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At least 793 records · Page 44Linked to original sources
PubMed1994

Surgical management of substernal goiter.

Seventeen cases of large substernal goiter are reviewed. The commonest clinical features were frequent upper respiratory tract infections, dyspnea and a cervical mass. Five of the patients had previous thyroidectomy. The substernal goiter was located in the right chest in 11 cases, the left chest in five and bilaterally in one case. On computed tomograms it was pretracheal or prevascular in ten cases and retrovascular in seven. Tracheal deviation was present in 15 cases, causing tracheal compression or stenosis in 14. Thyroidectomy was performed on all 17 patients (8 subtotal, 9 total) through a low transverse collar incision. The recommended technique for substernal goiter extending from the neck to a level below the subcarinal region includes concomitant finger dissection and upward traction of the cervical thyroid through the subcapsular plane, with obliteration of the postresection substernal dead space by sutures. Follow-up radiography showed that all the deviated tracheas had resumed near normal position 2-3 months postoperatively and the average diameter of the compressed tracheas had increased significantly.

Adult↗
PubMedDate not supplied

Utility of recombinant human thyrotropin for augmentation of radioiodine uptake and treatment of nontoxic and toxic multinodular goiters.

OBJECTIVE: To report our results in treating 16 patients with low radioiodine uptake (RAIU) multinodular goiter who had obstructive symptoms or suppressed thyroid-stimulating hormone (TSH or thyrotropin), indicating mild hyperthyroidism. METHODS: Six patients were treated with 0.3 mg of recombinant human thyrotropin (rhTSH) followed by 30 mCi of (131)I 72 hours later. Ten patients were treated with 0.9 mg of rhTSH followed by 30 mCi of (131)I 24 hours later. RESULTS: Of the 16 treated patients, all 10 with compressive symptoms and both patients with weight loss had remission or improvement, as did 1 of 2 patients with atrial fibrillation. All patients with suppressed TSH had a return to normal levels or became hypothyroid. During the next 3 to 7 months, estimated gland size reduction was 30 to 40%. Three of the 6 patients who received 0.3 mg of rhTSH and 6 of the 10 patients who received 0.9 mg of rhTSH, in conjunction with (131)I therapy, ultimately had TSH levels indicative of hypothyroidism. Mild radiation thyroiditis developed in only one patient, and no other side effects occurred. CONCLUSION: The 0.3-mg dose of rhTSH seemed to be as efficacious as the 0.9-mg dose. The greater than fourfold increase in RAIU at 72 hours after administration of rhTSH in our study is more than twofold higher than the 24-hour RAIU results previously reported in normal subjects and in patients with multinodular goiter. These findings have implications for future expanded studies and alternative dosing regimens in treating patients with both multinodular goiter and subclinical hyperthyroidism.

Aged↗
PubMed1994

Large, compressive goiters treated with radioiodine.

OBJECTIVE: To evaluate the effectiveness of radioiodine therapy as an alternative for surgery in elderly patients with a large, compressive goiter using objective methods for measuring thyroid volume and tracheal compression. DESIGN: Prospective study. SETTING: University hospital in the Netherlands. PATIENTS: 19 patients (mean age +/- SD, 66 +/- 14 years) with a large, compressive multinodular goiter who had a high operative risk or refused to have thyroid surgery. INTERVENTION: A single intravenous dose of 131I at 2.6 +/- 1.0 GBq (70 +/- 28 mCi) (3.7 MBq or 100 microCi/g of thyroid tissue), followed by daily administration of L-thyroxine in doses that did not suppress thyroid-stimulating hormone. MEASUREMENTS: Clinical evaluation and measurements of thyroid volume, maximal tracheal deviation, and the smallest cross-sectional area of the tracheal lumen with magnetic resonance imaging before and 1 year after 131I treatment. RESULTS: No exacerbation of compressive symptoms after 131I therapy was observed. Thyroid volume was 269 +/- 153 mL before treatment and 154 +/- 73 mL 1 year after treatment (P < 0.001). Thyroid volume was reduced 40% +/- 15% (range, 19% to 68%). Maximal tracheal deviation (1.9 +/- 0.8 cm before and 1.5 +/- 0.7 cm 1 year after therapy) had decreased by 20% +/- 20% (range, -4% to 73%; P < 0.001), and the smallest cross-sectional area of tracheal lumen (0.78 +/- 0.38 cm2 before and 1.04 +/- 0.48 cm2 1 year after therapy) had increased by 36% +/- 38% (range, -3% to 125%; P < 0.001). Clinical signs and symptoms improved in 8 of 12 patients with dyspnea and inspiratory stridor and in both patients with compression of the superior vena cava. CONCLUSIONS: Therapy with 131I is an effective alternative to surgery for elderly patients with a large, compressive multinodular goiter.

Aged↗
PubMed1998

[European project of structural funds: eradication of endemic goiter and iodine deficiency disorders in Southern Italy].

Iodine deficiency disorders and endemic goiter are still present in the population of Southern Italy, where the use of iodized salt is not widely diffused because of a lack of information and health education on this problem. The aim of this project financed by the "structural funds" (objective 1) of the European Union, is to eradicate endemic goiter and iodine deficiency in the population of Southern Italy. The project comprises various subsequent steps. Initially, the grade of iodine deficiency (measuring urinary iodine excretion) and the prevalence of endemic goiter (measuring thyroid volume by echography) will be evaluated in the whole schoolchildren population aged 12-14. In addition, a widespread promotional campaign on the mass media (newspaper, TV, etc.) will be performed in order to implement the use of iodized salt. Subsequently, the effect of this campaign to promote the use of iodized salt will be verified evaluating the increase of urinary iodine excretion and the decrease of enlarged thyroid volumes in the schoolchildren population.

Deficiency Diseases↗
PubMed1998

[Goiter and iodine deficiency in Veneto: study on 6285 elementary and media school children].

The aim of this paper was to determine goiter prevalence and urinary iodine excretion in the Veneto region. An extensive epidemiological survey was carried out in school-aged children visiting 6285 students and testing 1861 urinary samples. A goiter prevalence of 8.8% was found: 7.7% of grade 1A and 1.1% 1B; in the pre-mountainous area the prevalence was higher than 10% (11.7% in the Treviso and 12.7% in the Vicenza area). Urinary iodine excretion was less than 100 micrograms/Cr in about 45% of all examined children with a peak of 20% under 50 micrograms/Cr in the Vicenza district. According to the WHO criteria, the goiter prevalence in the Veneto can be considered under the limits of the epidemic standards. However the use of iodized salt seems advisable also in this area.

Adolescent↗
PubMed1998

[Verification and epidemiological study on endemic iodide-induced goiter in Jiangsu Old Yellow River flooded plain].

To verify the existence and reveal the epidemiological characteristics of endemic iodide-induced goiter in Jiangsu Old Yellow River flooded plain, 12 spots were selected in this survey. The results showed that the total goiter rate of 22.18% by palpation and 12.83% by B-ultrasound which surpassed the 5%-cutpoint-recommended jointly by WHO/UNICEF/ICCIDD. The urinary iodine median was 962 micrograms/L in 607 samples. The average 24 hours I31iodine-emissivity ratio was 4.6 +/- 0.3% with most of the serum TSH, T4, T3 within normal ranges. Of 1049 water samples in 65 towns, 771 had iodine content over 300 micrograms/L with water iodine concentration over 300 micrograms/L in 52 towns. These findings suggested that goiter in this plain had been endemic which related to excessive iodine in shallow well water. Heavy load of iodine over general population was noticed.

Child↗
PubMedDate not supplied

[The consumption of cassava is not responsible for the etiology of endemic goiter in rural areas in Senegal].

An epidemiological study of iodine deficiency disorders (IDD) was carried out in West Senegal and Casamance. Five hundred and eighty five households were selected in 3 areas with a high prevalence of goiter. We assessed the relative impact of iodine deficiency (estimated by mean iodine excretion in the urine of family members) and cassava consumption (mean frequency of consumption by the household). Cassava consumption, even if on a regular basis, neither caused nor increased goiter formation in this area of West Africa. This was probably due to the local method of cassava root preparation, which reduces the amount of cyanogenic compounds consumed. Iodine deficiency was principally responsible for goiter formation. Therefore, the commercial availability of iodine-supplemented salt should lead to the eradication of IDD from Senegal in the near future.

Adolescent↗
PubMedDate not supplied

[Intrathoracic goiter].

AIM: A goiter, situated partly or on completely in the thoracic cavity is usually referred to as intrathoracic goiter (ITG). However, inadequate definition of intrathoracic malpositions of thyroid gland caused usage of different classifications. This produced different and, often unclear criteria for the grouping of intrathoracic thyroid malpositions and, consequently, very different results and difficulties in any attempt of parallel review or analysis. The aim of this research was to analyze the ITG that include goiters with more than 80% of tissue in the thoracic cavity and intrathoracic thyroid choristomas, and to point out the diagnostic problems and surgical dilemmas. METHODS: Source of the used data were the studies published in the last 50 years in English, French, Italian, German and Russian language. Data have been integrated and combined for the detailed analysis, while quantitative synthesis was achieved by statistical analysis. RESULTS: ITG was represented in 1% of operatively treated thyroid diseases. One third of patients were asymptomatic. Commonly observed symptoms were dyspnea, stridor and dysphagia, and there was no significant difference in appearance of these symptoms between the two groups of ITG. Chest roentgenography and CT scan could provide the maximal information with no need for expensive procedures. Accuracy of scintigraphy in revealing and discerning of ITG is 70%, averagely. In 20% of patients correct preoperative diagnosis was not established. Therapy of choice in the treatment of ITG was surgical, even in asymptomatic cases. Thoracic approach was used in 95% of cases and there was no significant difference between the two groups of ITG. Total thyroidectomy or total lobectomy was definitely obligatory with contralateral subtotal lobectomy. There was no significant difference in the frequency of operative complications between ITG and non-ITG, and between the two groups of ITG. CONCLUSIONS: ITG is rare, but might present a difficult diagnostic and complex surgical problem. Common clinical presentation and identical surgical approach in operative treatment justify the common review of the two groups of ITG. With timely and adequately performed surgical approach, in specialized institutions, frequency of complications in operative treatment of ITG was not higher if compared to operative treatment of non-ITG.

Goiter, Substernal↗
PubMed2000

[Recurrent nodular goiter. Characteristic features and surgical management].

Purpose of the study was to investigate the frequency of the thyroid carcinoma in the recurrent nodular goiter, to analyse the applied operative methods, the observed complications and the obtained early and distant postoperative results. For the period 1985-1996 in the Clinic of Endocrine Surgery were performed 588 reoperations by 577 patients with nodular recurrent goiter, distributed as following: 539 females, aged 14-81 and 49 males, aged 11-69. In 431 cases (73%) was applied medial approach and in 157 cases (27%)--lateral operative approach by the mobilizing of the thyroid recurrence. In the early postoperative period were established the following complications: clinical hypoparathyroidism in 10 patients (1.7%) with calcium level from 1.44-2.01 mmol/l and recurrent nerve paralysis in 28 patients (4.76%), including: in 13 cases unilateral paralysis on the right side, in 9 cases unilateral--on the left side and in 6 cases--bilateral paralysis. The established in 28 patients (4.76%) thyroid carcinoma and the appeared in 59 cases (10%) new recurrence of the basic thyroid disease supported our tactic for radical operative treatment in all patients with nodular recurrent goiter.

Adolescent↗
PubMed2001

Life-threatening giant mediastinal goiter: a surgical challenge.

Mediastinal goiter is a well known benign disease, usually resectable through a cervical approach with minimal morbidity and mortality. Only occasionally a median sternotomy or a lateral thoracotomy may be required. The present case is worthy of presentation because of the exceptional dimension of the disease and the surgical challenge that it presented. In a 72-year-old woman a large intrathoracic goiter of the right thorax caused a severe dyspnoea due to an important contralateral mediastinal shift with compression of the lung, superior vena cava system and trachea. At surgical exploration, through a cervico-sternotomic approach, the mediastinal structures dislocation and the strong adherences between the anomalous neovascularized capsula of the mass and the surrounding structures, complicated the surgical dissection. An accidental lesion of the innominate artery required its reimplantation on the ascending aorta. An immense mass, was finally removed and pathological examination revealed a rare case of neovascularized, pseudosarcomatoid capsula among a benign hyperplastic proliferation. In spite of its benign nature, a giant goiter caused a life-threatening compression of the respiratory tract and lung parenchyma in this patient. The dimension of the lesions, the mediastinal anatomy alterations and the severe intraoperative haemorrhage represented major technical difficulties during surgical resection.

Aged↗
PubMed1997

Goiters in the Renaissance.

Enlargements of the thyroid gland known as goiters appear in artworks and artifacts of many cultures. They are represented in sculptures, bas-reliefs, masks, waxes, mosaics, bronzes, stained glass windows, paintings and drawings of the last two millennia. These are described in several monographs and in Merke's scholarly History and Iconography of Endemic Goitre and Cretinism (Barbieri 1993, Gianpalmo and Fulcheri 1988, Gianpalmo 1992, Medvei 1982, Merke 1984). Most numerous among these works are the portrayals of goiters in paintings and drawings of the Renaissance. This essay lists eleven additional Renaissance artworks in which goiters are represented, as well as reviewing reasons for this occurrence and examines the unusual case of Piero della Francesca.

Goiter↗
PubMedDate not supplied

[Diffuse and binodular goiter in a patient with tuberous sclerosis].

Tuberous sclerosis complex is hereditary multisystemic, neurocutaneous disorder characterized by hamartomatous lesions mainly involving the brain, skin and viscera. Thyroid gland is rarely affected in these patients. Case history of a patient with tuberous sclerosis complex and diffuse and binodular goiter was presented. No epileptic seizures occurred despite multiple intracranial calcifications, cortical and subependimal tubers, revealed by neuroimaging. Borderline intellectual functioning was determined. Ultrasonographic findings of the heart, abdomen and pelvis were normal. Bone radiographs revealed multiple cystic lesions of the metacarpal, metatarsal and terminal phalanges. Clinical, endocrine and metabolic evaluations were performed because of anxiety, mild weight loss, transient problems of swallowing and breathing complaints, developing when she was 39 years old. Palpable diffuse and asymmetric thyroid enlargement was found. Laboratory tests of thyroid function, ultrasonographic examination and scintiscanning of the thyroid gland and patohistological analysis of fine-needle aspiration biopsy revealed the euthyroid, inactive, diffuse and binodular goiter. Unusual association of goiter and tuberous sclerosis was discussed.

Adult↗
PubMedDate not supplied

[Endemic goiter in public health].

This work focuses on the medical condition known as endemic goiter considering its epidemiological aspects and its interest in Public Health. After delimiting some basic concepts, one will refer to the implications that the shortage of the daily ingestion of iodine, which is the main etiology of the affection in question, brings to the normal physical, mental and social development of the human being. One will discuss the concepts of risk group and of epidemiological risk factors, outline the guiding lines of prevention, namely, health education and point out certain vicissitudes of prevention programs in the field of endemic goiter. Finally, some brief notes on epidemiological aspects of endemic goiter, in Portugal, will be presented.

Goiter, Endemic↗
PubMed2002

[Iterative surgery for goiter].

AIM: Identify and resolve problems related to iterative surgery for goiter. PATIENTS AND METHOD: Fifty-nine patients who underwent surgery for recurrent benign goiter between 1990 and 1999 were included in the study. RESULTS: Forty-two patients had lobectomy and isthmusectomy (71.2 and 17 patients had subtotal thyroidectomy (28.8%). The delay from initial surgery to recurrence was less than 5 years for 44% of the patients and was more than 10 years for 17.8%. There was no post-operative mortality and no recurrent laryngeal nerve injury. Early post-operative hypocalcemia occurred in 2 patients (3.3%). CONCLUSION: The goal of revision surgery for recurrent goiter is total thyroidectomy. Prevention is a rational management scheme for thyroid nodules.

Adolescent↗
PubMed2002

[Percutaneous ethanol sclerotherapy of non-toxic nodular goiters--a clinical study of 76 patients].

INTRODUCTION: Ultrasonography-guided percutaneous ethanol injection (PEI) therapy is a new method for treating nodular goiters. PATIENTS AND METHODS: 76 patients with nontoxic nodular goiter (65 women, 11 men, mean age 49 years) underwent PEI in order to avoid surgery. In the first 14 patients with cystic nodule one session, while in the remaining 36 patients 3-8 sessions were performed. In each session after evacuation of the cysts half volume of absolute alcohol was injected into the nodule. In the cases of the 26 solid nodules each patient received a mean total dose of 0.98 ml (range 0.34-1.77 ml) ethanol per ml nodular volume. Ethanol was injected in a mean of 3.9 (range 2-8) sessions for solid nodules. Success was defined as shrinkage of the nodule to half or less compared to the pretreatment volume on 4.5 months and every later follow-up occasion. RESULTS: No serious side effects occurred. 2 previously operated patients became hypothyroid. In the case of cystic nodules treated on one session, in 4 of 14 cases the therapy was unsuccessful. In patients treated on multiple occasions the success rate was significantly (p = 0.02, chi 2(1) = 5.06) higher; in 34 of 36 cases. PEI was successful in 25 of 26 patients with solid nodules. A continuous shrinkage of the nodule was observed in those 25 patients who were followed for at least 2 years: the volume of the nodule was 35% at 1.5 month, 29% at 4.5 month, 21% at 1 year and 17% of pretreatment volume at 2 years follow-up. CONCLUSIONS: PEI should be reserved for patients who cannot or will not undergo surgery. On the other hand, patients with recurrent nodular goiter requiring surgery form a subset where PEI can be proposed.

Adult↗
PubMedDate not supplied

[Role of some environmental factors in the development of endemic goiter (a review)].

The review presents possible causes of endemic goiter since only iodine deficiency fails to explain such a great spread of this disease. Etiological factors of endemic goiter, such as the imbalance of trace elements, the use of contaminated drinking water, the toxic action of chemicals, exposure to ionizing radiation, genetic factors, are discussed. Prevalence rates of endemic goiter in Russia and other countries of the world are presented. The causes of a significant increase in the incidence of this disease are discussed.

Environment↗
PubMed2003

[Basedown disease, thyroid gland autonomy, nodular goiter. When is radiotherapy indicated?].

Treatment options for benign diseases of the thyroid include medication, radioiodine therapy and surgery. Patients with hyperthyroidism initially receive antithyroid drugs, with further treatment determined by the relapse risk. In the case of Graves' disease this is determined by a number of risk factors, including the volume of the thyroid gland or the presence of endocrinal ophthalmopathy. In such cases with a high relapse risk, radioiodine therapy is the recommended first-line treatment. Further indications--if surgery is not necessary--are autonomous goiter, recurrent (autonomous) goiter and latent hyperthyroidism. A single radioiodine treatment suffices to control the situation in more than 90% of the cases, and the goiter clearly diminishes in size. Radiation-induced malignancies or malformations have not been seen, but iodine treatment is contraindicated in pregnancy. In view of the short hospital stay of only four to five days, and the ready availability of treatment units, the authors consider radioiodine therapy a suitable first-line option in patients with Graves' hyperthyroidism.

Antithyroid Agents↗
PubMed2003

[Postoperative hypothyroidism in patients with multi-nodular goiter].

Results of surgical treatment of 69 patients with polynodous euthyroid goiter were studied. There was established, that postoperative hypothyrosis is occurring more often in women aged from 41 to 70 years with colloid goiter in combination with adenoma of thyroid gland (in 60% observations) and adenomatous goiter (in 42.8%). Increase of residual tissues volume of thyroid gland do not always provide the decrease of the hypothyrosis frequency occurrence. The physician control absence for the hormonal therapy management worsens the postoperative hypothyrosis course.

Adult↗