow-up material consisted of 214 patients with a median age of 55 yr (19-86). Eighty-eight percent were females. The period of observation was 33 months (1-205). All patients had technetium thyroid scans, serum T3, serum T4, T3 uptake test and serum TSH performed. TRH tests were performed in 58 patients. During the follow-up period 45 initially euthyroid patients became hyperthyroid (18%). The incidence increased with age, and the median age in the group, who developed hyperthyroidism, was 65 yr. An estimated minimal incidence of toxic nodular goiter was 23/100,000/yr. Contrary to previous assumption, hyperthyroidism developed frequently in elderly patients with nodular goiter in a low iodine intake area. Thyroid cancer was found in 13 patients corresponding an estimated incidence of 1.5/100,000/yr. The cancer incidence was very low compared to other nordic countries with high iodine intake. This finding may suggest a possible influence of iodine intake on the incidence of thyroid cancer.

Adult↗
PubMed1996

Improvement of upper airway obstruction after 131I-treatment of multinodular nontoxic goiter evaluated by flow volume loop curves.

Symptoms of tracheal-esophageal compression are often related to a large nontoxic goiter. The aim of the present study was to evaluate to what degree upper airway obstruction, as measured by flow volume loops, FIF50% and FEF50%/FIF50% (Forced Expiratory Flow at 50% of the vital capacity/ Forced Inspiratory Flow at 50% of the vital capacity) exists in nontoxic multinodular goiter, and whether changes occur after 131I-treatment. Thirteen patients with large multinodular nontoxic goiters were evaluated by estimation of FIF50%, FEF50%/FIF50% ratio and a graphic plot of the flow volume loop curve before and three, six and 12 months after treatment with 131I. FIF50% increased over 12 months from median 1.79 l/sec (range 1.46-3.02) to 2.84 l/sec (1.13-5.69) (p = 0.01). A progressive increase was seen over time (p = 0.001, trend analysis). The FEF50%/FIF50% ratio decreased from in 1.45 (0.32-2.26) to 1.03 (0.43-2.13) 12 months after treatment (p < 0.001). A progressive decrease was seen over time (p = 0.001, trend analysis). By visual evaluation 11 had a flow volume loop curve typical for an upper airway obstruction and in 9 patients the FEF50%/FIF50% ratio was > 1.2. In conclusion we found that upper airway obstruction is present in patients with multinodular nontoxic goiter, and seems to be reduced after 131I-treatment. Flow volume loop curves and measurement of FEF50% and FIF50% are important estimates for upper airway obstruction in these patients.

Aged↗
PubMed2001

[Surgical procedures and risk factors in therapy of benign multinodular goiter. A statistical comparison of the incidence of complications].

BACKGROUND: The best surgical approach for bilateral resections in the therapy of benign multinodular goiter is still controversial. METHODS: The purpose of this study was to compare different modes of resection concerning differences in complication rates and risk factors influencing the outcome. 2235 thyroid resections for multinodular goiter between 1985 and 1999 were analysed. RESULTS: When compared to bilateral subtotal resection (n = 327; 14.6%), those patients who received lobectomy and contralateral subtotal resection (n = 952; 42.6%) showed a statistically significant higher incidence of temporary hypocalcaemia (22.6% versus 15.9%) only. The "nerve at risk"-analysis demonstrated no significant difference of laryngeal nerve paralysis between the side of lobectomy and subtotal resection, respectively. In comparison to the entire patient population operations for recurrent goiters had an equal operative risk, whereas patients with goiter WHO III or an intrathoracic location had significant higher rates of temporary laryngeal nerve paralysis and hypocalcaemia. CONCLUSIONS: Lobectomy and contralateral subtotal resection offers numerous advantages concerning intraoperative variability and definitive resection of suspicious nodules. With an adequate standardized surgical technique and identification of the laryngeal nerve, the complication rate is comparable to bilateral subtotal resection.

Female↗
PubMed2006

HMG-CoA reductase inhibitors inhibit rat propylthiouracil-induced goiter by modulating the ras-MAPK pathway.

The aim of this study was to evaluate in vivo the antiproliferative effect of an inhibitor of isoprenoids metabolism, lovastatin, in an experimental model of propylthiouracil-induced goiter. In thyroid cells, thyrotropin (TSH)-induced proliferation requires active isoprenoid synthesis, and the HMG-CoA reductase inhibitors have antiproliferative effects in vitro. Propylthiouracil treatment (PTU) of rats led to thyroid hypertrophy and hyperplasia by TSH-induced activation of the mitogen-activated protein kinase (MAPK) pathway. Immunohistochemistry showed an increased number of proliferating cell nuclear antigen (PCNA)-positive cells in the thyroid gland of PTU-treated rats. Moreover, the phosphorylation of ERK1 and ERK2 was increased in the extract from goiter tissue as compared with the thyroid tissue of untreated rats. To determine whether the inhibition of selected pro-survival pathways (i.e., p21ras-MAPK) was sufficient to affect goitrogenesis, thyroids from 12 PTU-treated rats were injected in vivo with an adenovirus transducing a dominant-negative ras gene (Rad-L61.S186) and another set of 12 rats were injected with a pharmacological inhibitor of MAPK (PD98059). Both Rad-L61.S186 and PD98059 were able to inhibit the PTU-induced goiter. It is interesting to note that lovastatin, when administered in drinking water, significantly prevented the thyroid gland enlargement. Therefore, lovastatin-treated thyroid glands were significantly smaller than those treated with PTU alone. In addition, the lovastatin-treated glands also showed a decreased expression of phosphorylated ERK1/2 and a number of PCNA-positive cells. Our data suggest that lovastatin is an efficient inhibitor of goitrogenesis and provide a rationale for innovative therapeutic strategies employing statins in the treatment of nodular goiter in humans.

Animals↗
PubMed2000

Upper airway obstruction in patients with goiter studies by flow volume loops and effect of thyroidectomy.

The patient with goiter and his or her physician frequently overlook symptoms of upper respiratory obstruction. Conventional radiology is the accepted method for detecting upper airway obstruction in these patients. Flow volume loops provide additional information on airflow dynamics. Twenty-five patients of goiter undergoing surgery were evaluated for upper airway obstruction by symptomatology, conventional radiology, and flow volume loops. Flow volume loops were repeated 1 month after surgery. Ten (40%) patients had mild symptoms on direct questioning. Tracheal deviation, compression, or both were noted in eight (32%) patients on radiology. Flow volume loops detected upper airway obstruction in 15 (60%) patients. Surgery resulted in normalization of all preoperative abnormal curves. The flow volume loop is a simple noninvasive method for detecting upper airway obstruction in patients with goiter. Abnormal upper airway dynamics are present in more patients with goiter than previously recognized, and relief of this obstruction should be an important aspect of thyroid surgery.

Adolescent↗
PubMed2006

The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter.

BACKGROUND: In recent years, total or near-total thyroidectomy has emerged as a surgical option to treat patients with multinodular goiter, especially in endemic iodine-deficient regions. The aim of this study was to compare the complication rates of total and near-total thyroidectomy in multinodular goiter and the incidence of thyroid cancer requiring radioactive iodine ablation and completion thyroidectomy between groups. STUDY DESIGN: Patients with euthyroid multinodular goiter without any preoperative suspicion of malignancy, history of familial thyroid cancer, or previous exposure to radiation were randomized (according to a random table) to total thyroidectomy (group 1, n = 104) and near-total thyroidectomy leaving less than 2 g (group 2, n = 112). RESULTS: There were no persistent complications. The incidence of transient hypoparathyroidism in group 1 (26%) was significantly higher than in group 2 (9.8%) (p < 0.001). The rate of asymptomatic hypocalcemia in group 2 (7.4%) was lower than in group 1 (27%) (p < 0.001). The incidence of papillary cancer was 9.6% in group 1 and 12.5% in group 2 (p > 0.05). None of the patients underwent completion thyroidectomy before ablative therapy. Ten patients were found to have the histological criteria for radioactive iodine ablation. Of these 10 patients, four were in group 1 and six were in group 2 (p > 0.05). CONCLUSION: In conclusion, we recommend near-total thyroidectomy in multinodular goiter instead of total or subtotal thyroidectomy. While near-total thyroidectomy and total thyroidectomy obviate the need for completion thyroidectomy in incidentally found thyroid cancer, and while there is no difference in the rate of recurrent laryngeal nerve palsy between the two methods, near-total thyroidectomy causes a significantly lower rate of hypoparathyroidism compared to total thyroidectomy.

Adult↗
PubMed2004

Surgical management of substernal goiters: clinical experience of 170 cases.

PURPOSE: To discuss the presentation, diagnosis, treatment, histopathological findings, and complications of patients who underwent thyroidectomy for substernal goiter in our surgical clinic. METHODS: We retrospectively analyzed 170 patients with substernal goiters among 2650 patients undergoing surgical treatment for various thyroid diseases between 1990 and 2003. We evaluated the clinical data, preoperative diagnostic findings, surgical treatments, histopathological results, and postoperative complications. RESULTS: The most common symptoms were a cervical mass (88%) and dyspnea (35%), but 26% of the patients were asymptomatic. Chest radiography provided the first evidence of a substernal goiter in 77% of the patients. We performed total or near total thyroidectomy and operated through a cervical incision in all but 12 of the patients. There was no operative mortality but 12 (7%) patients suffered temporary hypoparathyroidism and 4 suffered transient vocal cord paralysis (2%). Malignancy was diagnosed by histopathological examination in 22 (13%) patients. CONCLUSION: We think that the diagnosis of a substernal goiter is an indication for thyroidectomy, which is associated with very low postoperative morbidity.

Adolescent↗
PubMed1988

Treatment of non-toxic multinodular goiter with radioactive iodine.

Fourteen patients with large non-toxic multinodular goiters were treated with 20 to 100 mCi (740 to 3,700 MBq) of radioactive iodine (iodine-131). In seven, the goiter had recurred after a partial thyroidectomy and four of these had had two operations. Eight had symptoms of respiratory obstruction, two had dysphagia, and the others sought treatment for cosmetic reasons. After administration of iodine-131, there was a significant decrease in goiter size in 11 of the 14 patients, and all those with obstructive symptoms showed improvement. No significant local side effects occurred, but hypothyroidism and Graves' disease each occurred once during follow-up from one to 13 years. Radioactive iodine in doses of 20 to 100 mCi is an effective, safe therapeutic alternative in patients with large non-toxic multinodular goiter, particularly when there is recurrence following surgery or when there are contraindications to surgery.

Adult↗
PubMedDate not supplied

Identification of the external branch of the superior laryngeal nerve (EBSLN) in large goiters.

BACKGROUND: Intraoperative injury to the external branch of the superior laryngeal nerve (EBSLN) can result in significant postoperative voice problems. This injury can be avoided by intraoperative nerve identification. The EBSLN has a close anatomic relationship with the superior thyroid pedicle. According to the previous anatomic classification, the type 2b nerve, which crosses the vessels below the superior thyroid pole and is considered high risk, is found in 14% to 20% of persons with normal or slightly enlarged thyroid glands. OBJECTIVE: To analyze the frequency of this type 2b nerve in a population with large goiters and to compare it with the previously mentioned proportions. DESIGN: Nonrandomized prospective study. PATIENTS AND METHODS: During a 15-month period, patients with large uninodular or multinodular goiters were entered in the study. The EBSLN was searched with the help of a nerve stimulator and the type was annotated. If the patient had to be submitted to a bilateral thyroidectomy, each superior thyroid pole, with the correspondent nerve, was considered as a separate unit. RESULTS: Nine patients, all women, underwent surgery. The average size of the goiters was 10.9 cm x 7.3 cm x 5.0 cm, and the average weight of the specimens was 431 g. There were four bilateral procedures, totalling 13 nerves analyzed. Seven (54%) were type 2b. CONCLUSION: The frequency of the type 2b EBSLN is considerably higher in large goiters. This finding suggests that it is even more advisable to try to positively identify the nerve in these situations, in order to prevent its injury, which is permanent and troublesome for voice professionals.

Adult↗
PubMed2007

Analysis of the sodium iodide symporter expression in histological slides from a nodular goiter.

BACKGROUND: The aim of the study was analysis at both the level and the cell site of the sodium/iodide symporter (NIS) in histological slides from hot, warm, and cold nodules and extranodular parenchyma according to scintigraphy. METHODS: The study population consisted of 97 people who underwent surgery for a toxic nodular goiter (26 patients) or a non-toxic nodular goiter (71 patients). Immunohistochemical study was performed with 198 histological slides from hot, warm, and cold nodules (study slides) and the extranodular parenchyma (control slides). The level of NIS expression was estimated objectively using the computerized image analysis system, Quantimet 600S (Leica, Cambridge, UK). RESULTS: We found significantly higher NIS expression in hot nodules than in cold nodules and in warm nodules than in cold ones. We found significantly higher NIS expression in hot and warm nodules than in the surrounding parenchyma. The level of NIS expression did not differ significantly between cold nodules and the collateral tissues. CONCLUSIONS: Our data indicate that NIS protein participates in the development of hyperthyroidism in the course of a nodular goiter. We confirm that the functional state of a nodular goiter is determined by NIS expression in nodules, not in collateral parenchyma. The low metabolism of cold nodules does not simply result from decreased level of NIS protein or its defective targeting to the cell membrane. The observation of NIS in the cell cytoplasm of hot nodules seems to indicate that the intracellular localization of NIS does not determine loss of its activity.

Female↗
PubMed1998

Use of a Foley catheter in the removal of a substernal goiter.

Substernal goiters present a technical challenge to the surgeon. Most substernal goiters may be removed through a cervical incision; however, a median sternotomy may be required in 1% to 2% of patients. To avoid a median sternotomy, many techniques have been described in the literature to facilitate extraction. Special spoons and clamps have been described, and techniques, such as morcellation, the drawer technique, and piecemeal extraction, have been popularized. We describe a method whereby a Foley catheter is used to deliver a large substernal goiter through a cervical incision. It consists of steady traction on the inflated balloon of a Foley catheter placed beyond the substernal component of the goiter. This method has been used successfully and safely on 2 patients and may obviate the need for a sternotomy.

Catheterization↗
PubMed1999

Colloidal aggregates of insoluble inclusions in human goiters.

To shed some light on the physicochemical properties of the thyroid follicular colloid, we have screened retrospectively the autoradiographs of 60 human nodular goiters labeled 17 h preoperatively with 100 microCi 125I for evidence of colloid compartmentalization. In 87% (52/60) of all goiters examined, sporadic or multiple colloidal inclusions ('colloid stones') not mixing with newly labeled Tg were detected. The detailed analysis of 17 goiters revealed a mean incidence of 0.09+/-0.11 'colloid stones' of variable size per follicle ranging from 0.02+/-0.01 (10) to 0.43+/-0.09 (5) (mean values +/- S.D., number of sections examined in brackets). In this study we did not find a clear-cut association of incidence of 'colloid stones' with sex, age or nosologic group (hyperthyroid, preclinically hyperthyroid, euthyroid). The existence of different colloidal compartments as demonstrated in this and other studies is of considerable importance for thyroid function, interpretation of iodine kinetics, and studies on the role of iodine on growth and function of the thyrocytes. Different thyroidal iodine compartments could well be of functional relevance, for example in the adaptation of thyroid hormone secretion to antithyroid drugs or in severe and prolonged iodine deficiency, when very slow compartments become an important source of minimal quantities of iodine and thyroid hormone. 'Colloid stones', for example, may well explain the repeatedly observed, surprisingly large total iodine store in human endemic goiters, even in the presence of severe iodine deficiency. It is evident that the existence of multiple iodine compartments and, in particular, of particulate slow-turnover pools complicates the interpretation of total glandular iodine measurements with modern techniques such as X-ray fluorescence and positron emission tomography.

Adult↗
PubMed2001

Prenatal diagnosis and early in utero management of fetal dyshormonogenetic goiter.

We present a case of a fetal dyshormonogenetic goiter diagnosed by ultrasound examination at 24 weeks of gestation, in a woman with no past history of thyroid disease or goitrogen treatment and with normal thyroid tests, including absence of auto-antibodies. In this situation, fetal goiter may only be associated with fetal hypothyroidism, therefore cord blood sampling was not performed but early treatment was initiated. Amniotic fluid instillation of thyroid hormone led to a rapid decrease in amniotic fluid volume and a clear reduction in thyroid goiter. However, fetal thyroid volume did not totally normalise, and cord blood analysis at birth showed elevated fetal TSH level. As prenatal treatment of fetal hypothyroidism remains controversial in euthyroid mothers, the main objective is to prevent obstetrical complications of large goiters. Therefore, in some selected cases with no maternal history of thyroid disease and normal thyroid function tests, cordocentesis is not necessary to confirm fetal thyroid status or to adjust fetal treatment.

Adult↗
PubMed1999

[Goiter and nodular thyroid disease: clinical guidelines for diagnosis and treatment. (Waiting? Hormone therapy? Surgery? radioiodine?)].

Nodular thyroid disease is a common problem. We present clinical guidelines for the management of patients with thyroid nodules, multinodular goiters and thyroid cysts for use by primary physicians. In the initial evaluation ultrasonography of the thyroid and fine-needle aspiration biopsy (FNAB) is recommended. FNAB has become the cornerstone in the evaluation of solitary thyroid nodules, cysts and dominant nodules within multinodular goiters. If the procedure is done properly, it should have a false-negative rate of less than 5% and a false-positive rate of not more than 1%. Thyroid radionuclide scans are less frequently used in the initial evaluation of a nodular goiter. Surgery is the primary therapy for patients with nodular thyroid disease. Other available treatment options are radioiodine and TSH-suppression with thyroxine. The main indications for surgery in euthyroid patients with thyroid nodule or with nontoxic multinodular goiter are recently documented or suspected malignancy, compression of the trachea and esophagus, significant growth of the nodule, recurrence of a cyst after aspiration, neck discomfort and cosmetic concern.

Algorithms↗
PubMed2001

[Intrathoracic goiter--a rare mediastinal tumor].

Intrathoracic, totally ectopic goiters are rare, but have to be considered as a diagnostic possibility in all mediastinal masses. The displacement of the thyroid tissue inferiorly in connection with the embryogenesis of the heart and the large vessels explains the aetiology of the disease. Ectopic goiters are often asymtomatic or oligosymptomatic. They may be classified into two groups according to their location in the anterior or posterior mediastinum. The diagnostic procedures include standard X-ray and CT scan imaging, eventually combined with radionuclide scintigraphy. Once the diagnosis of a intrathoracic goiter is obtained the treatment is surgical (unknown dignity, risk of compression or other symptoms). The approach of choice is through a median sternotomy in case of a anterior location and a posterolateral thoracotomy in case of a posterior location. We discuss the diagnostic and therapeutic approach in 2 patients with mediastinal goiters--one located in the anterior and one in the posterior mediastinum.

Adult↗