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PubMed2000

Persistence of goiter despite oral iodine supplementation in goitrous children with iron deficiency anemia in Côte d'Ivoire.

BACKGROUND: In developing countries, many children are at high risk of goiter and iron deficiency anemia. Because iron deficiency can have adverse effects on thyroid metabolism, iron deficiency may influence the response to supplemental iodine in areas of endemic goiter. OBJECTIVE: The aim of this study was to determine whether goitrous children with iron deficiency anemia would respond to oral iodine supplementation. DESIGN: A trial of oral iodine supplementation was carried out in an area of endemic goiter in western Côte d'Ivoire in goitrous children (n = 109) aged 6-12 y. Group 1 (n = 53) consisted of goitrous children who were not anemic. Group 2 (n = 56) consisted of goitrous children who had iron deficiency anemia. At baseline, thyroid gland volume and urinary iodine, thyrotropin, and thyroxine were measured by using ultrasound. Each child received 200 mg I orally and was observed for 30 wk, during which urinary iodine, thyrotropin, thyroxine, hemoglobin, and thyroid gland volume were measured. RESULTS: The prevalence of goiter at 30 wk was 12% in group 1 and 64% in group 2. The mean percentage change from baseline in thyroid volume 30 wk after administration of oral iodine was -45.1% in group 1 and -21.8% in group 2 (P < 0.001). Among the anemic children, there was a strong correlation between the percentage decrease in thyroid volume and hemoglobin concentration (r(2) = 0.65). CONCLUSION: The therapeutic response to oral iodine was impaired in goitrous children with iron deficiency anemia, suggesting that the presence of iron deficiency anemia in children limits the effectiveness of iodine intervention programs.

Administration, Oral↗
PubMed1989

Advanced upper airway obstruction caused by cervical goiter.

Goiters are an unusual cause of advanced upper airway obstruction. Previously described patients have been clearly symptomatic, and most have had substernal goiters. We present a patient with minimal symptoms with severe upper airway obstruction from a cervical goiter despite long-term therapy with thyroid hormone. Her spirometry exceeded criteria for urgent surgery. Patients with large goiters should have spirometry with flow-volume loop performed despite minimal or absent symptoms of respiratory distress.

Airway Obstruction↗
PubMed1987

Total thyroidectomy. The preferred option for multinodular goiter.

Total thyroidectomy is an operation that has generally been reserved for the management of differentiated thyroid carcinoma. Over the last decade total thyroidectomy has become used increasingly and is now the preferred option in the authors' unit for the management of multinodular goiter affecting the entire gland. Over the period from 1975 to 1985, 853 thyroidectomies have been performed for multinodular goiter; of these, 115 have been total thyroidectomies. During that time, the incidence of total thyroidectomy for multinodular goiter has increased in percentage terms from 9% in 1975 to 50% in 1985. There have been two cases of permanent hypoparathyroidism and one case of permanent recurrent laryngeal nerve injury, and these occurred in patients who had less than total thyroidectomy. Total thyroidectomy is an appropriate operation for the management of diffuse multinodular goiter where the entire gland is involved because it precludes patients from requiring further surgery for recurrent disease, with its high associated risks. It must be emphasized, however, that protection of the recurrent laryngeal nerve and parathyroid glands must still be paramount in dealing with benign thyroid disease.

Goiter, Nodular↗
PubMedDate not supplied

Computed tomography in amyloid goiter.

Two cases of amyloid goiter showed diffuse decreased density of enlarged thyroid on CT. The diffuse decreased density of amyloid goiter on CT is thought to represent large amount of adipose tissue often found in amyloid goiter. When diffuse decreased density of the enlarged thyroid is recognized on CT, amyloid goiter should enter into differential diagnosis.

Adult↗
PubMed1993

Unusual calcified goiter associated with increased iodoprotein in serum.

For 30 years we have followed the case of a euthyroid patient who had a goiter diagnosed at age 15. It was originally diffuse and did not shrink during treatment, first with desiccated thyroid extract and then with triiodothyronine. After treatment was stopped, the goiter gradually became nodular and calcified when the patient was in her late teens or early 20s; it then shrank. She remains clinically and chemically euthyroid, with a calcified, multinodular goiter and persistent elevation of the serum PBI concentration which, early in the course of the disease was shown to include a substantial fraction of butanol-insoluble iodine. In a euthyroid patient, the association of an elevated serum PBI concentration (with an abnormally large butanol-insoluble iodine fraction) with a diffuse goiter that became nodular and calcified may be unique.

Adolescent↗
PubMedDate not supplied

Repetitive monomorphic ventricular tachycardia in a 4-year-old boy with toxic multinodular goiter.

A case of toxic multinodular goiter associated with repetitive monomorphic ventricular tachycardia (VT) is reported. A 4-year-old boy was found to have asymptomatic VT. When treatment with antiarrhythmic agents turned out to be ineffective, thyrotoxicosis was suspected due to the rapid enlargement of the left thyroid gland and associated thyroid function studies. A diagnosis of toxic multinodular goiter was made on the basis of subsequent scintigraphy and ultrasonography. Treatment with antithyroid drugs and inorganic iodine restored the thyroid function to normal, and was accompanied by the disappearance of VT. A left thyroid lobectomy was performed, and the pathological findings were compatible with toxic multinodular goiter. After the operation, the patient was transiently hypothyroid and had no VT without medication. A review of the literature revealed no previously documented cases of VT with toxic multinodular goiter.

Anti-Arrhythmia Agents↗
PubMed2004

Unsuccessful radioiodine treatment of a non-toxic goiter: a case report.

A middle-aged woman with a large right-sided, non-toxic goiter with low iodine uptake was admitted to the Department of Endocrinology with the purpose of volume reduction of the goiter. Thyroid pertechnetate scintigraphy showed homogenous and diffuse uptake in both lobes. Initially thyroxine treatment was given without volume-reducing effect. Radioiodine was administered twice to deliver a total radiation dose of 70 mCi iodine (I)-131. Subsequent pertechnetate scintigraphy showed that the normal-sized, normally functioning left lobe had disappeared after radioiodine, whereas the enlarged right lobe appeared unchanged. During the following years the size of the right lobe increased, and compression symptoms developed. The thyroid gland finally had to be removed by surgery. A large solitary thyroid nodule was removed, but no left lobe was identified. After surgery the patient had no thyroid tissue and had to be substituted by thyroid hormones. Despite good results of iodine treatment of non-toxic goiters, this case describes an unintended outcome leaving a patient without thyroid tissue, and a protracted course could have been avoided if the patient had undergone surgery earlier. However, this reported case should not discredit the use of radioiodine treatment of non-toxic goiters, but focus on patients with a single large solitary adenoma in whom this treatment may be inappropriate.

Denmark↗
PubMed1982

Immunological characterization of mononuclear cells in thyroid gland and blood in Graves' disease, multinodular goiter and papillary carcinoma.

Mononuclear cell infiltrates in thyroid gland tissue sections from patients with drug-treated Graves' disease (n = 5), non-toxic nodular goiter (n = 12) and papillary carcinoma (n = 5) were characterized by immunological membrane receptors. T lymphocytes were identified using 2-aminoethylisothiouronium bromide hydrobromide (AET)-treated sheep erythrocytes (E) (E-AET). E sensitized with rabbit IgM antibodies (A) and human complement (C) (EAC) were used to detect receptors for C3b (B lymphocytes and monocytes) or C3d (B lymphocytes). E sensitized with rabbit IgG antibodies were used to detect receptors for the Fc portion of IgG (FcR; lymphocytes and monocytes). The results indicate that T and B lymphocytes infiltrate the thyroid gland in Graves' disease as well as in nodular goiter. T lymphocytes seemed to predominate in both disorders. In thyroid papillary carcinoma the number of B and T lymphocytes was negligible. However, EA absorbed strongly to sections from 3 of the 5 tumors studied, indicating the presence of FcR on tumor cells or infiltrating host cells. The percentage of active and total T lymphocytes in peripheral blood from the patients with drug-treated Graves' disease was markedly reduced (9 +/- 5 and 28 +/- 11%, controls 22 +/- 9 and 68 +/- 11%; p less than 0.01 and less than 0.001). In patients with nodular goiter the percentage of total T lymphocytes was slightly, but significantly decreased (p less than 0.05). We suggest that the marked decrease in blood T lymphocytes observed in Graves' disease might be caused by the drug therapy. In nodular goiter the predominance of T lymphocyte infiltration together with a slight decrease in blood T lymphocytes suggest that autoimmune mechanisms are involved in the pathogenesis.

Adult↗
PubMed1985

Pathogenesis of heterogeneity in human multinodular goiter. A study on growth and function of thyroid tissue transplanted onto nude mice.

Functional and morphologic heterogeneity of human multinodular goiters was investigated in 300 samples from "cold" and "hot" regions of 20 goiters transplanted onto nude mice. Transplants were labeled with [3H]thymidine and radioiodine, while the host's thyroid-stimulating hormone (TSH) secretion was either stimulated or suppressed. Proliferation and function of follicular cells were assessed in whole follicles reconstructed from autoradiographs of serial sections. Hot transplants had a higher autonomous iodine uptake than those of cold tissue in TSH-suppressed hosts. Functional autonomy widely varied among the follicles, but even more so among individual cells. Hot grafts differed from cold ones only by a comparatively larger fraction of autonomous cells. Intercellular differences of iodinating activity were not abolished by TSH. Grafts faithfully reproduced the individual growth pattern of the original tissue. Between 0.5% and 7% of all follicular cells replicated despite suppression of TSH. Up to 70% of these cells were clustered, forming scattered foci of autonomously growing tissue. Other cells only started replicating after long-term TSH stimulation. Thus, goiters contained subsets of cells with high and others with low growth response. Progenies of replicating cells remained clustered, sometimes budding outwards to form new follicles. Autonomy of growth and autonomy of function are independent traits of epithelial cells. Epithelial cells have their individual growth pattern, replication rate, and functional capacity. These traits are passed on from a mother cell to its progeny during follicle neogenesis. To this main mechanism accounting for the morphologic and functional heterogeneity of human goiters, inheritable modifications of gene expression must probably be added.

Animals↗
PubMed1989

Transforming growth factor beta regulates thyroid growth. Role in the pathogenesis of nontoxic goiter.

The production and growth regulatory activity of transforming growth factor beta were studied in human thyroid tissue. As estimated by its mRNA expression in fresh tissue samples, transforming growth factor beta was produced in normal and in diseased thyroid glands. Transforming growth factor beta mRNA was mainly produced by thyroid follicular cells and in lesser quantities by thyroid infiltrating mononuclear cells. The concentrations of transforming growth factor beta mRNA were lower in iodine-deficient nontoxic goiter than in Graves' disease and normal thyroid tissue. Transforming growth factor beta protein secretion by cultured thyroid follicular cells was also low in nontoxic goiter, but could be increased by addition of sodium iodide (10 microM) to the culture medium. Recombinant transforming growth factor beta did not affect basal tritiated thymidine incorporation in cultured thyroid follicular cells, but inhibited, at a concentration of 10 ng/ml, the growth stimulatory influence of insulin-like growth factor I, epidermal growth factor, transforming growth factor alpha, TSH, and partly that of normal human serum on cultured thyroid follicular cells. This inhibition was greater in Graves' disease than in nontoxic goiter. These results suggest that transforming growth factor beta may act as an autocrine growth inhibitor on thyroid follicular cells. Decreased transforming growth factor beta production and decreased responsiveness to transforming growth factor beta may be cofactors in the pathogenesis of iodine-deficient nontoxic goiter.

Adult↗
PubMed1995

Clinical and morphologic findings of familial goiter in bongo antelope (Tragelaphus eurycerus).

Inherited defects of thyroglobulin synthesis resulting in congenital goiter are well described in certain breeds of domestic ungulates and in human beings. Goiter associated with synthesis of an abnormal thyroglobulin and the presence of thyroidal albumin was identified in five closely related bongo antelopes (Tragelaphus eurycerus). The goiter had an adult onset, and the affected bongos appeared to remain euthyroid with normal serum T3 and T4 values, normal serum cholesterol concentrations, and nonelevated concentrations of circulating thyroid stimulating hormone (TSH). Goitrous bongos had significant reproductive difficulties, including reduced cyclic activity and prolonged gestations, but were otherwise normal. Over the course of the disease, the thyroid glands greatly enlarged (up to 10 x 20 cm) and became polycystic. Microscopically, there was an admixture of giant colloid-filled follicles and follicles of normal size lined with variable follicular epithelium ranging from squamoid to mildly to moderately hyperplastic. The pathogenesis of goiter in the bongo may reflect a mixture of genetic predisposition coupled with environmental factors, including a period of exposure to a goitrogen.

Animals↗
PubMed2002

Difference in goiter rates between regular and occasional users of iodized salt in Mongolia.

In Mongolia many households use iodized salt only occasionally. We investigated whether the occasional use of iodized salt had an impact on the reduction of goiter size. We examined 685 children (8-11 years old) in five groups of households that (1) used iodized salt regularly, (2) used more than 10 kg of iodized salt annually, (3) used 6 to 10 kg annually, (4) used less than 6 kg annually, (5) and regularly used noniodized salt. The prevalence of goiter as determined by ultrasound in these five groups was 31.1%, 30.3%, 40.6%, 52.1%, 56.6%, respectively. There was no difference between goiter rates among the first three groups, but these groups had significantly lower rates than the last two groups. We concluded that annual use of more than 6 kg of iodized salt, preferably more than 10 kg, by a household had a beneficial effect on the rate of goiter. In addition, the possibility was suggested that households that consumed only iodized salt consumed less salt than other households.

Child↗
PubMed1990

Familial goiter in bongo antelope (Tragelaphus eurycerus).

Congenital defects in thyroglobulin (Tg) synthesis in animals have proven to be useful models for the study of Tg synthesis and regulation. Defects in Tg synthesis have been well described in Afrikander cattle, Australia Merino sheep, and goats in The Netherlands. This report describes a study of goiter in a nondomesticated bovine species, bongo antelope (Tragelaphus eurycerus), an African bovid. Three animals housed at the National Zoological Park, Washington, D.C. were studied; two had visible goiters, and a third bongo had microscopic evidence of goiter. Tg extracted from thyroid glands or thyroid colloid from these animals had a high mol wt component that was greater than 220K daltons and differed in apparent mol wt from 19S Tg from domestic cattle. Thyroid extracts also had thyroid albumin; albumin was more than half the total protein in colloid extract. The animals with goiter were euthyroid according to their circulating levels of thyroid hormones.

Animals↗
PubMed2003

Comparative efficacy and side effects of the treatment of euthyroid goiter with levo-thyroxine or triiodothyroacetic acid.

Euthyroid goiter is usually treated with TSH-inhibitory doses of levo-T(4) (L-T(4)). Because triiodothyroacetic acid (TRIAC) decreases TSH levels, the following study was perfomed: 36 euthyroid goitrous female patients (no cancer or chronic thyroiditis) were randomized to TRIAC (19.6 micro g/kg) (n = 19) or L-T4 (1.7 microg/kg) (n = 17) treatment during 11 months. Goiter volume; lumbar and femoral bone mineral density; serum osteocalcin; deoxypyridinoline; TSH; free T(4); total, high-density lipoprotein, and low-density lipoprotein cholesterol; and triglycerides were measured before and after the study period. Student's t test and chi(2) analysis were performed. TSH values (microunits per milliliter) in the TRIAC and L-T(4) groups were: 1.91 +/- 0.6 (basal) and 0.180 +/- 0.1 (after) and 2.1 +/- 2.5 (basal) and 0.180 +/- 0.3 (after), respectively. Thyroid volume decreased 37.9 +/- 35.4% in the TRIAC patients and 14.5 +/- 39.5% in the L-T(4) group (P = 0.069). Forty-two percent of the goiters with TRIAC reduced more than 50% their initial volume vs. 17.7% with L-T(4) (P = 0.15). With TRIAC, patients experienced fewer side effects. No differences in the changes of bone mineral density, serum deoxypyridinoline, osteocalcin, or the lipid profile were observed between both groups. The present results show that TRIAC is more effective than L-T(4) in the reduction of goiter size, with comparable effects on peripheral parameters.

Adult↗
PubMed1975

Serum thyroid hormone and thyrotropin levels in subjects from endemic goiter regions of New Guinea.

We studied serum thyroid hormone and thyrotropin (TSH) levels in subjects from two regions (Nomane and KarKar) of New Guinea where endemic goiter and/or iodine deficiency are prevalent. The results of the studies in 285 patients from Nomane indicated subnormal serum T4 (mean plus or minus SD, 6.5 plus or minus 2.8 vs 8.4 plus or minus 2.0 mug/1ll ml, for normal Americans, P less than 0.001), supranormal serum T3 (161 plus or minus 51 vs 126 plus or minus 33, ng/100 ml, p less than 0.001), supranormal serum T3/T4 ratio (T3/T4 x 100, 3.1 plus or minus 2.4 vs 1.5 plus or minus 0.4, P less than 0.001) and supranormal serum TSH (16 plus or minus 40 vs 2.7 plus or minus 1.2 muU/ml, P less than 0.001). Serum free T4 and free T3 were measured in 42 subjects. Serum free T4 was subnormal (2.0 plus or minus 0.9 vs 2.8 plus or minus 0.5, ng/100 ml P less than 0.001) and free T3 was elevated (677 plus or minus 150 vs 375 plus or minus 105, pg/100 ml, P less than 0.001). Serum T4 in goitrous patients was significantly lower than that in non-goitrous patients (5.9 vs 6.9 mug/100 ml, P less than 0.005). However, serum T3 and TSH were no different in the presence or absence of goiter. The frequencies of elevated serum TSH or serum T3 in presence of goiter were also no different from those in its absence. The mean values of various thyroid function tests in 37 subjects from KarKar Island were similar to the corresponding values in Nomane subjects. Serum T4, T3 and TSH values in 8 of 13 deaf-mute patients were similar to the corresponding mean values of other inhabitants of the region. However, the remaining 5 patients had deaf-mutism with no appreciable abnormality in thyroid function. Serum TSH correlated inversely with serum T4 (r= -0.31, P less than 0.001). There was, however, no significant relationship between serum TSH and T3 levels. The data suggest that: 1) circulating T4 exerts a significant negative feedback effect on serum TSH level and that this effect of T4 may be even more important than that of circulating T3; 2) factors other than hypothyroidism may be important in the genesis of neurological defects in endemic goiter regions.

Adolescent↗
PubMed1976

Preclinical hyperthyroidism in multinodular goiter.

The thyrotropin (TSH) response to thyrotropin-releasing hormone(TRH) (200 mug iv) was determined in 80 surgical patients with nontoxic multinodular goiter. The TSH reserve was normal in multinodular goiter. The TSH reserve was normal in 55 and elavated in 8 patients. No TSH response to TRH (deltaTSH less than or equal to 1 muU/ml) was detectable in 17 patients (21%). Individual and mean serum T4, FT4I and serum T3 values did not differ from normal in 13 of the TRH unresponsive patients; in 4 patients FT4I or serum T3 was marginally elevated. No statistical differences were noted for I131-uptake, PBI131 and conversion rate between controls and TRH unresponsive patients. All patients who failed to respond to TRH were euthyroid on clinical evaluation. Goiters were large multinodular and long-standing in most instances. In 12 tested subjects TRH responsiveness recovered following partial thyroidectomy. In 3 of 7 TRH unresponsive euthyroid patients tested 9-12 days post surgery a transient lack of TSH to respond to TRH was observed. Recovery of TRH responsiveness was accompanied by a significant (P IS LESS THAN 0, 02) decrease in serum T4and FT4I in the euthyroid range, whereas no change in serum T3 occurred. It is suggested that TRH unresponsiveness represents a state of preclinical hyperthyroidism maintained by autonomously functioning goiter compartments.

Adult↗
PubMed1982

The pathogenesis of "hot" and "cold" follicles in multinodular goiters.

The prominent characteristics of euthyroid and hyperthyroid human nodular goiters are the regional variability of iodine metabolism and the appearance of "hot" autonomous follicles. No explanation for the pathogenesis of the interfollicular heterogeneity of iodine turnover has yet been offered. We have investigated whether the recently demonstrated polyclonality of normal follicular epithelia could possibly be related to goiter heterogeneity. The present work demonstrates, by means of autoradiographic and histological techniques, that single cells or tiny cell families with widely differing metabolic properties are normally present within single mouse, rat, and human thyroid follicles. In animals, intercellular heterogeneity is demonstrated in respect to 1) iodinating capacity, 2) peroxidase content, 3) endocytotic response to TSH, and 4) proneness to replicate. Moreover, [3H] thymidine labeling of stimulated mice thyroids reveals that mitotic cells are not randomly distributed; some follicles contain large colonies of rapidly replicating cells, and these clonogenic cells give rise to new follicles. Since simple goiter formation invariably implies replication of normal thyroid follicles, we conclude that the large differences in iodine turnover among the follicles of simple goiters are a consequence of the generation of new, metabolically heterogeneous follicles from genetically distinct cell clusters existing with the epithelia of all normal mother follicles.

Animals↗
PubMed1986

Normal level of thyroglobulin messenger ribonucleic acid in a human congenital goiter with thyroglobulin deficiency.

Two siblings with congenital goiter were investigated from clinical, biochemical, and molecular biology standpoints. The association of clinical and biological hypothyroidism with undetectable levels of serum thyroglobulin (Tg) and the presence of iodohistidines in the urine suggested the diagnosis of defective Tg gene expression. This conclusion was confirmed by analysis of proteins present in goiter extracts. Only minute amounts of Tg-related material was detected by RIA (0.28 and 0.17 mg/g tissue compared to 80-100 mg/g in normal thyroid tissue), by Sepharose 6B chromatography, and by sucrose density gradient centrifugation. Surprisingly, the goiters contained normal amounts of Tg mRNA. The size of the mRNA and the sequence organization of its first five exons also were normal. We conclude that no gross alteration of structure or transcription of the Tg gene was present in these patients. The results are compatible with a lesion affecting the mRNA sequence (point mutation, splicing error etc.), leading to defective translation or abnormal routing of the translation product through the membrane system of the cell. This latter hypothesis is supported by the extreme distension of the goiter endoplasmic reticulum found on electron microscopy.

Adolescent↗