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PubMed1991

[The diagnosis and surgical treatment of nodular euthyroid and toxic goiter].

The authors discuss their experience in treating 815 patients who underwent an operation for nodular euthyroid and toxic goiter. Thermography was used in the examination of 367 patients and the results were compared with those of radioisotope scanning of the thyroid, intraoperative findings, and the results of histological study. It was established that in complex with clinical methods of examination, thermography is very important in making the differential diagnosis of thyroid diseases. The specific features of surgical tactics in patients with nodular goiter are shown. Economical resection of the gland together with the node is recommended in nodular euthyroid goiter and subtotal subfascial resection of the involved lobe or the thyroid gland in nodular toxic goiter.

Goiter, Nodular↗
PubMed1991

[Substernal goiters].

In a series of 363 patients operated for goiter, 60 were retrosternal (16.5%). The female incidence although less than in cervical goiters remains predominant (2,5:1). Most patients are in older age group, 68% being above 40 years. The majority of goiters are multinodular and of long duration. Bilateral (37%) and left sided location (43%) were common. The incidence of cancer was 7%, thyrotoxicosis was noted in 5 patients (8%). Most patients were symptomatic (97%). Diagnosis is easily done by physical examination, chest X-Ray and thyroid scintigraphy. Computed tomography might be helpful. Retrosternal goiter is an indication to surgery except in high risk patients. The cervical approach has been used in 98% of cases. There were no post-operative death and no major complications (compressive hematoma, laryngeal nerve paralysis, hypocalcemia).

Adult↗
PubMedDate not supplied

[Goiter and chronic lymphocytic thyroiditis].

Sixty patients with goiter, aged 3 to 16 years, 58 girls, were studied for evidence of chronic lymphocytic thyroiditis (CLT). Thirty eight patients, 63%, presented two or more diagnostic elements of TLC, according to Fisher's criteria, with a high frequency of thyroid function involvement (47.4% had hypothyroidism and 18.4% had hyperthyroidism). The rest of the patients with diffuse goiter (37%) did not meet Fisher's criteria, they were mostly euthyroid (95%) and they were designated "non thyroiditis goiter". All patients with probable CLT had positive antimicrosomal antibodies at relatively high titer (greater than 1 x 600 in 71% of the cases) and 32% of them had both antimicrosomal and antithyroglobulin antibodies. In the "non thyroiditis goiter" group we found 28% of children with positive antimicrosomal antibodies at low titers (1 x 100 and 1 x 400, respectively). In a control group of 28 children of similar ages, without endocrine diseases neither familiar history of thyroid diseases only 3 (11%) cases showed positive antimicrosomal antibodies, always at low serum titers.

Adolescent↗
PubMed1990

[Activation of immunity in patients with recurrent goiter].

The authors studied the morphological pattern of the thyroid gland in patients with goiter and in those with a recurrence of the disease. They found lymphoid infiltration and autoimmune thyroiditis twice more frequently in patients with recurrent goiter. Dynamic study of features of the immune and thyroid status of patients with recurrent goiter after the operation led to the isolation of a group of patients with an increase in the relative content of T and B lymphocytes and thyroxine. These changes preceded the recurrence of goiter.

Autoantibodies↗
PubMed1990

[Intrathoracic goiter. Apropos of 36 cases].

This article is concerned with 36 cases of plunging goiters responding to Eschapasse and Merlier definition. The frequency of plunging goiters is 5.2%, women are predominating with 96% and the average of age is 45 years. In 34%, these goiters gave rise to fow symptoms, while there was mediastinal complication in the others cases. Paraclinic investigations are limited to a face and profile pulmonary roentgenographies, and scintigraphy of the thyroid. In the treatment, cervicotomy proved to the completely satisfactory to removal of all the goiters and there were no need to sternotomy or thoracotomy. The pathology revealed two malignant tumors. Post operative evolution was uneventful except one death in the 10th post operative day by pulmonary emboli.

Adult↗
PubMed1990

[Diagnosis and surgical treatment of recurrent goiter].

Operations were conducted on 1,055 patients with postoperative recurrent goiter, in 211 of them the disease had recurred repeatedly. Thyrotoxicosis was diagnosed in 331 and nontoxic adenomatous goiter in 724 patients. Autoimmune thyroiditis was revealed in 77 of 237 patients with an autoimmune process in the thyroid gland. Carcinoma of the thyroid was recognised in 68 cases. The authors show the necessity for complex clinical, anamnestic, laboratory, radioisotope, ultrasonic, radiological, and aspiration cytologic examinations. An operation is indicated in severe thyrotoxicosis and all forms of adenomatous goiter. It is technically difficult to perform an operation for a second time. Those performed for adenomatous forms of goiter must be accompanied by an emergency histologic examination. Two methods for repeated operations are described. Correcting hormonotherapy after reoperations is a practicable means for preventing repeated recurrences. Quite favourable late results of surgical treatment are shown.

Adolescent↗
PubMed1985

Diagnosis and management of large toxic multinodular goiters.

Toxic multinodular goiters, estimated weight 100 g or more, occurred in 35 patients between 1961 and 1984. All but two were older than 50; 32 were females. Twenty had goiters of 100-130 g; four of 140-200 g; and 11 were massive. Radioiodine uptakes were 30% or less for 22. Seven of 17 with both T4 and T3 data had T4 toxicosis. Thirty-two patients received radioiodine therapy, delivering 200 microCi per gram when possible. Doses were 25-30 mCi for 17 patients; 50-100 mCi for 12 patients, and 150-200 mCi for three patients. Hyperthyroidism was eliminated with one dose in 25 patients (78%); five patients required two doses. Twenty-two patients were euthyroid after radioiodine; 25 of 28 had persistent goiters. Two patients were treated successfully surgically. One refused surgery and radioiodine, and has been maintained on antithyroid drugs for 10 yr. Two patients died within a few months of an unsuccessful initial dose of radioiodine. Large dose radioiodine therapy is simple, safe, and effective for most patients with large toxic multinodular goiters.

Adult↗
PubMedDate not supplied

[Prevalence of endemic goiter among school children of central and southern Chile].

The prevalence of endemic goiter was evaluated during 1986 in 1,015 school age children from basic public schools of Santiago and Temuco, Chile. The prevalence of goiter, defined by WHO's standards was 7.6% as a whole, without differences related to children's geographical origin. A greater prevalence of goiter, in females than in males, which increased with age, was detected. Prevalence of endemic goiter decreased from year 1982 to year 1986 from 18.8% to 7.4% in similar samples of school children from Santiago. This change may be due to preventive iodination of table salt.

Adolescent↗
PubMedDate not supplied

[Immunological reactivity and the HLA system antigens in patients with autoimmune thyroiditis and nodular euthyroid goiter].

Factors of nonspecific resistance, cellular and humoral immunity were investigated before operation in 84 patients with nodular euthyroid goiter and in 50 patients with autoimmune thyroiditis, 50 patients were investigated in the long-term postoperative period. Class I HLA antigens were investigated in 205 patients. Humoral changes of immune homeostasis (hyper-production of antithyroid antibodies, an increase in the level of IgM and IgG against a background of the raised number of peripheral blood B-cells, a decrease in the level of lysozyme), disorder of the cellular factor of immunity (specific sensitization of T-lymphocytes to thyroid antigens, a decrease in the number of T-lymphocytes, especially T-suppressors) were detected in autoimmune thyroiditis. Immunological changes in nodular euthyroid goiter were characterized by T-cell sensitization to thyroid extract and microsomal antigen against a decrease in the total number of T-lymphocytes. In most patients with nodular goiter immunity indices after operation returned to normal whereas in patients with autoimmune thyroiditis they showed no tendency to improvement. These data as well as an increase in the frequency of HLA-A11, HLA-A19 and HLA-B8 were indicative of genetically determined primary nature of immune disorders in autoimmune thyroiditis. It was not typical of nodular euthyroid goiter in which an autoimmune process seemed secondary, occurring in response to damage of thyroid tissue by a growing nodule.

Antibody Formation↗
PubMed1989

[Characteristics and surgical treatment of nodular goiter in middle-aged and aged patients].

Four hundred and two elderly and senile patients with nodular goiter were operated on. In most of them, hypothyrosis (decreased triiodothyronine level and increased thyrotropic hormone content in the blood) was revealed; in all--concomitant diseases (2.9 per a patient) and immunologic disorders; in 47%--cervico-retrosternal location of a goiter. In 65.2% of goiter preparations, the degenerative-sclerotic changes were found, in 33%--lymphoid infiltration of stroma, in 18.7%--malignant growth. Operation is the most effective method of treating elderly and senile patients with nodular goiter. It should be of little trauma relative to normal parenchyma.

Age Factors↗
PubMed1989

Thyroid peroxidase activity in human nodular goiters.

1. Thyroid peroxidase (TPO, iodide-oxidation) activity was evaluated in nodular and paranodular tissue samples from 27 patients with nodular goiter (19 "cold" and 8 "hot" nodules), and compared to 11 diffuse toxic goiter and 9 normal thyroid tissue samples. 2. In terms of U/g digitonin solubilized protein, TPO activity was increased in hot nodules (P less than 0.05), although not as much as in diffuse toxic goiters (P less than 0.01). 3. The mean TPO activity of tissues paranodular to a cold nodule was not different from that of normal thyroids. 4. Both the highest and the lowest TPO activities were found in cold nodules, but their mean value did not differ from those of their paranodular tissues or normal thyroids. 5. Inter-tissue variability was significantly increased (P less than 0.01) in cold nodules and in tissues paranodular to a hot nodule. 6. These data show that heterogeneity both within and among tissues contributes to the wide range of TPO activity detected in nodular goiters.

Adult↗
PubMed1988

Vitamin A status and endemic goiter.

Serum vitamin A levels were determined in two groups of subjects living in an endemic goiter area in Iran. The first group consisted of 242 non-goitrous subjects, and the second, contained 603 subjects with different grades of goiter. Serum vitamin A concentrations were correlated with goiter, sex, and age. Serum retinol values were not statistically different between goitrous and non-goitrous females, but goitrous male subjects especially those under 13 years of age, had lower serum retinol values than non-goitrous male subjects. The prevalence of low vitamin A levels was higher in goitrous boys. In both groups the prevalence of low serum vitamin A decreased with the increase in age. The prevalence of goiter was not statistically different between boys and girls under 18 years, but was more prevalent in women over 18 years, than men in the same age group (P less than 0.001). This difference was in accordance with serum vitamin A status between women and men after the age of 18 (P less than 0.001). Serum vitamin A increased with age up to 18 years, in both sexes and remained unchanged afterwards. The increase was gradual in girls under 18 years but was sharper in boys during puberty years. Although the values for serum vitamin A in each sex covered wide overlapping ranges, but a general superiority of male serum vitamin A levels over the females was observed.

Adult↗
PubMedDate not supplied

[Autonomic nervous system function of euthyroid and thyrotoxic goiter patients].

Variation pulsometry, a method of mathematical analysis of the cardiac rhythm, was used to assess function of the autonomic nervous system in patients with euthyroid and thyrotoxic goiter. Simultaneously orthostatic tests for a selective effect on parts of the autonomic nervous system were done. A total of 46 patients were examined: 16 with nodular forms of euthyroid goiter and 30 with thyrotoxic goiter III. In the patients with euthyroid goiter a moderate degree and in the patients with thyrotoxicosis a pronounced degree of tension of both parts of the regulation system were revealed. At the visceropathic stage of thyrotoxicosis, intra-endocrine interrelationships with the blockade of the sympathetic part of the autonomic nervous system are changed that can be of importance for working out medicamentous preoperative preparation of patients.

Adult↗
PubMed1985

[Endemic goiter in school children of Salta Province, Argentina].

The Province of Salta, located in the northwest of Argentina, showed severe endemic goiter-cretinism. The purpose of our work, therefore, was to evaluate the results of the iodized salt prophylaxis measure implemented since 1963. In 1980-1981 the prevalence of goiter was determined in 16,935 school children whose ages ranged from four to 15 years. The urinary iodine/creatinine index was also determined in a subsample of 401 children. Findings revealed that the goiter prevalence in the Province was 16.1%. In 10 Departments of the Province, those with greater socioeconomic development and denser population, the prevalences found were below 10%, limit established as endemic. In the remaining 13 Departments, especially in those less developed--where mountainous regions make their access difficult and hence, their populations consume non-iodized salt obtained from natural salt basins--values exceeded this limit. The average ioduria was 104.0 micrograms I/g Cr, with 4.5% presenting values below 25 micrograms. After 20 years of prophylaxis, endemic goiter has therefore been partially eradicated. It is suggested, however, that consumption of iodized salt and, even the supply of iodized oil in those areas where prevalence is high, be recommended.

Adolescent↗
PubMed1985

[Cervico-mediastinal goiter. Problems of surgical technic and tactics].

The Authors, on the basis of their experience, as well as of the data of the literature, discuss the problems of technique and tactics involved in the treatment of retrosternal goiters. As to the way of approach, they think cervicotomy should be primarily preferred, and the complementary sternotomy should be associated to the former only in some limited cases of totally dipped and large-sized goiter. They, moreover, assert that, beyond the diagnostical and therapeutical difficulties, endothoracic goiter, if adequately treated, keeps a favourable diagnosis, not dissimilar from the one of cervical goiters.

Adult↗
PubMedDate not supplied

[Surgery of the intrathoracic goiter (author's transl)].

One is often obliged to resect intrathoracic goiters. This is not directed towards functional problems but towards the local compression on other organs in the vicinity. Goiters that extend through the cervicomediastinal inlet are of this kind. In cases where the major part is in the mediastinum there still exists a continuity with the cervical part. Most cases can be resected by a cervicostomy. The vascularization comes from the neck except in true thoraic goiters. This makes it possible to ligate the vessels before extracting the gland. In difficult cases a mid sternotomy may be useful so that all thoracic goiters can be operated safely.

Diagnosis, Differential↗
PubMed1993

Serum selenium concentrations in patients with autoimmune thyroiditis and non-toxic nodular goiter.

Selenium (Se) deficiency is said to contribute to the atrophy of the thyroid gland in certain endemic goiter areas in Africa. To test the hypothesis that, a low Se intake could protect against goiter development in autoimmune thyroiditis, we analysed the Se concentration in 20 patients with the atrophic variant of lymphocytic thyroiditis, 23 patients with Hashimoto's thyroiditis and 23 patients with non-toxic nodular (colloid) goiter. Twenty healthy females served as controls. We did not find any significant difference in serum selenium (S-Se) levels between the patients with the various thyroid disorders or between patients and controls. There was no difference in the S-Se concentration and the triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH) or thyroglobulin concentrations in serum. Thus, the Se status had no impact on the development of goiter.

Adult↗
PubMedDate not supplied

Goiter in Tibetan medicine.

The visit of two Tibetan physicians provided a unique opportunity to gain insight into a practice of medicine very different from that of Western civilization. Initial discussions indicated that the practice of medicine and mysticism were inextricably interwoven in the Tibetan culture. Accordingly, the focus of the study was directed to goiter, which is both common in the Himalayas and easy to define.In Tibetan medical practice, illness is considered to be derived from both proximate and distant causes. Three humors, "wind," "bile," and "phlegm" are thought to be responsible for normal mental and physical functions when in balance, but disease when out of balance. Goiter was thought to be due to an imbalance of these humors. The Western discovery that endemic goiter in the Himalayas was due to iodine deficiency explained the proximate cause but did not explain why some individuals have goiter and others do not in the same iodine deficient village.

China↗