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PubMed1995

[The efficacy of iodine prophylaxis in the prevention of endemic goiter in the southwestern area of Asturias].

The aim of the present work was to assess the prevalence of the endemic goiter in Asturias southwestern area (46,000 inhabitants; 6,638 in school age), after 10 years of iodized salt introduction in diet. 317 schooling children were randomly chosen (stratified by age, sex and geographic area). We evaluated thyroid gland size and urinary iodine excretion (microgram of iodine per gram of creatinine = I/C). Previously, studies of infantile population suggested a 63% of prevalence. Our results indicate a decrease to 16.4% of endemic goiter prevalence. Nevertheless, the success of iodine prophylaxis was heterogeneous and not good in some case: point out Ibias population with a prevalence of 48.5% (2,000 inhabitants and 353 in schooling). Remainder population was prevalences between 6.9% and 19.8%. The mean of urinary iodine excretion increased to I/C = 106 (previously I/C = 53). The smallest index I/C become to Ibias population = 78. (p < 0.01 and p < 0.05 with regard to Cangas del Narcea and Tineo population respectively). Only 2 of the 52 cases of goiter were hypothyroidism (but because of autoimmune thyroiditis). We conclude that iodine prophylaxis with salt was effective generally, in order to diminish the endemic goiter in the area.

Adolescent↗
PubMed1994

[Thyroid dysfunction and goiter among immigrants from Ethiopia].

1131 immigrants from Gonder, Ethiopia were surveyed a year after arrival in Israel. The overall prevalence of goiter was 46.1%; the lowest rates (6.7%) were in infants (aged 1-2 years) and the peak prevalence in males was 56.7% (in those aged 12-14 years) and in females, 77.7% (in those aged 35-40). A significant decrease in goiter prevalence was observed after the age of 60 for both men (7.2%) and women (35%). The prevalence of hypothyroidism was 1.1%, 2% in children and 0.2% in adults. That of hyperthyroidism was 1.7%, 0.8% in children and 2.4% in adults. The high prevalence of goiter and hyperthyroidism with low prevalence of hypothyroidism probably resulted from the combined effects of food goitrogens and iodine deficiency in Ethiopia, with the latter playing only a minor role. Neither factor was in effect after arrival in Israel. Genetic and hormonal factors may contribute to the low prevalence of both goiter and hypothyroidism in the adult males. In view of the high prevalence of hyperthyroidism, iodine enrichment is not recommended for Ethiopian immigrants.

Adolescent↗
PubMed1994

[Endemic goiter in a non-goitrogenic country].

Although goiter is not endemic in Israel, an iodine-rich country due to its bordering on the Mediterranean, we see many adults with massive goiters among immigrants from Afro-Asian and eastern European countries. 702 thyroidectomies were performed between January 1986 and March 1993 and 39 consecutive cases of goiter were studied. The patients ranged in age from 32-83 years (mean, 48); the female/male ratio was 36/3. There were 15 cases (13%) of thyroid carcinoma. In 1 case hyperthyroidism was diagnosed and treated preoperatively (3%) and in 2 others subclinical hypothyroidism was found (5%). The cervical approach was used, including cases with substernal extension. In only 1 was sternal splitting necessary. In our experience enlarged nodular goiter, with or without substernal extension, should be operated before symptoms of tracheal pressure develop and to avoid the risk of neglected malignancy hidden in an enlarged thyroid.

Adult↗
PubMedDate not supplied

[Prevalence of somatic diseases in children with endemic goiter].

A total of 1649 children aged 0 to 16 years were examined in the Khvalynsk district of the Saratov region endemic for goiter. Age-specific features of prevalence of goiter and chronic somatic diseases were studied. Goiter was found to form starting from the first years of life, with its morbidity peaks observed at the age of 3, 5, 7, and 12. Disease incidence in children with endemic goiter was found to be higher than in those without thyroid abnormalities.

Adolescent↗
PubMed1993

Goiter prevalence in children in Lower and Middle Silesia (Wrocław--coordinating center).

As a part of the programme concerning iodine deficiency and iodine prophylaxis in Poland, 2518 children of age between 6 and 13 years, living in Lower and Middle Silesia, were studied. The anamnesis was based on a questionnaire answered by parents of the investigated children. The physical examination included measurements of body height and mass, clinical symptoms of thyroid functions as well as size and compactness of the thyroid gland on the basis of WHO classification. Urinary concentration of iodine was measured. The majority of children with goiter were inhabitants of mountainous villages. The goiter was most frequent in the age group 9-10 years. No significant differences in goiter incidence could be found between children consuming and not consuming iodized kitchen salt. The urinary concentration of iodine was low in all children examined. It was concluded that the territory of Lower and Middle Silesia is still a region of moderate endemic goiter. The urinary iodine concentrations is low in children living in Lower and Middle Silesia. The present system of iodine prophylaxis is not adequate and new measures should be urgently introduced.

Adolescent↗
PubMed1993

Prevalence of goiter, iodine deficiency and iodine prophylaxis in Poland. The results of a nationwide study.

A nation-wide epidemiological survey was conducted on a random sample of 19,300 schoolchildren, 0.5% of the 6-13-years-old child population. The study included data on body mass, height, thyroid size according to the ICCIDD/WHO classification, and information on iodized salt intake. Thyroid volume was measured with a portable USG also, and iodine concentrations in casual urine specimens were measured. In 80% of the children, urine iodine concentrations were below 100 mu/l; about 5% of the children had enlarged thyroid glands in class II or III of the ICCIDD/WHO classification, and hypothyroidism was not observed during examination. These findings mean that Poland is an area of mild or moderate endemic goiter. The highest prevalence of goiter as determined by USG was observed in the Sudeten, Carpathian, and northeastern parts of Poland. In these areas, 40-80% of the children had urine iodine concentrations within 0-50 micrograms/l; this region was classified as a moderate endemia area. The lowest prevalence was in the northwestern part of the country; 60-90% of the children had iodine concentrations above 50 micrograms/l, and 23-35% above 100 micrograms/l. This area was classified as a mild endemic goiter area. Comparison of the thyroid size measures yields a very low (20%) coefficient of accuracy for class Ia. This class seems of questionable value for an epidemiological survey. Multifactorial analysis of variance of iodine concentrations shows the effects of some main factors: geographical area, iodine prophylaxis and urban/rural residence. The questionnaire results indicate that only about 20% of the total population uses iodized salt. The effectiveness of prophylaxis was very low; increases in urine iodine concentrations and decreases of goiter prevalence in the children using iodized salt did not exceed 10%. This points to the need to increase the KJ dose in table salt and to develop a new model for distribution of iodized salt in Poland.

Adolescent↗
PubMedDate not supplied

[The hypothalamo-hypophyseal system in patients with multinodular colloid euthyroid goiter].

Eighty patients with multinodular colloidal euthyroid goiter were examined. Thyrotropin-releasing hormone (TRH) test was carried out in 22 patients and 7 healthy women. The results of the test indicate a clear-cut tendency to reduction of hypophyseal TTH reserve in patients with multinodular euthyroid goiter with enlarged thyroid. In other words, clinical diagnosis of an euthyroid condition in the examinees appears to be groundless, particularly in patients with stage IV multinodular euthyroid goiter who may be referred to latent hyperthyrosis group on the basis of TRH test results. Three types of STH reaction were revealed by TRH test in these patients. The authors put forward a hypothesis on STH contribution as a growth factor to the pathogenesis of multinodular colloid euthyroid goiter.

Adolescent↗
PubMedDate not supplied

Endemic goiter in Ethiopian Jews--possible pathogenetic factors.

Goiter size, thyroid function tests and thyroid cytology were studied in 100 immigrant Ethiopian Jews, 1-12 months after arrival in Israel on Operation Solomon (1991), who were referred for evaluation of goiter. Female-to-male ratio was 2.2:1. Hypothyroidism was rare (1%) whereas hyperthyroidism was frequently diagnosed (11%). Elevated thyroglobulin (TG) serum levels were found in 36% of the patients. Antithyroid antibodies were not detected. Thyroid cytology revealed rich colloid goiters in all patients. Thyroid carcinomata and chronic lymphocytic thyroiditis were not diagnosed. Both hyperthyroidism and elevated TG levels were found only in female patients and were equally distributed in patients maintained on either Israeli or Ethiopian diets. It is suggested that the major factors in the pathogenesis of endemic goiter in Ethiopian Jews are genetic and/or food goiterogens, with only a minor role for iodine deficiency.

Adolescent↗
PubMed1993

Surgical management of intrathoracic goiter.

Thirty-three consecutive patients of intrathoracic goiters underwent resection at the TCVGH during a nine-year period 1982-1991. The mean age of 21 men and 12 women was 65 years. Six (18 per cent) had undergone prior thyroid surgery. Thirty-one of the 33 patients were euthyroid. Thirty patients underwent transcervical approach for resection; three had cervical incision plus median sternotomy. Pathological examination revealed multinodular goiter in 31 (94 per cent) and follicular carcinoma in two (6 per cent). The mean mass of goiter was 201.25 g and the mean greatest dimension was 10 cm. Thyroidectomy is advisable in all cases of intrathoracic goiter and resection can almost invariably be performed through a transcervical approach.

Adult↗
PubMed1993

[Goiter surgery from Kocher to today].

When thyroid surgery was founded and developed by Billroth, Kocher, Miculicz, Halsted and De Quervain, a variable approach was used with respect to the extent of dorsal mobilization, completeness of goiter resection and finesse of the operative technique. These aspects of goiter resection are still of interest today: nodules are now considered as a growth marker and must be completely excised, necessitating careful dorsal mobilization; Kocher's correct plane of dissection is now anatomically defined as lying anterior to the lamella which covers the vessel and nerve-containing plate of the neck. In a prospective study, this technical approach for complete goiter excision has proven to harbour a low operative morbidity, to eliminate autonomous function, and to prevent goiter recurrence.

Goiter↗
PubMed1993

[Substernal goiter: new diagnostic methods and treatment].

The authors report 47 cases of substernal goiters operated between 1971 and 1990. Forty-five patients had mediastinal-cervical-goiters (g.c.m.) and 2 had ectopic goiter (g.e.). Cervicotomy was performed in the 45 g.c.m., in 3 cases associated with sternal "split". The g.e. were treated with thoracotomy. Computed Tomography (TC) has been performed since 1984 in 26 patients; Magnetic Resonance (RM) since 1987 in 6 patients. The diagnostic accuracy for TC was 84.6% and 100% for MR on anatomical-topographic-definition, and 80.8% and 83.3% for presumptive diagnosis of nature, respectively. Considering the high diagnostic accuracy, the possibility to reconstruct the images in sagittal and coronal planes, the RM seems to be the elective diagnostic procedure for all substernal goiters.

Adult↗
PubMedDate not supplied

[Endemic goiter in Croatia].

In the early nineties, 40 years after the introduction of iodine prophylaxis in Croatia (10 mg KI/kg salt), a nationwide study was initiated with the aim to determine the real prevalence of goiter in the country. A total of 2436 schoolchildren of both sexes, aged 7-15 years, were included in the study. Investigations were designed in a way to cover most of geographical regions in Croatia and subjects were randomly selected. The prevalence of goiter in schoolchildren was assessed by palpation and in part by ultrasonography of the neck. At the same time urinary iodine excretion was measured and potassium iodide content in salt samples was determined. The results revealed the persistence of mild endemic goiter in the inland parts of Croatia with the prevalence of 6-29% in the age group 7-11 years and 10-43% among the age group 12-15 years. The overall goiter prevalence in schoolchildren in Croatia fluctuates from 8% to 35%. The urinary iodine excretion in Zagreb varied from 1.6 to 24.4 micrograms/dL with a median of 9.0, while in 14% it was below 5 micrograms/dL. The urinary iodine excretion in Samobor varied between 0.5 and 19 micrograms/dL with a median of 7.4 micrograms/dL, while in 30% it was below 5 micrograms/dL. Examination of salt from all three salt plants in Croatia showed iodine contents between 0.0 and 12.73 mg/kg with the average value of 5.39 mg/kg. Such prevalence, most probably due to less than optimum iodine intake, is unlikely to change until potassium iodide content of salt is increased from its present level of 10 mg of KI per kg of salt, with concomitant stricter observance of legal regulations.

Adolescent↗
PubMed1996

[Therapy of euthyroid iron deficiency goiter. Effectiveness of a combination of L-thyroxine and 150 micrograms iodine in comparison with mono-L-thyroxine].

BACKGROUND: In terms of the pathomechanism, TSH and intrathyroid iodine deficiency are the interconnecting elements between alimentary iodine deficiency and the growth and genesis of goiter. L-Thyroxine treatment for suppression of hypophyseal TSH production and supplementary iodide have a synergistic effect in reducing the size of goiter. An individual adaptation of the L-Thyroxine dose is necessary for optimal TSH suppression. Excessive suppression of the TSH level prevents uptake of iodine by the thyroid and thus compensation of the intrathyroid iodine deficiency. Combination therapy of an individually adjusted amount of L-Thyroxine with a small, mostly constant amount of iodine is a recognized concept of goiter therapy today. Administration of a combination preparation with an individually adjustable dose of L-Thyroxine and 150 micrograms iodine complies with these recommendations and improves compliance since only one tablet is required. PATIENTS AND METHODS: In the present study, the thyroid iodine supply, efficacy and tolerance of such a combination preparation was tested for the first time in 49 patients with euthyroid iodine deficiency goiter (group A). 45 patients receiving an individual L-Thyroxine therapy served as controls (group B). RESULTS: Supplementation of individually dosable L-Thyroxine with 150 micrograms iodide leads to a markedly raised iodine excretion in the urine (p < 0.005). This is an indirect indication of an improved thyroid iodine supply. Patients of group A showed a greater reduction of the thyroid volume (18.5% as compared to 16.8%, p = n. s.) and a more persistent TSH suppression (lowering by 39% [group A] as compared to a rise of 17% [group B]) in relation to the initial value (p < 0.004). This is attributable to the improved supply of iodine. CONCLUSION: The combination therapy tested was tolerated just as well as the mono-L-Thyroxine treatment with better efficacy.

Adolescent↗
PubMed1996

[A case of intrathoracic goiter].

Intrathoracic goiter is an uncommon conditional lesion. A case of intrathoracic goiter in a 66-year-old woman is herein described. Her chief complaint was anterior chest opplession. A computed tomographic scan and magnetic resonance imaging (MRI) revealed intrathoracic goiter pressed the trachea to the right side. The tumor was safety and completely took by collar incision without thoracotomy. Histologically, the mass was diagnosed the adenomatous goiter. In this case, MRI was very useful to be determined the surgical approach.

Aged↗
PubMedDate not supplied

Complications of 867 thyroidectomies performed in a region of endemic goiter in Turkey.

This article aims to define the incidence of complications in 867 thyroidectomies performed by residents with attending surgeons' supervision as part of a training programme, in a region of endemic goiter. Seven hundred and nine patients were female and 158 were male. The age of the patients ranged between 6 and 76 and mean age was 32.5. Cases were divided into two groups according to their disease nature. Group 1 included 805 patients with nodular colloidal goiter (NCG) and adenomas. The remaining 62 cases, 25 with recurrence of goiter (RG), 21 with thyroid malignancy (TM) and 16 with thyroiditis formed group 2. While the overall complication rate was 11.3% (93 cases) in group 1, it was 20.9% (13 cases) in group 2. The mortality rate was zero in both groups. The incidence of complications of 867 thyroidectomies performed by residents with the attending surgeons' supervision was within acceptable limits especially as far as group 1 was concerned. However we suggested that attending surgeons themselves, disregarding residents training, should perform the operation in special cases such as recurrent goiters, thyroid carcinomas with positive regional lymph nodes and thyroiditis with regional adhesions.

Adolescent↗
PubMed1997

Iodine-131 therapy in sporadic nontoxic goiter.

UNLABELLED: The effect of radioiodine in the treatment of nontoxic goiter is seldom evaluated quantitatively. The aim of this study was threefold: (a) to assess the effect of 131I on goiter volume, (b) to establish a relationship between CT volume reduction and the amount of radioactivity taken up by the thyroid and (b) to assess the precision of scintigraphic thyroid volume measurements. METHODS: In 27 patients with sporadic nontoxic goiter, the thyroid volume was estimated from a [99mTc]pertechnetate scintigram. Two different models (cylinder model and surface model) were applied. The 131I dosage varied between 507 and 3700 MBq. In all patients, noncontrast CT scanning of the neck was performed before therapy and 1 yr after therapy. RESULTS: The mean CT thyroid volume before therapy was 194 +/- 138 ml. A reduction was obtained in all patients and averaged 34% +/- 17%. The volume reduction measured by CT correlated well with the amount of 131I in the thyroid (r = 0.70). In thyroids larger than 200 ml, both scintigraphic volume estimation methods were imprecise. For smaller volumes, the surface model was superior. Hypothyroidism developed in 14% of the patients. No other side effects occurred. CONCLUSION: Iodine-131 therapy for volume reduction in nontoxic goiter is a safe and effective treatment. For scintigraphic estimation of thyroid gland volumes smaller than 200 ml, the surface model is preferred.

Adult↗
PubMed1997

[Surgical treatment of diffuse hyperthyroid goiter. Experience at a hospital in Valdivia, Chile].

BACKGROUND: The choice of medical, radiation or surgical therapy for hyperthyroid diffuse goiter is still empirical. AIM: To report a retrospective analysis of the surgical treatment of hyperthyroid goiter in a Regional Hospital in Chile. PATIENTS AND METHODS: The charts of 64 patients, 54 female, aged between 15 and 57 years old, operated between 1985 and 1995 were analyzed. RESULTS: The indication for surgical treatment was failure of medical treatment in 59 patients and a big goiter causing mechanical compression in 3 patients. A subtotal thyroidectomy was done after an abbreviated surgical preparation. The mean weight of the resected glands was 65.9 g. Four patients had transient hypocalcemia and 4 had surgical wound seromas. After a mean follow up of 31 months, 77% of patients remain euthyroid, hyperthyroidism relapsed in 13.1% and 10% became hypothyroid. CONCLUSIONS: Surgical treatment of hyperthyroid goiter is safe but the percentage of hyperfunction relapse is high.

Adolescent↗
PubMed1997

Surgical management of intrathoracic goiter.

Intrathoracic goiter is a rare clinical entity. This goiter can develop slowly and the patient may be asymptomatic for many years. A significant number of these patients, however, may develop various complications as a result of compression of vital structures or malignancy. In this report, the surgical management of 18 cases of intrathoracic goiter are reviewed. Six of the patients underwent right thoracotomy with resection of the posterior mediastinal goiter. The remaining 12 patients had their tumor removed via median sternotomy. There were no surgical deaths within this series. Although the incidence of intrathoracic tumor is limited, the threat of malignancy and compressive symptoms clearly indicates the need for surgical excision. Our group recommends thoracotomy and median sternotomy for surgical excision.

Adult↗