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At least 667 records · Page 37Linked to original sources
PubMed1997

[Cost minimization analysis for the definitive therapy of hyperthyroidism: comparison of goiter resection with radioiodine therapy].

AIM: Cost-analysis of strumaresection and radioiodine treatment in patients with hyperthyreosis. METHOD: Matched by age, sex, comorbidity, volume of goiter, and entity of hyperthyreosis 18 patients of a clinic of surgery, and 28 patients of a clinic of nuclear medicine were analysed by the reimbursed costs, and by a retrospective calculation of the real costs. RESULTS: Based on the rate for the reimbursed costs the radioiodine treatment (6450 DM) was more favourably than the strumaresection (7562 DM); based on the calculation of the real costs including regional specialities there was a minimal difference in favour of the strumaresection (5185 DM versus 5562 DM) because of the selection of large goiters (median 53 ml), the longer hospitalisation after radioiodine treatment due to legal reasons (12.5 days), and the frequent controls before and after the radioiodine treatment. Most important cost-factor of the radioiodine treatment was the volume of goiter, most important cost-factor of the strumaresection was the age of the patient. The treatment of Graves disease was more expensive than that of autonomy in surgery as well as in nuclear medicine. CONCLUSION: In order to achieve cost-minimization, radioiodine treatment should be prefered in cases of small goiters or in older patients.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Surgical treatment of multinodular goiter at the Instituto Nacional de la Nutrición Salvador Zubirán].

BACKGROUND: Surgical treatment is the first option for patients with obstructive multinodular goiter. The extent of the resection and the use of postoperative hormonal therapy are, on the other hand, still under debate. OBJECTIVE: To analyze the results of surgical treatment in 101 patient with multinodular goiter seen from 1980 to 1995. MATERIALS AND METHODS: The clinical/pathologic charts of all patients were reviewed with emphasis to the clinical diagnosis, extent of resection, final histology, type and number of complications, and long-term follow-up. The mean follow-up was three years (range 0.5-12). RESULTS: Ten males and 91 females with a mean age of 46 years were included. Surgery was recommended for a nodule suspicious of malignancy in 60 patients, for airway compression in 33, and for cosmetic reasons in eight. Unilateral lobectomy was performed in 30, bilateral subtotal thyroidectomy in 55 and total thyroidectomy in 16. Postoperative hormone therapy was administrated to 83 patients. Surgical complications occurred in six patients. Four developed permanent hypoparathyroidism and two vocal cord paralysis. There was no operative mortality. A final diagnosis of multinodular goiter was established in 89 whereas 12 had cancer. There were three asymptomatic recurrences in the group with benign lesions (they had undergone unilateral lobectomy followed by hormonal therapy). CONCLUSION: Bilateral subtotal thyroidectomy was the best treatment for multinodular goiter in our series. This procedure had few complications and there was no recurrence of the disease.

Adolescent↗
PubMed1997

[A study of biological and histological criteria of thyroid autoimmunity in diffuse goiters with hyperthyroidism].

Hyperthyroidism is usually classified as follows: with diffuse or with toxic plurinodular goiter, respectively considered as autoimmune and non-autoimmune thyroid disorders. This classification seems partially inadequate as signs of thyroid immunity may be found in some plurinodular toxic goiter and alternatively may by lacking in some cases of Graves' disease. These observations led us to study the intensity of intrathyroidal autoimmune process (IAP) and the levels of TBIAb, TPO- and Thyroglobulin-antibodies in 105 cases with diffuse goiter, hyperthyroidism and elevated RAIU (92 women and 13 men, age 34 +/- 11, mean +/- SD). The intensity of intrathyroidal autoimmune process (IAP) was determined by one pathologist (HT) by semi quantitative method applicable to routine clinical use. Subtotal thyroidectomy was performed because of a large goiter (n = 29), a concomitant cold nodule (n = 20), a recurrent disease (n = 18), intolerance to antithyroid drugs (n = 5) or because patients chose surgical treatment (n = 33). All cases were rendered euthyroid at the time of surgery using antithyroid drugs or iodine. The results show a lack of IAP and undetectable levels of TBIAb, TPO- and Thyroglobulin-antibodies in 10%, 11%, 25% and 47% respectively. The intensity of IAP was not different in case of first episode or recurrence of hyperthyroidism and was not related to type or duration of medical treatment. Comparison of patients with or without IAP show higher levels of TPO- and thyroglobulin-antibodies but not of TBIAb in the former group (P < 0.005). TBIAb were higher when ophthalmopathy and/or dermopathy were present vs absent (p < 0.05) and were correlated with FT4 levels (p < 0.05). The negative predictive value of TBIAb, TPO- and thyroglobulin-antibodies to predict the lack of significant IAP was 42%, 65% and 64%. The total absence of clinical, biological and histological signs of thyroid autoimmunity was found in only one case (female aged 35 with first episode of hyperthyroidism and no family history of thyroid disease) (0.9%). These results suggest that routine available criteria of thyroid immunity (including IAP) have a low specificity. It follows that they are probably inadequate to screen cases of hereditary toxic familial hyperplasia, a rare entity of still unknown prevalence.

Adult↗
PubMedDate not supplied

[Prevalence of endemic goiter in the health sector of Zitenga (Burkina Faso)].

The prevalence of iodine deficiency disorders (IDD) was studied in the health district of Zitenga village (Oubritenga province, Burkina Faso), as part of an assisted development program. The study was designed to assess the prevalence of IDD in a population of more than 2,000 people. A multistage cluster sample of 210 people was randomly selected. The women in the sample were aged 0 to 45 years and the men, 0 to 25 years. Clinical and laboratory results (circulating TSH concentration, T4 and iodine excretion in urine), and dietary intake were recorded. The prevalence of goiter (all grades) was 55.2%. The values recorded for iodine excretion in urine showed that there was moderate iodine deficiency in this area. Blood thyroxine levels were below the laboratory reference range for 63% of the subjects, whereas TSH levels were above the laboratory reference range for 69.3% of the subjects. There was no correlation between hormone status, iodine excretion and goiter. The entire population of this area was deficient in iodine; some individuals had clinical signs of iodine deficiency, such as goiter. Further studies are required to investigate the factors responsible for goiter in this area and iodine supplementation should be provided for the population.

Adolescent↗
PubMed1997

Dyshormonogenetic Goiter: A Clinicopathologic Study of 56 Cases.

Dyshormonogenetic goiters (DG) are genetically determined thyroid hyperplasias due to enzyme defects in thyroid-hormone synthesis. We report 56 cases of DG occurring in 34 females and 22 males. The patients age ranged from newborn to 52 yr (median 16), 75% of the cases occurring before the age of 24. All patients presented with clinically evidence of goiter except for two patients that were diagnosed at autopsy. Hypothyroidism was documented before the histological diagnosis was made in 36 patients (64%). The thyroid gland was enlarged and multinodular in all cases, weighing up to 600g. Microscopically, the most common alteration consisted of markedly cellular nodules exhibiting a variety of architectural appearances, the solid and/or microfollicular patterns predominating. Papillary proliferations and an insular growth pattern were also present. Fibrosis was a common finding; in some instances it was very conspicuous, resulting in irregularities at the edge of the nodules simulating capsular invasion. Other constant features included marked nuclear atypia and minimal amount of colloid. In 18% of the cases, the degree of hyperplasia and atypia were such as to result in a mistaken diagnosis of follicular, papillary, medullary, or undifferentiated carcinoma. Three of the glands contained incidental small neoplasms fulfilling the criteria of papillary microcarcinoma; one of them was multicentric. The presence in a thyroid gland of the combination of these morphologic features should suggest the diagnosis of dyshormonogenetic goiter. The only other condition we are aware of that can result in a similar microscopic picture is iatrogenic goiter resulting from the administration of antithyroidal agents.

Journal Article↗
PubMed1981

Reaccumulation of thyroglobulin and colloid in rat and mouse thyroid follicles during intense thyrotropin stimulation. A clue to the pathogenesis of colloid goiters.

Since Marine's observations some 50 years ago, it has been generally accepted that colloid goiters invariably result from colloid repletion of originally hyperplastic goiters after cessation of the goitrogenic stimulus. However, clinical observations suggest that many goiters never go through a stage of hyperplasia, but are colloid-rich from the beginning. We have injected rats and mice with thyrotropin (TSH), three times a day for 4 d, while the animals were kept on an iodine-rich diet (HID). Additional groups of animals were fed an iodine-poor diet (LID) or a diet containing 0.15% propylthiouracil (PTU) or 1% sodium perchlorate (ClO4). At intervals, thyroid weight, DNA, iodine and thyroglobulin content, thyroglobulin iodination, and intracellular droplet formation were measured. Histologic sections were also prepared and stained with periodic acid Schiff. Furthermore, thyroxine concentration was measured in the serum. Thyroglobulin content dropped by approximately 30% in HID animals but by 60% in all other groups 1 d after starting TSH. Thereafter, thyroglobulin reaccumulation occurred and droplet formation correspondingly decreased despite continuous heavy TSH stimulation. The largest amount of thyroglobulin was reaccumulated in HID animals followed by the PTU/LID groups, whereas no reaccumulation was observed in the ClO4 group. Reaccumulation of thyroglobulin only occurred if there was concomitant organification of at least some iodine. The subsequent phases of depletion and reaccumulation of thyroglobulin were mirrored by the morphology of the follicular lumina, the staining properties of the colloid and the serum T4 concentration. These observations suggest that endocytosis gradually becomes refractory to continuous TSH stimulation if a certain minimal amount of iodine is available for organic binding. Thus, primarily colloid-rich goiters may form in the presence of continuously higher than normal thyrotropin levels without a previous stage of follicular hyperplasia. The view should be revised that accumulation of colloid and intense thyrotropin stimulation are mutually exclusive events.

Animals↗
PubMed1993

Immunohistochemical studies on thyroid peroxidase and thyroglobulin in 13 human thyroid tumors and 7 Graves' goiters.

Thyroid peroxidase (TPO) in 4 benign tumors, 9 malignant tumors and 7 Graves' goiters was examined both by biochemical methods (guaiacol and iodide oxidation assays) and histochemical methods (indirect immunofluorescence methods with polyclonal anti-TPO antibodies). The protein-based specific activity of TPO of Graves' goiters was comparable to or higher than that of normal thyroid tissues, while that of benign and malignant tumors were comparatively lower and variable. TPO was stained with the polyclonal anti-TPO antibodies in the cytoplasm of all benign adenomas, Graves' goiters and follicular carcinomas, but not of papillary carcinoma and metastatic cells. TPO staining markedly appeared in apical areas of Graves' goiters but was scarcely detected in the areas of other disordered thyroids. Polyclonal anti-thyroglobulin antibodies detected thyroglobulin in the follicular lumen of these diseased thyroids except in metastatic carcinoma cells.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

[Immunological and morphological comparisons in toxic goiter].

Histostructural peculiarities of the toxic goiter tissue were compared with humoral parameters of the autoimmune aggression and with the lymphoblasttransformation intensity in 29 patients operated on for thyrotoxicosis. The intensity of intradermal hypersensitivity reaction of delayed type in response to homologous and autologous tissue of the toxic goiter was also investigated. The majority of the patients displayed marked signs of autoimmune aggression, regardless of the structure of the goiter parenchyma and the intensity of ilt lymphoid infiltration. Immunological disturbances increase with the rise in the clinical severity of thyrotoxicosis. It is suggested that immunological changes of toxic goiter have phasic development. Humoral manifestation of autoimmune aggression were marked and stable, whereas changes of cellular immunity were less significant and specific; they were apparently due to a secondary increase in the lymphocytic immunological activity.

Antibody Formation↗
PubMedDate not supplied

Superior vena cava syndrome and tracheal obstruction due to multinodular goiter.

Tracheal obstruction and superior vena cava (SVC) syndrome are rare complications of retrosternal goiter. These two conditions present a difficult diagnostic and therapeutic challenge. Malignancy is the most common cause of SVC syndrome. Determining whether SVC syndrome is due to a benign or malignant process is imperative before instituting treatment, but this determination may be difficult. We present a case of a patient presenting with upper airway obstruction and SVC syndrome with a large mediastinal mass. The mass was determined to be a multinodular goiter. The patient was managed by surgical removal of the goiter with complete resolution of symptoms. This case illustrates the need for careful preoperative evaluation and the importance of establishing a histologic diagnosis prior to initiating treatment for SVC syndrome.

Airway Obstruction↗
PubMed2006

Iodine deficiency and goiter prevalence in Turkey after mandatory iodization.

OBJECTIVE: The determination of (a) iodine deficiency, and (b) the relation between the iodized salt consumption in the Isparta province of Turkey. METHODS: Five hundred students between 6-11 yr of age were evaluated. With a questionnaire, the subjects were asked whether they were using iodine-containing salt or not. After their body weight and height were measured, thyroid glands were examined with palpation, thyroid volumes were determined with ultrasonography (USG), and urinary iodine concentration was analyzed. RESULTS: The median urinary iodine concentration (UIC) of children was 7.00 microg/dl. This value reveals that Isparta is a region with mild iodine deficiency. The total goiter prevalence was 30.4% with palpation and 26% with USG. The goiter prevalence by ultrasonography was 14.2% for the urban and 36.2% for the rural areas. This difference was statistically significant (p<0.05). The rate of total iodized salt consumption was 68%, which was not a satisfactory level. The consumption of iodized salt in the urban areas was significantly higher than that in rural areas (74 vs 62%, p<0.05). The median UIC value was 10.00 microg/dl in urban areas compared to 5.00 microg/dl in rural areas. CONCLUSIONS: Our results indicate that although Isparta is a region with mild iodine deficiency, goiter prevalence remains a serious problem.

Child↗
PubMed1992

Serum thyroglobulin level in patients with diffuse and nodular goiter, after therapeutic application of stable iodine.

This study analysed the changes in serum thyroglobulin levels in euthyroid female patients, suffering from diffuse and scintigraphically functional nodular goiter, after therapeutic administration of two preparations of stable iodine: dried bovine thyroid, containing 100 mcg of iodine in one dragee (Thyral, Yugoslav Pharmacopea) and synthetic Na-salt L-thyroxine (Vobenol, with 100 mcg of iodine, too), for relatively short time of following-up, 8 weeks only. Having in mind the key role of TSH in regulation, all aspects of thyroid gland function, the interrelationship between TSH and thyroglobulin concentrations in those patients were also investigated. Prior to the therapy females had elevated thyroglobulin serum concentrations, caused by existence of diffuse and nodular goiter, which reflected an increase in intraglandular turnover of thyroglobulin (192 +/- 140 mcg/L in GROUP A further treated with Thyral and 121 +/- 14.80 +/- mcg/L in GROUP B, whose patients received Vobenol, mean +/- SD). Positive linear correlation between TSH and Tg levels was not established before therapy. Our data indicate that administration of two different preparations containing stable iodine in doses of 100 mcg every second day, during a two months period, resulted in significant decrease in the size of diffuse and nodular goiter, with diminished complains in a great number of patients. In thyroid humoral status, significant decrease of thyroglobulin concentrations was evident in both analysed groups (62 +/- 48 mcg/L, and 60 +/- 66, respectively). Presented results confirmed positive linear correlation between TSH and thyroglobulin in serum samples, after therapy, especially strong in the group treated with dried bovine thyroid.

Adult↗
PubMed1970

Circulating immonoglobulin M: increased concentrations in endemic and sporadic goiter.

Increased concentrations of immunoglobulin M have been found in the circulation of approximately half of patients with either endemic or sporadic nontoxic goiter. Blood was obtained from patients in several iodine-deficient goitrous areas; the patients with sporadic goiter resided in or about New York City. Concentrations of immunoglobulins G, A, and D were normal. Blood for control purposes was taken from patients residing in cities near the goiter areas where there was no iodine deficiency, and in New York City. Most of these samples came from hospitalized patients without known thyroid disease and were collected at random. Chi-square values for the difference between the number of goitrous patients with elevated concentrations of immunoglobulin M and those in the control patients were highly significant statistically.

Ecuador↗
PubMed1999

Bilateral recurrent nerve paralysis associated with multinodular substernal goiter: a case report.

Substernal goiter is an infrequent occurrence and is found in two to five per cent of all patients undergoing thyroid surgery. These lesions are well known to cause respiratory symptoms and alterations in phonation due to direct compression of airway structures. Infrequently, unilateral recurrent nerve palsy has been reported in patients with substernal goiter. We report a case of bilateral recurrent nerve palsy associated with multinodular substernal goiter in an 89-year-old female who presented in respiratory distress.

Aged↗
PubMed2001

[Surgery of substernal goiter].

OBJECTIVE: To study the surgical approaches and operative techniques for substernal goiter. METHOD: A retrospective study of 27 cases with substernal thyroid nodules was made in our hospital. RESULT: The operations on 27 patients with substernal nodules have been successfully carried out. Among them, 10 were goiters, 9 adenomas, 4 malignancy and 4 were thyroid cancer metastasizing to paratracheal or substernal nodes. Resection via cervical collar incision was adequate in 23 cases. Three thyroid cancers with paratracheal node metastasis were completely resected by sternotomy and only one thyroid cancer with paratracheal and substernal nodes metastasis was resected by combined thoracotomy and cervical collar incision. CONCLUSION: Resection via cervical collar incision for all retrosternal thyroid nodules were advised. The preliminary experience with this procedure suggests that it has some advantages in the management of substernal goiter, including: 1. ease of operation compared to both sternotomy and thoracotomy; 2. relatively low morbidity; 3. safe and reliable.

Adult↗
PubMedDate not supplied

Usefulness of fine needle aspiration of the thyroid in an endemic goiter region.

The accuracy of fine needle aspiration (FNA) cytology of the thyroid was addressed in 142 nodular goiters from an endemic goiter region. The aspirations and their interpretation were based on the methodology of the Karolinska Hospital. For practical purposes, the follicular lesions were divided into type I (benign), type II (atypical benign) and type III (suspicious). Excluding the follicular lesions, the cytohistologic agreement for the whole series was 87%, with a correlation of 81.5% for carcinomas. The type I and type II follicular lesions were benign on histologic grounds; 39% of the carcinomas were detected in the type III follicular lesions. The 0.7% false-positive diagnoses increased to 15% when type III follicular lesions were included. No false negatives were recorded. These observations, together with the increase of surgically resected thyroid carcinomas after FNA was accepted as a diagnostic modality, indicate that FNA biopsy of the thyroid is an accurate diagnostic method and is useful in selecting patients for subsequent surgery in areas of endemic goiter.

Adenocarcinoma↗
PubMed1986

[Value of sonography in assessing nodular changes of the thyroid in an endemic goiter area].

In an area of endemic goiter 304 patients with an increased thyroid gland were examined by palpation, sonographically and partly scintigraphically. The average age was 37 (12-78) years, the average age of the patients with nodular changes of the thyroid gland 38-44 years. Patients with a diffuse struma were significantly younger with an average age of 33 years. A false-positive enlargement of the thyroid gland established by palpation occurred in 16.1% (n = 49/304). In the sonographic examination 148 out of 304 patients revealed a diffuse enlargement of the thyroid gland without provable nodular change. However, in about one third already more or less clearly characterized regressive changes could be observed. In 156 of the 304 patients 109 times solitary nodes and 47 times multinodular changes were established sonographically. In more than one third of all nodular goiters or one fifth of all patients examined a cyst was demonstrated sonographically. Two thirds of the sonographically established nodular changes were, however, solid. In 53 of all 304 examined patients could sonographically be established additional, unexpected nodes which had escaped the palpation and partly also the scintigraphic investigation. In 14% the node suspected by palpation could not be ascertained sonographically. According to the echo structure echo-poor and echo-equal solid nodes dominated. The frequency of carcinomata of the solid nodes was 6.7%. Apart from 4 echo-poorly and 2 complexly structured nodes a carcinoma of the thyroid gland demonstrated itself sonographically to the same echo. Finally conclusions are drawn for the diagnostics of the thyroid gland in the endemic area of goiter.

Adult↗
PubMed1986

[Surgical treatment of nodular endemic goiter].

The article analyzes results of the surgical treatment of 142 patients with nodular endemic goiters in Algeria. Intracapsular, extracapsular and combined methods were used. The selection of the method for different clinico-anatomical features of the goiter is grounded. The extracapsular method is thought to be the method of choice in diffuse-nodular and nodular goiters of a huge size.

Adolescent↗
PubMedDate not supplied

[Cervicomediastinal and thoracic goiters].

Between 1950 and 1979 approximately 2400 patients with thyropathies have been operated in the I-st Surgical Clinic of Jassy. Of these 100 had cervico-mediastinal goiters, of which 79 were of the plunging cervico-mediastinal type, 18 were of the mediastino-cervical type and 3 were mediastinal goiters. The surgical treatment was applied in 98 patients, cervicotomy being sufficient to relieve the symptoms in 92 of the cases. The mixed approach (cervicosternotomy, or cervico-thoracic approach) were necessary in 5 cases, and the thoracic approach was selected in one case with an independent posterior mediastinal goiter. The immediate postoperative evolution, as well as the late evolution was good in most of the cases. Postoperative mortality was of 2 percent.

Adolescent↗