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PubMedDate not supplied

[Substernal goiter: a diagnostic and therapeutic problem. (Report of 39 surgically treated cases)].

Substernal goiter is a rare pathology and its definition varied from author to author. We considered substernal the goiter that has the larger diameter below the thoracic inlet, in accord to definition of Valdoni (1957). The authors examined retrospectively 40 cases of endothoracic goiter, that represent 6.1% of patients operated on thyroid. Surgical access was in 35 cases a cervical collar incision; in 2 patients was necessary to associate a median superior sternotomy and in another patient a lateral thoracotomy. In 3 patients the access was a median sternotomy and in the last patient a posterolaterally thoracotomy. The authors carried out 12 total thyroidectomy (30.7%), 15 subtotal thyroidectomy (38.6%), 10 total lobectomy (25.6%), 2 subtotal lobectomy (5.1%). No mortality was observed. The morbility was represented by 5 monolateral temporary palsy of recurrent laringeal nerve, 6 transitory hypocalcemia, 1 tetanic syndrome, 1 transitory arrhythmy. The follow-up was managed on 35 patients (89.7%). We observed 1 definitive hypoparathyroidism, 1 paralysis of recurrent laringeal nerve, 1 mediastinic relapse. One patient was operated on total thyroidectomy 14 years after the first surgery for a differentiated carcinoma. In conclusion the treatment of substernal goiter is surgical. Debating point is the entity of exeresis. We think that the first choice operation is thyroidectomy, done through a cervical collar incision. Occasionally sternotomy or thoractomy are necessary.

Female↗
PubMedDate not supplied

Diagnostic imaging of euthyroid goiter.

In diffuse or nodular euthyroid goiter, diagnostic imaging is indicated to define, by sonography, the morphology, size and structure of the goiter and to evaluate, by scintigraphy, the regional thyroid function. The instrumental diagnosis of thyroid nodule is essentially based on sonography, scintigraphy and (US-guided) needle aspiration cytology. The evaluation of some sonographic findings (echogenicity, calcification, lesion margins and presence of peripheral ring) may direct to the differentiation of a benign or malignant lesion. The role of color Doppler in the characterization of thyroid nodules is still controversial. Scintigraphy provides information on nodular function, being also the only exam able to show the presence of autonomously functioning thyroid tissue ("hot" nodule), whose diagnosis allows to rule out the presence of thyroid carcinoma with a very strong probability. In intrathoracic goiter, CT and MRI and indicated to show the continuity with the cervical thyroid and to define the relationships with adjacent structures. Radioiodine scintigraphy shows with high (> 90%) diagnostic accuracy the thyroid nature of a mediastinal mass (plunging goiter).

Diagnostic Imaging↗
PubMed1998

Incidence of goiter among children in a village with nitrate contamination of drinking water.

An epidemiological survey was conducted on the incidence of goiter among children in the 6-14 years age group, permanently living in a village with an increased content of nitrate pollutants in drinking water. Their incidence of goiter was compared to that in a control group of children. The study comprised a total of 359 children--181 from the experimental village and 178 from the control village. A high percentage (40.9%) of goiter is observed among the children in the village with nitrate contamination of drinking water. A statistically significant difference in goiter incidence in children between the experimental and control village is present.

Adolescent↗
PubMed2000

Progress in the molecular genetic research of multinodular goiter.

Multinodular goiter is a worldwide-distributed disease, but yet its pathology and genetic etiology are not clear. At present, most researches have been restrained to traditional epidemiological survey and the disease has been rarely studied at the level of molecular genetics. The pathogenesis of multinodular goiter, as is generally accepted by most researchers, can be attributed to many factors such as hormones, growth factors and the inherent functional heterogeneity of thyroid follicles. Since hormone and iodine metabolization are widely recognized as a major mechanism in determining the formation of multinodular goiter, some reports in literature are mainly focused on such genes that are responsible for hormone synthesis and iodine metabolization. Mapping experimental data were available to support location of multinodular goiter gene(s) onto chromosome 14q by whole genome scanning in a large pedigree analysis. Additional data, particularly those extracted from large scaled marker-assisted mapping experiments, are important so as to confirm the gene location, to improve resolution of the location, and finally to dissect the genes underlying the disease at molecular level.

Chromosome Mapping↗
PubMed2000

Amyloid goiter: the first evidence in secondary amyloidosis. Report of five cases and review of literature.

Amyloid deposition in secondary amyloidosis frequently involves thyroid gland, but rarely is responsible of a goiter. Amyloid goiter in secondary amyloidosis is characterized by deposition of amyloid A protein (AA) in the gland, associated to atrophic follicles. We identified cases of amyloid goiter in the files of our department in the period from 1985 to 1998. Five cases of amyloid goiter with ingravescent symptomatology, characterized by dyspnea, dysphagia and hoarseness were selected. In four cases of five we observed predisposing conditions as, for example, tuberculosis, Crohn's disease, or rheumatoid arthritis. In all cases the symptoms relative to thyroid enlargement preceded or, anyway, predominated over other clinical evidence of systemic amyloidosis. In one case a symptomatology of systemic amyloidosis was not evident. We would like to underline that in all cases the immunoreactivity for amyloid A in the amorphous material present in the gland permitted the diagnosis of secondary amyloidosis even in the absence of systemic symptoms.

Adult↗
PubMedDate not supplied

Surgical treatment of substernal goiter.

BACKGROUND: Substernal goiter differs from its cervical counterpart in regard to its clinical presentation, surgical management, pathological analysis and postoperative complication. METHODS: Retrospective analysis of 1320 thyroidectomies performed at the Hacettepe University Hospital between 1990 and 1997. RESULTS: 30 (2.3%) of 1320 thyroidectomies underwent operation for removal of substernal goiters in an 8-year period. The most common symptom was cervical mass (67%) and 33% of the patients were asymptomatic. Computerised tomography was the most accurate pre-operative test for detecting substernal extension. Substernal goiters were removed by collar incisions in 93% of the cases. The pathology was generally found to be benign (94%), but follicular carcinoma was present in two (6%) patients. There was no mortality and no complications were observed in 73% of the patients. CONCLUSIONS: The presence of substernal goiter is an indication for removal given the lack of any effective medical therapy, low surgical morbidity, risk of malignancy and acute obstructing symptoms.

Adult↗
PubMedDate not supplied

[Surgical treatment of multinodular goiter in iodine deficiency states].

Data are submitted from the analysis of factors of the pathogenesis of multinodular non-toxic goiter in 380 persons. Of these, 256 underwent surgery. An apparent iodine deficiency in the body (in two thirds of patients) has been found out to be an important cause of development, progression and recurrence of goiter. Only 5 to 14 percent of patients, predominantly those presenting with recurrent goiter, demonstrated an elevated level of thyrotrophin. More commonly seen in these patients is inherited predisposition to goiter. The authors attach much value to urine iodine levels, and consider it mandatory that a correction of iodine deficiency be carried off with available drugs both during the conservative treatment and in recurrences.

Adolescent↗
PubMed2002

[Total tyroidectomy in malignant goiter, significance and problems].

Surgical operation of the thyroid gland is a basic operation in the treatment of malignant diseases of thyroid gland. At present, total removal of the thyroid gland (total thyreoidectomy = TTE) has been the most frequently used means of the surgical intervention. TTE has been a unique surgical method for thyroid cancer. The aim our study was to confirm the increasing number of radical operations, how often surprising and unexpected histological findings of carcinoma appear, the incidence rate of carcinoma among the patients being operated on for goiter, which histological findings are most frequently encountered and the survival rate of the patients with carcinoma of the goiter. In our retrospective study, we have collected a set of 233 patients with goiter from 1997 until 1999. Nineteen patients from this group had thyroid cancer: 16 females, 3 males, average age 55.5 years. The histological findings represents 14 papillary carcinomas, 3 folicullar carcinomas, 1 medullary carcinoma and 1 malignant lymphogranuloma. TTE was performed in any case where there was suspicion of thyroid cancer before the operation. In the case of one sided operations, when we had no suspicion of thyroid cancer but histological investigation found cancer, we had to remove the opposite lobus (TTE). However, we have found an increasing rate of thyroid cancer. The unexpected histological finding of carcinoma was reported in 69% of the cases. The number of these cases was higher in the middle 2000 (83%). Clinical stage la, microcarcinoma, was found in 52.9% of papillary carcinomas, and further oncological treatment was not indicated. The number of proper radical operations has been increasing. The high rate of unexpected histological findings of thyroid carcinoma is the main reason for early indication for operation of goiter and the radical extent of the primary operation.

Female↗
PubMedDate not supplied

Operative management of substernal goiter: analysis of 52 patients.

Thyroid surgery for substernal goiter is an uncommon operation. This study was carried out to evaluate the clinical presentation, workup, surgical complications, and risk of malignancy for substernal goiter. From January 1995 to June 2001, 52 patients [27 men and 25 women (ratio, 1.1:1); average age of 52 years (range, 26-71 years)] underwent thyroid surgery for substernal goiter at Akdeniz University Hospital. All patients were symptomatic at presentation. A chest radiograph was used for most patients with a computed tomography scan being by far the most helpful in the study. A cervical approach was adequate for resection of the lesions in 50 (96%) patients. Two (4%) patients required medial sternotomy for removal of thyroid tissue. There was no perioperative mortality. Transient recurrent laryngeal nerve (RLN) palsy occurred in 2 (4%) patients, and permanent RLN occurred in 2 (4%) patients. The incidence of transient and permanent hypoparathyroidism was 8% and 6%, respectively. Other complications included wound infection in 2 (4%) patients and postoperative bleeding in 1 patient (2%). Histopathologically, 46 (88%) lesions were benign and 6 (12%) were malignant. Because the history of substernal goiter is progressive enlargement, surgical removal of thyroid tissue is always indicated and should be performed as soon as possible, unless there are contraindications for surgery. Cervical collar incision is nearly always adequate, with few exceptions.

Adult↗
PubMed2002

[Thyroiditis in patients operated on for goiter].

UNLABELLED: The paper is aimed at evaluating the frequency of incidence and the thyroiditis type in patients operated on for goiter. In the years 1989-2000, 5149 patients were operated on because of different thyroid disorders. The clinical data of 66 patients with thyroiditis, diagnosed in a post-operating histopathological examination, were subject to a retrospective analysis. There were 64 women and 2 men, aged from 22 to 70, on an average 50.1 years old. There were determined the preoperative diagnosis, the thyroid function--basing upon the levels of TSH and thyroid hormones, the type of operation effected as well as post operative complications. Then, there was also measured the weight of the resected lobes. The prevalent indication for the surgery was non-toxic goiter; instead, toxic goiter was such an indication only in a few cases. In most patients, the thyroid function revealed euthyreosis. The following complications were observed: transient hypocalcemia [two patients], transient paralysis of recurrent laryngeal nerve on one side [one], and wound suppuration [one]. The following types of thyroiditis were found in histopatological examination: Hashimoto (59 patients), Riedl (3 patients), de Quervain (2 patients) and non-specific thyroiditis (2 patients). CONCLUSIONS: 1. Thyroiditis is a rare case in patients operated on for goiter. 2. The most frequent pathological finding is Hasimoto disease.

Adult↗
PubMedDate not supplied

Iodine and selenium deficiency in school-children in an endemic goiter area in Turkey.

Endemic goiter is one of the most important health problems in Turkey. However, there are not enough studies associated with iodine and selenium status. This study was carried out to establish the effects of iodine and selenium levels on thyroid gland size and thyroid functions in 73 healthy school-children, 7-12 years old (mean 9.56 +/- 1.77 years), 38 girls (52%) and 35 boys (48%), living in an endemic goiter area. Goiter was found in 32 of the children (43.8%) by palpation, and 56 of the children (76.7%) by ultrasonography. Mean serum T3 and TSH levels were in the upper limit of normal, and mean serum T4 levels were within the normal limits, but mean serum thyroglobulin levels were higher than the normal limits. Mean serum selenium level was 30.84 +/- 23.04 microg/l, and mean urinary iodine level was 3.91 +/- 3.77 microg/dl, appropriate for moderate iodine and selenium deficiency. Thyroid volumes of the children were negatively correlated with serum selenium levels, but there was no correlation with urinary iodine levels and thyroid hormones. In conclusion, school-children in this area had significant goiter problems, probably due to the iodine and selenium deficiencies.

Child↗
PubMed2002

Toxic multinodular goiter in the elderly.

Toxic nodular goiter (TNG) is the most frequent cause of thyrotoxicosis in the elderly, specially in iodine deficient areas. Epidemiological studies have shown that in iodine deficient areas (Jutland) the incidence of hyperthyroidism is significantly higher with respect to areas with normal iodine intake (Iceland) and it is due to TNG. A careful epidemiological study recently carried out in Pescopagano, in southern Italy, an area characterized by a mild to moderate iodine deficiency, indicates that, in its natural history, nodular goiter contributes to the development of functional autonomy and eventually hyperthyroidism. Somatic activating mutations of the TSH receptor are involved in the pathogenesis of TNG. It is supposed that the prolonged iodine deficiency associated with chronic TSH stimulation increases the replication of follicular thyroid cells, and favor the appearance and expression of mutations of the TSH receptor gene. The clinical signs are usually more subtle than those observed in Graves' disease: a long phase of subclinical hyperthyroidism (normal circulating thyroid hormones and undetectable TSH levels) can precede the appearance of the symptoms. Cardiac symptoms are most frequent, (arrhythmia and atrial fibrillation). Thyroid scintigraphy in toxic multinodular goiter shows an uneven distribution of the radionuclide with multiple hyperfunctioning nodules and cold nodules. Thyroid US shows goiter with inhomogeneous solid nodules often with ill-defined borders. The treatment with antithyroid drug does not allow a permanent remission of hyperthyroidism, but its use is indicated to achieve euthyroidism before the definitive treatment. The definitive treatment is radioiodine or thyroidectomy.

Aged↗
PubMed2003

Cytologic appearance of toxic nodular goiter after thyrostatic treatment. A karyometric study.

OBJECTIVE: To assess whether the cytologic appearance of aspirates from toxic nodular goiter is substantially modified during the course of therapy with thyrostatic drugs. STUDY DESIGN: Morphometric features of thyrocyte nuclei in aspirates obtained from nontoxic nodular goiter (NTNG), toxic nodular goiter before treatment (TNG-untreated) and toxic nodular goiter during thyrostatic administration (TNG-treated) were examined. The relationship between the degree of morphologic changes and the duration of therapy was evaluated. An analysis of the composition of aspirates was also performed. RESULTS: The sizes of thyrocyte nuclei in the TNG-untreated group were larger than in the NTNG and TNG-treated groups, and treatment with thyrostatics was accompanied by a gradual decrease in the sizes of thyrocyte nuclei. However, karyometric features showed a tendency to increase again in patients treated for longer than 1 year, with the variability of nuclear size in a smear (anisokaryosis) increasing more markedly than the mean size of nuclei. Moreover, in those patients, nuclei with visible nucleoli were found. CONCLUSION: Only long-term therapy with thyrostatic drugs leads to changes in the microscopic appearance of smears obtained by fine needle aspiration biopsy (FNAB) of the thyroid relevant to cytologic diagnosis. Thus, FNAB can be performed successfully after the onset of treatment with thyrostatics if the cytologist is informed of the time scale of treatment in each case.

Adult↗
PubMed1992

Treatment of iodine deficiency goiter with iodine, levothyroxine or a combination of both.

During recent years several studies have been published comparing different ways of pharmacological treatment of a goiter due to iodine deficiency. These studies usually were performed with 300 to 500 micrograms of iodine, 100 to 150 micrograms levothyroxine, or a combination of in most cases 100 micrograms levothyroxine and 100 micrograms iodine. The largest data have been accumulated in 166 patients with in most cases diffuse goiter. Group A (n = 61) received 150 micrograms levothyroxine per day, group B (n = 50) 400 micrograms iodine per day and group C (n = 55) a combination of 75 micrograms levothyroxine and 200 micrograms iodine per day. During the eight months of therapy, in all three groups a significant and comparable mean decrease in goiter size was documented (-32.1% in group A, -37.3% in group B and -38.7% in group C [n.s. between the three groups]). Striking differences between the three groups are evident in the changes of basal and thyrotropin releasing hormone (TRH) stimulated thyrotropin (TSH). In group A, after eight months a sharp and significant decrease of TSH occurred (from 1.2 mU/l to 0.4 mU/l; mean; p < 0.05), while in group B TSH showed only a minor decrease (from 1.3 mU/l to 0.9 mU/l) and remained significantly higher compared to both, group A and C (p < 0.01). Similar changes were documented when the TSH after TRH administration was calculated. It is concluded, that all three therapeutic approaches are effective for goiter reduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Forgotten mediastinal goiter: seven cases].

The authors relate their experience with 7 cases of mediastinal goiter residual to a subtotal thyroidectomy for substernal goiter. The differential diagnosis with ordinary recurrence was based on the absence of connection with the cervical remnant. The reasons for surgical decision-making was mediastinal compression in 4 patients, hyperthyroidism in 1 patient and absent diagnosis in 1 patient; surgery was systematic in 1 asymptomatic patient. Sternal splitting incision was required in 6 patients: alone in 3, associated with cervical incision in 3 others; excision by an exclusively cervical route was possible in one patient. No malignancy was discovered. Postoperative outcome was uncomplicated in all patients. The residual goiter has the same clinical and paraclinical presentation as the ordinary intrathoracic goiter; treatment should be principally surgical for the same reasons. Nevertheless, for this mediastinal tumor, sternum-splitting incision will be required in most cases.

Aged↗
PubMed2003

[The use of antioxidants in children with diffuse endemic goiter].

Activity of lipid peroxidation and antioxidation activity was investigated in 33 children with endemic goiter in 13 children with chronic autoimmune thyroiditis bu the method of chemiluminescation of blood. The control group was consisted of 20 healthy children. Disbalance in the system "Lipid peroxidation-antioxidation activity" (LP-AOA) was revealed in 72% of children with endemic goiter and in 92% of children with chronic autoimmune thyroiditis. Vegetable antioxidant "Neonivit" and vitamin "Aevit" were used to used to correct the changes LP-AOA system in children with endemic goiter. The effect was received in 70% of cases that allows recommending these antioxidants in the complex treatment of endemic goiter.

Adolescent↗
PubMed1992

[Epidemiology of goiter in Auvergne].

An epidemiological study about goiter, related to the French national survey concerning school children aged 10-16, was carried out in region Auvergne. The prevalence of goiter was 12.52%, including 2.8% patients with WHO stages I and II, thus being slightly below national average (16.7%). Iodine urinary excretion was 62.9 +/- 34.3 micrograms per gram creatinine (French mean value 85.0), although sometimes major variation was noted in the same area. Later, two studies were performed in adults, in two places of Haute-Loire and Puy-de-Dôme, respectively Arsac-en-Velay and Besse-en-Chandesse. Both places were selected because of high frequency of goiter in children. Prevalence in adults was 16.1% in Arsac-en-Velay including 12.5% stages I and II, and 8.9% in Besse-en-Chandesse including 5.9% stages I and II. Mean iodine urinary excretion was respectively 59.78 micrograms/gram creatinine and 43.45 micrograms/liter. Thus, these surveys confirm a significant prevalence of goiter in Region Auvergne, with endemic places, and a generally low iodine urinary excretion.

Adolescent↗
PubMed1992

[Goiter in pre-school children from the Rzeszów district].

The examination included 1594 children at the age of 3 to 6 from the city Rzeszów (834) and from villages in the Rzeszów district chosen at random (760). There were 865 boys (54.3%) and 729 girls (45.7%) in the group. The size of thyroid gland was measured according to the modified classification of WHO from 1974. All the examined children were in the clinical euthyroid state. Enlarged thyroid gland was found in 369 children (23.1%). Goiter OB was diagnosed in 271 children, I degree in 85, II degrees in 11, III degrees in 2. Enlargement of thyroid gland occurred significantly more often in rural areas (36.8%) than in towns (14.8%). The lowest percentage of goiter was found in 3-year-olds. These results point out that the province is an endemic area of mild goiter. Emphasis was put on the necessity to increase goiter prevention in the Rzeszów district.

Child↗