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PubMedDate not supplied

[Serum thyroxine-binding protein for determining the functional state of the thyroid gland in pregnant women with endemic goiter].

A determination was made of the hormone-forming capacity of the thyroid gland in pregnent women under conditions of goiter endemic at various periods of pregnancy by trimesters (123-in healthy pregnant women, 206-with euthyroid goiter of the I degree, 271-or II degree, 90-of the II degree, and 4-of the IV degree). A method of zonal electrophoresis in the medinal-veronal buffer was applied. Thyrofixin with I131 isotope (made in the USSR) was used. With increase of the periods of pregnancy and the degree of euthyroid hyperplasia of the thyroid gland and goiter the thyroid gland function became elevated irrespective of age.

Female↗
PubMed1991

Changes in serum T4, T3 and TSH concentrations in newborns and infants with congenital goiter from the Mazovia region.

Thyroid function was investigated in a group of 61 newborns with congenital goiter before starting the therapy with thyroid hormones. The group included 19 girls and 42 boys, of which 27 were of age not exceeding one week (group I), 19 were between the first and the second week (group II), and 15 were between the second week and the third month of life (group III). The concentrations of the thyroid hormones were determined by radioimmunoassay. The values obtained have been compared with the local reference range obtained for the newborns of the Mazovia region. The values remaining outside the reference range were found in 47.5% of the newborns studied. The elevated values of TSH were observed mainly in group I newborns (12 from 27); among group II newborns there was only one with the elevated values, and none among the newborns of group III. thyroxine (T4) values were lowered in 14 among 27 newborns of group I, and in 2 among 19 newborns of group II; all T4 values were normal in group III. The percentage of the elevated values of triiodothyronine (T3) was higher in older newborns (group III). The elevated level of T3 accompanied by the lowered level of T4 with the normal or moderately elevated level of TSH is characteristic for the adaptation to the deficiency of iodine. There is preferential secretion of T3 aimed at maintaining euthyreosis. The elevated levels of T3 found in 30% of newborns with untreated goiter suggest an intrauterine deficit of iodine as a cause of the goiter appearance.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMedDate not supplied

Scanning electron microscopy of euthyroid goiter and Graves's disease.

The scanning electron microscopy of 5 euthyroid polynodular goiters and 5 cases of Grave's disease was studied. In the polynodular goiter most of the follicular cells were flattened. Small, coarse, irregular microvilli were noticed. In the Grave's disease cases the follicular cells were columnar, covered with long microvilli. Marked epithelial infoldings were found. Thick bundles of collagen surrounded the follicles, especially in the polynodular goiter.

Adult↗
PubMed2003

[Toxic multinodular goiter].

OBJECTIVES: We report a series of 70 patients with toxic multinodular goiter (TMNG) and analyze results after surgical removal. PATIENTS AND METHODS: Over a 15-year period, patients underwent thyroid surgery for TMNG. The large majority, 85.5% were women and mean age was 40 years. All patients had had goiter for more than 5 years. Clinical signs of toxicity were present in all patients, 100% presented tachycardia and palpitations. Nodules were identified at ultrasound in 95% of the patients and at scintigraphy in 90%. Serum T4 was elevated in 40 patients and THS was depressed in all. The chest x-ray revealed a plunging goiter in 10 patients. All patients were given medical treatment prior to surgery for total thyroidectomy in 15 and subtotal thyroidectomy in 55. There were no deaths. Two patients developed hematomas, to suffered injury to the recurrent nerve, and five developed acute hypoparathyroidism. Three cases of thyroid carcinoma were observed. DISCUSSION: TMNG is an indication for radical treatment, generally surgery. Medical treatment is required in preparation for surgery. Total thyroidectomy is used increasingly, providing a definitive cure of toxic hyperthyroidism and avoiding the risk of recurrence. With increasing surgical skill, the risk of recurrent or parathyroid injury is greatly decreased.

Adolescent↗
PubMed2003

[Three dimensional spiral computed tomography imaging in preop diagnosis of substernal goiter (preliminary study)].

The aim of the study was the estimation of substernal goiter by use of three-dimensional spiral computed tomography (3-D sCT) with the contrast agent. The size and anatomy of goiter as well as its relation to surrounding tissues, particularly blood vessels was evaluated. The examination allowed good visualization of both inferior thyroid arteries. The use of 3-D sCT may have a great meaning in preoperative examination in particular in technically difficult cases of substernal goiter.

Arteries↗
PubMed2003

[Development of Basedow disease after radioiodine therapy for nodular goiter].

It has been observed in the past few years, that radioiodine therapy triggers autoimmune thyrotoxicosis. The possible mechanism of this phenomenon is that protein fragments enter the circulation after thyroid cell damage induced by radiation. TSH-receptor autoantibodies are produced in genetically susceptible patients after radiotherapy. In treating nodular goiter--a non-immune thyroid disease--with 131I, an immunogenic disorder--Basedow-Graves' disease--may develop. The authors present this phenomenon in a case of a 67 year-old woman with a history of operation for euthyroid nodular goiter in 1977. In November 2001, she was admitted to the hospital with local signs and symptoms of relapse of euthyroid nodular goiter (TSH-receptor antibodies were not detected). She was treated with oral doses of 320 MBq of radioiodine to reduce the thyroid volume. Four months after radioiodine therapy the patient had developed signs of thyrotoxicosis. At that time TSH-receptor antibodies were found to be positive. Thyreostatic therapy was administered and still being in use till today. The authors draw the attention to the fact that, when a hyperthyrosis develops after radioiodine therapy of a non-immune thyroid disease, the possibility of Graves-Basedow disease should be raised, especially in a patient with a positive family history.

Aged↗
PubMedDate not supplied

[Prevention of endemic goiter in areas jointly exposed to natural and industrial chemical factors].

The present paper deals with the sanitary evaluation of goiter endemia and with a rationale for principles in its prevention in areas exposed to natural and industrial chemical factors (in case of the Perm Region). The findings suggest that the elevated levels of some toxic metals and organic compounds in the body and zinc deficiency are strumogenic factors that maintain and aggravate the severity of goiter endemia in the presence of iodine deficiency. Comprehensive programs for prevention and correction of goiter endemia should be worked out differentially, by taking into account a combined influence of natural and industrial chemical factors on the population.

Environmental Exposure↗
PubMed2004

Dosimetry of radioiodine therapy in patients with nodular goiter after pretreatment with a single, low dose of recombinant human thyroid-stimulating hormone.

UNLABELLED: A single, low dose of recombinant human thyroid-stimulating hormone (rhTSH) doubles 24-h RAIU and causes a more homogeneous distribution of radioiodine on thyroid scintigrams of patients with nodular goiter. Pretreatment with rhTSH allows the therapeutic dose of (131)I to be reduced by 50%-60% without compromising the result of thyroid volume reduction. The present study focused on the dosimetric aspects of therapy with a reduced dose of (131)I after pretreatment with rhTSH in patients with nodular goiter. METHODS: Thirty-six patients were treated with (131)I to reduce thyroid volume. Nine patients were pretreated with a single dose of 0.01 mg of rhTSH, and 9 patients, with 0.03 mg of rhTSH. Two control groups of 9 patients, matched for thyroid weight and 24-h radioactive iodide uptake, were not pretreated with rhTSH. The therapeutic dose of (131)I was aimed at being sufficient to result in retention of 3.7 MBq of (131)I per gram of thyroid tissue at 24 h. Thyroid radioactivity after (131)I administration was measured every 24 h for 3 d and on days 7, 10, 14, 21, and 28. A model of iodine biokinetics was used to estimate absorbed doses in organs. Protein-bound (131)I activity was measured at 1, 2, 3, 7, and 10 d and at 2, 3, and 4 wk after (131)I therapy. RESULTS: The administered activities were 1.5 times lower in the 0.01-mg rhTSH group and 1.9 times lower in the 0.03-mg rhTSH group than in the control groups. The absorbed dose in the thyroid was similar in the rhTSH-pretreated groups and in the control groups. In the organs of excretion (bladder) and uptake (stomach) of inorganic iodide, the absorbed doses were 2- to 3-fold lower in the pretreated groups than in the control groups. The effective dose equivalent outside the thyroid was considerably lower in the rhTSH-pretreated groups than in their respective control groups (1.6-fold in the 0.01-mg rhTSH group and 2.3-fold in the 0.03-mg rhTSH group). The time course of protein-bound (131)I activity in serum and the cumulated protein-bound (131)I activity in serum did not differ significantly between rhTSH-pretreated and control groups. CONCLUSION: (131)I therapy after pretreatment with a single, low dose of rhTSH, with the dose reduced according to the rhTSH-induced increase in 24-h radioactive iodide uptake, caused lower radiation-absorbed doses in extrathyroidal organs and tissues, especially bladder and stomach, and no significant increase in the release of (131)I-labeled thyroid hormones into the circulation of patients with nodular goiter. Thus, this mode of therapy can be recommended, especially when the dose of radioiodine to be administered without rhTSH pretreatment is high.

Aged↗
PubMed2004

[Iodine-131 therapy for large goiter with hyperthyroidism: clinical observation of 38 cases].

OBJECTIVE: To evaluate the therapeutic efficacy and safety of iodine-131 therapy for large goiter complicated by hyperthyroidism. METHODS: After the diagnosis of large goiter complicated by hyperthyroidism was established, the weight of the patient's thyroid gland was determined, and the doses of iodine-131 calculated according to the formula currently available. After a single dose of oral iodine-131 capsule, the patients were observed for the therapeutic efficacy and side effects. Some patients were given the second or even the third dose of iodine-131. RESULTS: All of the 38 patients were cured by 1 to 3 single doses of iodine-131 therapy, of whom 23 (60.5%) needed only a single dose for the cure, 13 (34.2%) required the second dose, and 2 (5.3%) necessitate a third dose. Hypothyroidism occurred in 4 cases (10.5%), and none of the patients developed hyperthyroidism crisis and dyspnea. CONCLUSIONS: Iodine-131 therapy for serious goiter with hyperthyroidism is safe and effective, which can be used as a routine therapy for this condition.

Adult↗
PubMed2004

The incidence of thyroid carcinoma in multinodular goiter: retrospective analysis.

Thyroid carcinoma (TC) is a relatively rare tumour, but it represents the most frequent form of cancer of the endocrine glands. Epidemiologically ascertained risk factors are ionising radiation, the presence of thyroid adenoma and multinodular goiter (MNG). Multinodularity of goiter should no longer be considered an indicator of probable benign disease. A retrospective analysis was performed on patients operated of MNG at the Unit of Otolaryngology, Sanremo Hospital (Italy) from January 1st 1995 to December 31st 2002, in order to establish the incidence of carcinoma. The results of this retrospective study, demonstrate that in 13.7% of the patients operated for goiter, the presence of a carcinoma was noticed in the definitive histopathologic examination. Such incidence percentage of MNG is in accordance with the data reported in published reports. Thus, the authors conclude that the risk of malignancy in MNG has not to be underestimated, and that a dominant nodule in MNG should be valued as if it were a solitary nodule in an otherwise normal gland.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

[Endemic goiter epidemiological study of prevalence in Oleiros].

This research was carried out in the county of Oleiros, which integrates the only defined endemic goiter zone in Portugal, since 1969. We intend to characterize, from the epidemiological point of view, the prevalence of the endemic goiter by the observation of all students (N=699) and by the determination of the iodine urinary excretion in a sample of them (n=43). The prevalence value was of 27.5% (192 in 699), corresponding to 21.6% and to 5.9%, respectively for the total cases of degree 1A and degrees 1B and 2. No cases of degree 3 were found. Prevalence was of 36.4% (116 in 319) for females, and 20% (76 in 380) for males (proportion of about 2:1). The iodine urinary excretions presented 20% of the values out of the normal limits, and about 10% of them below minimum. These results allow us to classify the region as one of low to moderate endemic severity. However, in order to eradicate, among us, the endemic goiter, it is essential to proceed with the prophylactic program.

Adolescent↗
PubMed2005

[Multinodular goiters].

The incidence of multinodular goiters (MNG) differs according to the countries, and seems to be widely dependent of the iodine status. In France, the SU.VI.MAX study indicates that 4.75% of the active population is suffering from MNG, this incidence is increased with gender and age. The role of genetic factors is estimated as being around 80%. The remaining 20% are related to environmental factors, some of them being still unknown. Admit these external factors, the iodine deficiency is predominant and should be theoretically easy to avoid. Most of MNG develop on diffuse goiters and could be prevented when these underlying lesions are treated early by the administration of thyroid hormone alone or associated with iodide potassium. Once the nodularity of the thyroid tissue is present, the medical treatment is of weak efficacy, it usually stabilises the goiter and prevents the occurrence of new nodules. The two main treatments are surgery and radioactive iodine, the latter is currently used not only when the former is contra-indicated. In some countries, radioactive iodine is considered as the best alternative in the majority of cases.

France↗
PubMedDate not supplied

Management of retrosternal goiters: experience of a surgical unit.

The aim of this study was to retrospectively analyze 5 years' experience of cervico-mediastinal goiters (CMG) management. Twenty-five patients with cervico-mediastinal goiters underwent surgery between January 1998 and December 2002. The group consisted of 16 females and 9 males (mean age, 48.2 years; range, 42-74 years). A total thyroidectomy under general anesthesia was always performed. A no. 7 Fogarty catheter with a 5-ml balloon was employed in the seven last cases to lift the retrosternal portion of the goiter into the neck. The mean postoperative stay was 3 days (range, 1-7 days), and the mean follow-up time was 29 months (range, 1-58 months). There were no postoperative deaths; overall morbidity rate was 28.0%. One patient with a severe life-threatening hematoma required surgical re-exploration. Surgery for CMGs shows a low morbidity rate; total thyroidectomy is the treatment of choice to prevent recurrences or re-surgery for malignancy.

Adult↗
PubMedDate not supplied

Prevalence of goiter and urinary iodine status of 7-11-year-old children in Malatya province, Turkey.

Goiter prevalence and urinary iodine excretion levels were assessed in 568 schoolchildren (317 boys and 251 girls), aged 7-11 years, living in the Malatya province, a well-known endemic goiter area in Turkey. Five hundred sixty-eight children aged 7-11 years consented to thyroid gland palpation and provided a urine sample on the day of examination in April 2004. Median urinary iodine concentration for the total group was 66 microg/L. There was an association between presence of goiter or not and urinary iodine levels (67 microg/L versus 62 microg/L, p=0.000). The median urinary iodine concentration was lower in rural areas than in urban areas (54.6 microg/L versus 59.7 microg/L, respectively) and schoolchildren living in rural areas had significantly lower urinary iodine levels (p=0.000). In conclusion, the present study reports mild iodine deficiency in the Malatya province, despite a mandatory iodization program in Turkey which has been in force since 1998.

Child↗
PubMedDate not supplied

[Recent findings on the etiopathogenesis of multinodular goiter. I. Immunoglobulin stimulation of thyroid growth].

This present review of the literature deals with the possible autoimmune genesis of the multinodular goiter. Some investigators have identified an immunoglobulin stimulating specifically the growth of the thyroid gland (TGI) in the sera of patients affected with sporadic goiter, quite different from TSI, involved in Graves' disease. Other authors report divergent results; however there are many methological differences in these studies that give rise to controversies about the evaluation of the data. At present, these studies have failed to demonstrate consistently an autoimmune genesis of multinodular goiter.

Autoantibodies↗
PubMed2006

Thyroidectomy for substernal goiter via a mediastinoscopic approach.

We report an unusual case in which a patient presented with a large posterior mediastinal goiter that extended to the level of the aorta. The goiter was resected through a standard Kocher neck incision with mediastinoscopic assistance. The large goiter was completely excised without the need for a sternotomy.

Goiter, Substernal↗
PubMedDate not supplied

[A case of primitive amyloid goiter].

Amyloid goiter is a rare pathology due to massive amyloid infiltration of thyroid tissue, which cause diffuse or localized enlargement of the gland. It can be totally asymptomatic or cause only non-specific symptoms (compression of adjacent structures, tracheal deviation). Thyroid disfunction (hypothyroidism or hyperthyroidism) is rare. It is important to differentiate primitive amyloid goiter from other kinds of amyloid infiltration of the thyroid, such as in systemic amyloidosis. The correct diagnosis can be difficult because of the common presence of amyloid in thyroid neoplasms, such as medullary thyroid carcinoma (MTC). The Authors present a case of primitive amyloid goiter, that needed immunohistochemical analysis for a correct diagnosis, and a review of the concerning literature.

Aged↗
PubMed1991

Discordant hypothyroxinemia and hypertriiodothyroninemia in treated patients with hyperthyroid Graves' disease and toxic multinodular goiter.

Hypothyroxinemia and hypertriiodothyroninemia may occur in the course of antithyroid drug or 131I treatment for hyperthyroid Graves' disease and toxic multinodular goiter. To determine the frequency of this discordance, we reviewed 62 patients with hyperthyroidism. Among 41 Graves' disease patients treated with antithyroid drugs and/or 131I, discordant serum triiodothyronine (T3) and thyroxine (T4) levels occurred in 26.8%. Of these patients 72.8% had a high serum T3 level associated with a normal serum T4 level, whereas in 27.2% a high serum T3 level was associated with a low serum T4 level. Among 21 toxic multinodular goiter patients, 14.3% had discordant T3 and T4 levels. We conclude that discordance of serum T4 and T3 concentrations is frequently encountered in patients with hyperthyroid Graves' disease and less frequently in toxic multinodular goiter during or after therapy.

Adult↗