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PubMedDate not supplied

Fine needle aspiration cytology and immunocytochemistry in a case of intrathoracic thyroid goiter.

Fine needle aspiration (FNA) was performed in the case of a patient with an anterior mediastinal mass. Examination of the smears revealed individual and groups of benign nondiagnostic cells. Surgical removal and histologic examination indicated that the mass was a true intrathoracic thyroid goiter. Subsequent immunocytochemical studies on the FNA smears showed thyroglobulin in the cytoplasm of the aspirated cells. The cytologic findings are presented; while not diagnostic of a thyroidal origin in this case, they serve as a reminder of the wide range of cytologic appearances of colloid nodules and goiters. This case will hopefully heighten the awareness of cytologists and other physicians to the consideration of the possibility of intrathoracic goiter in the differential diagnosis of mediastinal lesions seen in fine needle aspirates.

Biopsy, Needle↗
PubMedDate not supplied

Prevalence of endemic goiter in Mureş County.

A number of 20,000 children representing 91.19% of all the enlisted children aged 6-14 years were examined. The clinical status of each child was assessed according to the WHO criteria. Goiter was found in 3,363 (16.81%) children. Of these, 1504 (44.72%) were boys and the zero degree, 2,137 (63.54%) to the 1 degree and 84 (2.49%) to the 2nd degree. As related to the total number of children examined, the zero degree goiter was found in 5.71%, the ist degree in 10.68% and the 2nd degree in 0.42% of the cases. The incidence of goiter in rural and urban areas was in the range of 6.80%-38.46%. Only in 2 areas the incidence was higher: 42.33% and 60%. A predominantly increased incidence was found in those areas which were not screened in 1951 and consequently prophylaxis was not constantly applied.

Adolescent↗
PubMedDate not supplied

[Unusual clinical and therapeutic aspects of intrathoracic goiter].

Out of the 220 cases of goiters operated in the clinic 19 were partially or totally intra-thoracic, as follows: --totally intra-thoracic: 7 cases; --partially intra-thoracic: 12 cases, of which: mediastino-cervical: 2 cases; cervico-mediastinal: 10 cases. Five of the totally intra-thoracic goiters were in the anterior mediastinum, while two were in the posterior mediastinum, in a retro-oesophageal position. Three of the 19 intra-thoracic goiters were malignant. The symptomatology, the diagnosis and especially the therapeutical attitude are discussed.

Adult↗
PubMed1978

[Unrecognized hyperthyroidism in hospital patients. Analysis of clinical symptoms compared to aged euthyroid goiter patients].

During a 14-month period hyperthyroidism has been diagnosed in 39 of 2916 inpatients of a general medical service. Graves' disease was present in only 8 cases. 21 patients had solitary autonomous nodules or multiple autonomous nodules (toxic multinodular goiter). In 10 patients the type of hyperthyroidism could not be established. The referring practitioner suspected hyperthyroidism in all 8 patients with Graves' disease, but in only 5 of the 31 remaining cases. The relative rarity of Graves' disease in inpatients reflects the fact that this form of hyperthyroidism is easily recognized by the practitioner and treated on an out-patient basis. Graves' disease patients and those with autonomous solitary or multiple nodules were of comparable age and had an identical serum free-thyroxin. Thus, neither higher age nor lower thyroxin is responsible for the atypical clinical presentation of autonomous nodules. A comparison with age- and sex-matched carriers of euthyroid goiters identified weight loss, resting pulse rate over 90 and auricular fibrillation as reliable clinical features. A thyroid function test is therefore indicated in every patient with a goiter and one of the three above clinical findings.

Adenoma↗
PubMedDate not supplied

[Thyroid tissue link of hemostasis in diffuse toxic and euthyroid goiter].

Blood coagulation system and fibrinolysis factors contained in the thyroid gland tissue of patients with diffuse toxic and euthyroid goiter and also of apparently healthy persons were investigated. The thyroid gland of healthy persons was shown to possess thromboplastin, antithrombin, anticoagulant, antiheparin, and fibrinolytic properties and to contain plasminogen, plasminogen activators, antiplasmins. The function of the external hemocoagulation system was reduced due to diminished thromboplastin and antiheparin activity of the gland tissue, reduction of aggregation and increase of disaggregation properties of the gland tissue. External blood coagulation system was undisturbed in patients with euthyroid gland. Local fibrinolysis was enhanced in patients with diffuse toxic goiter on account of increase in the thyroid gland of plasminogen activators, reduction of antiplasmin activity, and increase of the nonenzymatic fibrinolysis activity. Analogous changes in local fibrinolysis occurred in patients with euthyroid goiter.

Adolescent↗
PubMed1979

Anticomplementary activity in diffuse and nodular goiters.

The occurrence of anticomplementary activity and its correlation to serum thyroglobulin was investigated in 71 patients with thyroid diseases and 63 age and sex matched control subjects. The patients which were subgrouped according to thyroid function and characteristics of the goiter, were examined at the time of diagnosis. The anticomplementary activity was measured by a complement consumption (CC) assay. Sera from patients with Graves' disease and nontoxic diffuse goiter, showed stronger activity than sera from patients with nontoxic goiter. Seventeen of the patients and one of the controls were positive in the CC-assay. The percentage hemoglobin release in this assay was normally distributed using control sera but not for the patient group. There was no correlation either between CC-activity and serum concentrations of thyroglobulin or CC-activity and antibodies to the O-antigen of Yersinia enterocolitica serotype 3, thyroid cytoplasma, thyroglobulin, nuclear factors, streptolysin O, streptococ hyaluronidase, and parietal cells, respectively. However, correlation between the levels of thyroid stimulating immunoglobulins and CC-activity, was noted (Rho = 0.511, P less than 0.05), which suggests that these immunoglobulins also are present as immune complexes. Thyroglobulin--antithyroglobulin complexes preformed in vitro at high thyroglobulin concentration, gave negative results in the CC-assay.

Adult↗
PubMed1983

TSH secretion and regulation in endemic goiter and endemic cretinism.

In endemic goiter patients living in a chronic iodide deficiency area (less than 50ug/day) TSH basal levels and the TSH response to TRH is significantly higher (31 +/- 8uU/ml) than in normal controls (10 +/- 4uU/ml). There is a negative correlation between levels of iodine intake and serum TSH concentration and thyrotropin is thus increased when iodine decreased. Also it was shown that serum TSH levels correlate inversely with the serum concentration of T4 (r=0.69) but not with the usually normal or elevated serum concentration of T3 in endemic goiter patients. It has been postulated that in the absence of appropriate serum levels of T4 the pituitary thyrotrophs have an abnormally low T4 to T3 conversion and the pituitary-nuclear/serum T3 ratio does not increase sufficiently to compensate this phenomenon. On the other hand nuclear receptor saturation of T3 in tissues such as liver and kidney would remain at euthyroid levels due to the higher serum T3 concentrations. Endemic goiter patients when moving to an urban area where iodine intake is higher (greater than 150ug/day) than in the rural villages, had a blunted TSH response to TRH (15/23 subjects) or developed a mild clinical and laboratory picture of hyperthyroidism (7/23 individuals). Serum TSH levels and the TSH response to TRH is abnormally elevated in the myxedematous type of endemic cretinism but more than one third of the neurological goitrous cretins (euthyroid) have an exaggerated and sustained TSH response to TRH. This has been considered as a decreased thyroid reserve. Measurement of alpha subunits and TSH-beta in both types of endemic cretinism demonstrated that although these patients have a marked enlargement of the sella turcica the alpha subunits, although higher than normal (1.7-3.4 ng/ml) were not suggestive of a pituitary tumour. The pituitary enlargement was probably secondary to the long standing untreated thyroid failure.

Adult↗
PubMed1980

[Atherosclerosis of the major vessels of the neck and circle of Willis in different forms of endemic goiter (in the Fergana Valley)].

The age dynamics of the atherosclerotic process in the major arteries of the neck and the Willisian circle was examined morphometrically in 330 subjects with diverse morphofunctional states of the thyroid. It was found that in patients with endemic goiter characterized by hyperthyroidism, the speed of the atherosclerotic process development was slowed down; the process took a milder course with prevalence of lipoidosis. In patients with the endemic goiter characterized by hypothyroidism, the atherosclerotic process in all the arteries examined was found to develop at a faster rate, with prevalence of grave complicated forms. Complicated affections and calcinosis of the Willisian circle vessels were prevalent in patients with the hypofunctional forms of endemic goiter.

Adult↗
PubMed1984

Two abnormal thyroglobulin-like polypeptides are produced from Afrikander cattle congenital goiter mRNA.

In vitro translation of the mRNA from the congenital goiter tissue of Afrikander cattle directs the synthesis of two (Mr congruent to 250,000 and congruent to 75,000, respectively) abnormal thyroglobulin-like polypeptides. Common features of these polypeptides are the following: 1) both are immunoprecipitated by purified, anti-thyroglobulin antibody; 2) the signal sequence is present on their nascent polypeptide chains, and 3) their synthesis is apparently directed by the same high molecular weight mRNA. However, the goiter thyroglobulin mRNA shows, by Northern blot analysis, a slightly reduced size (congruent to 30 S) as compared to the mRNA from normal, bovine, thyroid tissue (33 S). Furthermore, a 10- to 15-fold decrease (as assessed by dot blot hybridization) in relative mRNA concentration was observed. Thus, it can be concluded that the genetic defect in congenital goiter of Afrikander cattle results in the synthesis of an altered mRNA which is present in decreased amount and directs the synthesis of two abnormal thyroglobulin-like polypeptides.

Animals↗
PubMed1984

[Therapeutic results in hyperthyroid patients from the Bern endemic goiter region].

Among 239 hyperthyroid patients from the Bernese endemic goiter area referred to specialist, 66% were found to have Graves' disease (MB), 12% hyperthyroid autonomous adenoma ( AAH ) and 22% multinodular toxic goiter (HK). 189 (79%) of these 239 patients have been followed up 5.4 +/- 3.8 years after the last treatment. At the time of follow-up, 146 patients (77%) were euthyroid without additional treatment. 97 of these (51%) became euthyroid after a single, initial treatment (41% of the MB, 83% of the AAH and 67% of the HK). 68 patients (36%) developed recurrences, in some cases several (48% of the MB, 4% of the AAH and 15% of the HK). These recurrences occurred in 56% of cases treated with carbimazole, in 19% of the thyroidectomies and in 11% of the radioiodine treated cases. 30% of the recurrences occurred two or more years after the last treatment. At the time of follow-up, 40 patients (21%) were found to be hypothyroid (23% of the MB, 13% of the AAH and 21% of the HK). However, only 20 of these patients had been treated properly with 1-thyroxin; the other 20 were either insufficiently treated or not at all. Hypothyroidism has been observed in 27 (25%) patients after thyroidectomy and in 13% (23%) patients after radioiodine. No complications were recorded after radioiodine or under carbimazole treatment. After surgery, 2.8% of the patients had recurrent nerve palsy and 2.8% permanent hypoparathyroidism. The present data are in accordance with those published from outside the goiter areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1978

[Study of thyroxine synthesis in non-toxic goiters using dispersed thyroid cells (author's transl)].

The ability of thyroid tissue from non-toxic goiter to synthesis thyroid hormones was investigated by measuring 131 I-iodide incorporation in T4 in dispersed thyroid cell system. Dispersed thyroid cells were prepared by trypsinization from 5 pathological and 2 Normal thyroid specimens. The patients with non-toxic goiter were euthyroid or in mild hypothyroidism. The capacity of T4 synthesis was decreased in 4 cases and increased in 1 as compared to that of normal thyroid tissue. In one case, the impairement of T4 synthesis seemed to be related to the presence of thyralbumin as the major thyroid iodoprotein. In the 3 other cases with a decreased T4 synthesis, a good correlation was found between the capacity of T4 synthesis in dispersed thyroid cells and the thyroid activity in vivo (6 hr - 132 I-uptake). The discrepancy between in vivo and in vitro data in the case showing an increased T4 synthesis could be explained by the difference in the iodide supply in vitro (5 X 10(-8) M) and in vivo (urinary iodide : 2 microgram/24 hr). Thyroid cell preparations may serve as an experimental model to confirm or invalidate the hypothesis of a defect of thyroid hormone synthesis in non-toxic goiters.

Cells, Cultured↗
PubMedDate not supplied

Studies on T and B lymphocytes by the technique of immune and non-immune rosettes and by scanning electron microscopy (SEM) in Graves' disease and nontoxic nodular goiter.

T and B lymphocytes were studied by the rosettes technique (R) and scanning electron microscopy (SEM). Both techniques showed pathogenic changes in Graves' disease and nontoxic nodular goiter patients. In normal subjects, the mean value for T lymphocytes was 63.8% by R and 62.9% by SEM and for B lymphocytes was 39.9% by R and 29.8% by SEM. In Graves' disease the mean value of T lymphocytes was 93.1% by R and 92.8% by SEM whereas B lymphocytes represented 6.6% by R and 11.5% by SEM. In nontoxic nodular goiter, the mean T lymphocytes count was 64.5% by R and 61.5% by SEM, whereas B lymphocytes represented 27.9% by R and 29% by SEM. The increase in T lymphocytes number in Graves' disease confirms the role of cell immunity in its pathogeny unlike nontoxic nodular goiter where this mechanism has not been confirmed.

Adult↗
PubMed1983

Cowden's disease: familial goiter and skin hamartomas. A report of three cases.

Multiple hamartoma syndrome (Cowden's disease) consists of characteristic skin lesions of the face, mucous membranes and distal extremities in association with a variety of benign and malignant internal tumors, especially of the thyroid and breast. We describe a family in which the father, daughter and son were found to have goiter associated with the skin lesions of Cowden's disease. Review of the 40 reported cases of this syndrome indicates that thyroid disease occurs in two thirds of patients with Cowden's disease and most often presents as goiter at an early age. Thyroid cancer has occurred in only three (7.5%) of the patients.Surgical removal of the large goiter of the son showed that it was composed of multiple encapsulated follicular adenomas and a few areas of lymphocytic thyroiditis. Studies of the thyroid tissue showed that peroxidase activity was decreased, the thyroglobulin had a reduced content of thyroxine and triiodothyronine (perhaps due to the therapeutic suppression of thyroid-stimulating hormone) and thyroxine 5'-monodeiodinase was greatly increased; increased outer ring monodeiodinase activity may be a characteristic of human follicular adenomas.

Adenoma↗
PubMed1978

[Scintigraphy and fine needle biopsy in nodular goiter. Results in 548 patients].

The results of scintigraphic and cytological investigations in 548 patients with goiter are presented: In 402 goiters 470 nodes were detected, 385 of which were scintigraphically "cold". 276 solitary nodules were found, 109 in cases of multinodular goiter. Solitary nodules were preferentially located in the right lobe. The cytological diagnosis was confirmed histologically in 88 cases. Out of 24 malignant tumors, 21 were diagnosed correctly by means of cytology. The positive smears and the histological findings were in agreement in 14 of 15 cases. The accuracy of cytological diagnosis in the detection of thyroid malignancies was 87.5%. 12.5% of the smears were false negatives, 1.6% false positives and 10.9% false suspicious. The relative high percentage of false suspicious smears is caused by difficulties in cytologic differentiation of thyroid lesions due to microfollicular structures which are usually only classified as "follicular neoplasia". This cytologic term necessitates an obligatory histologic examination since cytology does not allow to differentiate between follicular adenomas and carcinomas. 5.5% of the histologically ascertained cold nodules were malignant, in 19% of the cases with cold nodes thyroid punction revealed cystic lesions.

Biopsy, Needle↗
PubMed1982

[The TRH test in simple goiter].

The TSH response to TRH and the increase in serum T3 after TRH infusion were measured in 25 euthyroid patients with non toxic goiter. On the ground of anatomic characters we divided the goitrous patients into 3 groups: subjects with diffuse goiter, with multinodular and with uninodular goiter; delta TSH and delta T3 did not differ significantly in the three groups. On the contrary, either absent hormonal increase (preclinic hyperthyroidism), or exceeding response (preclinic hypothyroidism), or normal response (real euthyroidism) were found in the different patients of a same group. Therapeutic implications of such a finding were taken into consideration.

Female↗
PubMed1982

[Focal lymphocytic thyroiditis and iodized salt prophylaxis. Comparative studies on goiter specimens at the Institute of Pathology of Zurich University].

Hashimoto's thyroiditis is rare in endemic goiter areas. Recent investigators, however, claim an overall increase in its occurrence even in goiter areas. According to some reports the rising incidence of focal lymphocytic thyroiditis may be correlated to iodine prophylaxis. Consequently, 675 thyroid specimens were examined for the presence of focal lymphocytic thyroiditis. They had been collected at our Institute of Pathology over two 1-year periods 25 years apart (1954 and 1979), when iodine content in table salt differed considerably. Cursory examination seemed to confirm the original claim, since non-nodular tissue exhibited focal thyroiditis in 20.7% and 31.2% of cases in 1954 and 1979 respectively. Morphometric analysis, however, produced equal results for both years as far as depth of infiltration was concerned. Focal thyroiditis particularly affects non-nodular parenchyma, which was found to take up 1.5 times more area in 1979 than in 1954. Thus, infiltrates located between nodules appear more frequently as routine sections pass through larger areas of non-nodular parenchyma. However, changes in the absolute frequency or extent of focal lymphocytic thyroiditis in goiters under increasing iodine prophylaxis could not be demonstrated.

Adult↗
PubMedDate not supplied

The thyroglobulin variations during the thyroid surgery for polynodular goiter, hyperthyroidism and cancer.

A radioimmunoassay (RIA) double antibody system for human thyroglobulin (Tgl) was developed with a sensitivity of 2.5 ng/ml T3 and T4 did not interfere in the antibody Tgl binding. The blood was collected pre-, intra- and 24 hrs post-thyroidectomy from 50 females and 4 males diagnosed as polynodular goiter, hyperthyroidism, chronic thyroiditis and thyroid cancer. The ratios of the intra- and post-operatory values versus pre-operatory values were calculated. The basal values in the patients having thyroid troubles varied within very large limits (two orders of magnitude) and these values could not be clearly correlated to the thyroid pathology, However, in untreated hyperthyroid patients the basal values exceeded 100 ng/ml, while in medullary carcinoma they were near the sensitivity limit of the technique. The intra-operatory values varied within the percentual area (thyroid carcinoma), multiplicative area (polynodular goiter and some cases of hyperthyroidism) and the order of magnitude area (hyperthyroid patients and some of the polynodular goiters). The value of the RIA measurement of the Tgl in the serum as an adjuvant in the post-treatment follow up of thyroid patients is discussed.

Female↗
PubMedDate not supplied

[Various indicators of the B-system of immunity in endemic goiter].

Blood serum immunoglobulins (Ig) and the circulating antibodies against thyroglobulin, which are known to characterize the state of the immunity B-system, were investigated in 167 patients with endemic goiter and in 80 healthy persons. A significant elevation in the IgM, IgG, and antithyroglobulin antibody levels was observed in patients with hyperthyroid goiter. An increase in the antibody titre to thyroglobulin and in the IgG level was found in euthyroid goiter cases. The extent of functional activity of the thyroid gland and the presence of ophthalmopathy influenced the incidence and the level of the serum Ig elevation and of the antithyroglobulin antibodies increase.

Adolescent↗