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PubMed1980

[The problem of cancer diagnosis in thyroid nodules: a study in an endemic area for goiter in North Sardinia].

In a 5-year prospective study in an endemic area for goiter, 275 patients with solitary thyroid nodules or with predominant nodules in multinodular goiters underwent surgery without selection on clinical grounds. The incidence of cancer was 13.1%. Preoperative diagnosis was based on personal history, local signs and radioisotope data. As compared with histologic findings, clinical and scanning data yielded a diagnostic accuracy of 19% and 31% respectively. 30% of all malignancies were not suspected preoperatively. 100% identification of cancer is possible only it all nodules are excised. Selection is, however, necessary: our data suggested that patients under 20 and over 50 years, all males, and goiters with more than 2 physical and/or scanning signs suspect for cancer should be operated upon. Much unnecessary surgery would be save and most, but not all, cancers would be excised.

Adolescent↗
PubMedDate not supplied

[Posterior (retrovascular) mediastinocervical goiters].

Three cases are presented of endo-thoracic goiters with posterior, retro-vascular developement, a very rare variety of the mediastino-cervical goiter. The anatomic pathways are described, along which this variety of goiter can migrate inside the thorax, as well as the radiologic signs which allow to make a diagnosis. In view of making a choice of the access route the importance of the diagnosis is particularly stressed, before surgery is attempted. It is also demonstrated that the best route is the vertical cervicosternotomy of the partial type (the Welti technique), completed by antero-lateral thoracotomy in the III-rd right intercostal space.

Adult↗
PubMed1994

Bone metabolism in premenopausal women with nontoxic goiter and reduced serum thyrotropin levels.

OBJECTIVE: To study whether premenopausal women with nontoxic goiter, but reduced serum TSH as a sign of spontaneous subclinical hyperthyroidism have decreased bone mass or other indications of increased bone turnover. DESIGN AND SUBJECTS: In a cross-sectional study, bone mass measurements were performed in the distal forearm and the lumbar spine in 11 premenopausal women with nontoxic goiter and a stable reduction in serum TSH (median (range) 8 months (6-108 months)), and in 22 matched controls. In a longitudinal study, measurements were repeated every 3 months for a maximum period of 2 years in 9 of the patients (6 completed 9 months, 4 completed 2 years follow-up). RESULTS: Serum TSH in the patients were (median (range)) 0.025 mU/l (< 0.005-0.256 mU/l). Patients had a bone mineral content of the distal forearm and a bone mineral density of the lumbar spine similar to those of controls, medians of controls: 98.4% and 93.8%, respectively. The risk of a type 2 error for over-looking a 10% difference was 2% for the distal forearm and 20% for the spine. TSH correlated negatively with marginal significance (p < 0.10) with markers of bone turnover: plasma osteocalcin, serum alkaline phosphatase, and fasting urinary hydroxyproline corrected for creatinine, although all patients had absolute values of these parameters within normal range. During follow-up bone mass measurements did not tend to decrease, but serum alkaline phosphatase and fasting urinary hydroxyproline showed increasing trends (p < 0.05). CONCLUSIONS: Premenopausal women with nontoxic goiter and reduced serum TSH do not seem to have reduced bone mass but seem to demonstrate signs of increased bone turnover.

Adult↗
PubMedDate not supplied

Comparison between computed tomography and magnetic resonance data and pathologic findings in substernal goiters.

Computed Tomography (CT) and Magnetic Resonance (MR) permit the acquirement of important diagnostic elements for the anatomo-topographic staging of substernal goiters, and for their characterization. The authors compared data obtained by CT and MR with intraoperative anatomo-topographic findings and definitive histology in 28 patients with substernal goiters. CT was performed in all these patients while MR only in 9. The results obtained showed an accuracy of 85.7% for CT and 100% for MR regarding the anatomo-topographic correspondence with intraoperative findings, without a significant statistical difference between these two diagnostic procedures. MR is more accurate than CT in showing the vascular dislocations. CT and MR have an accuracy of 82.1% and 77.7% respectively comparing their findings with histologic results obtained in operative specimens, without a significant statistical difference. In conclusion MR has to be considered the more accurate diagnostic procedure and therefore recommended in the study of patients with substernal goiters, while CT can be performed only in selected patients.

Adult↗
PubMed1994

[Substernal goiter: diagnostic and therapeutic problems (apropos of a personal series of 585 interventions)].

This retrospective study is based on a personal experience of 585 operations performed between 1958 and 1993. The diagnosis and topographic evaluation of the thoracic extension of a goiter were greatly improved by the development of the new imaging technics (CT Scan and RMN). Those rather expansive and complex technics were not necessary in 505 cases (86.3%), the diagnosis and topographic evaluation being easy from the conventional tests (X-ray, echography, scintigraphy). But in 80 cas (13.7%) either the diagnosis or the topographic evaluation were difficult or mistaken because Scan or RMN were not yet available or were not used (20 thoracic extensions overlooked; 26 separated thoracic goiters; 24 crossed thoracic extensions; 5 massive degeneration of thoracic extension; 5 false thoracic extension simulated by a mediastinal tumor). The surgical ablation of the substernal goiter could be achieved through a simple cervical approach in 96.4% of the operations. In 21 cases it appeared necessary to prolong the cervicomy by a median sternotomy (total and extrapleural sternotomy in all cases). The transternal approach was imposed in 9 cases by a profound and voluminous thoracic extension in contrast with a small cervical thyroid. In 5 cases, the reason was a massive malignant degeneration of the thoracic extension. In 7 patients the operation was done for a mediastinal redux after a previous cervical thyroidectomy having overlooked the thoracic extension. In spite of all the difficulties, all operations were successful with no mortality and a low morbidity (although slightly higher than the overall morbidity of thyroid surgery).

Goiter, Substernal↗
PubMedDate not supplied

[Computed tomographic diagnosis of substernal goiter].

The authors analyze the results of computer-aided tomographic (CAT) diagnosis in 25 patients with restrosternal goiter. They claim that CAT is a method of choice in the preoperative diagnosis of retrosternal goiter, permitting the solution of a problem on the volume of surgical intervention and of the type of anesthesia. CAT helps specify the site, size, and dissemination of goiter beyond the sternum and assess its relations with the adjacent organs and tissues.

Adult↗
PubMedDate not supplied

Age-related changes in the size of thyrocyte nuclei in aspirates from nontoxic nodular goiter.

It is believed that the size of thyrocyte nuclei correlates with the age of the patient in both normal thyroid tissue and nodular goiter. Therefore, we examined karyometric parameters in aspirates obtained from 38 patients ranging from 18 to 79 years (48.8 +/- 15.2, mean +/- SD). Routine cytologic evaluation revealed nodular goiters in all the patients. Subsequently, the same smears were analyzed with a computer system for karyometric measurements. The mean volume, intersection area and perimeter of nuclei of thyrocytes from nodular goiters correlated positively with age. The results suggest that the age of the patient should be considered when interpreting thyrocyte nuclear size during cytologic examination.

Adult↗
PubMed1993

Goiter incidence and urinary iodine excretion in children of age group 6-13 years living in south-eastern Poland (Kraków coordinating center).

The study included 4103 school children attending randomly selected schools localized in towns and villages of 3 geographically distinct regions: mountainous, (Carpathian endemia), upland, lowland. The children were divided into four age-related groups. The incidence of goiter as detected by palpation was 38.1% in all the children studied, the value being similar in all three regions (38.1, 37.3 and 38.6%, respectively). Goiter incidence differs slightly among urban and rural children, amounting to 40.5 and 34.5%, respectively, in the two groups. In about 60% of children urinary iodine excretion was lower than 50 micrograms/l, while in about 30% it was normal. In about 10% of children studied urinary iodine excretion was lower than 20 micrograms/l. The results obtained indicate the occurrence among children of the studied region of goiter endemy of moderate degree. It was found that the percentage of children excreting more than 50 micrograms/l of urinary iodine was higher among those consuming iodized salt as compared to those consuming non-iodized salt. The first effects of resumption of common salt fortification with iodide in southern Poland can already be noted. There is, however, a need for optimization and steady control over this prophylactic action.

Adolescent↗
PubMed1993

Goiter incidence in region of Katowice in relation to iodine deficiency and iodine prophylaxis (Katowice coordinating center).

Geographical region of Katowice is situated in an upland built of carbonate rocks, often with predominance of loss. A randomized trial was carried out in the urban population of this area. 1080 children aged 7-13 were examined. In 505 urine iodine was measured. 17.5% of the examined children had enlarged thyroid glands (Ib, II, III) in palpation, 82.3% did not have goiter (O, Ia). Interviews with patients revealed that 48.8% of the examined children used iodized salt, while 51.2% did not. Mean urine iodine concentration was 70.6 micrograms/l. No correlation between use of iodized salt, urine iodine concentration, and goiter was found. However, prevalence of goiter and low urine concentration suggested deficiency of this microelement in the examined industrial region. Therefore there is need for further investigations and for a profound change of the existing ineffective iodine prophylaxis.

Adolescent↗
PubMed1993

Iodized salt consumption, urinary iodine concentration and prevalence of goiter in children from four districts of north-western Poland (Szczecin coordinating center).

The study was aimed at evaluation of iodized salt consumption, urinary iodine concentration and incidence of goiter in children from four districts of north-western Poland: Szczecin, Koszalin, Słupsk and Gorzów Wlkp. The study was a part of the national programme: "Investigations of iodine deficite and iodine prophylaxis in Poland". The investigations were performed in ten schools randomly selected by Coordinating Centre in Kraków. Altogether 1793 children attending these schools (838 boys and 955 girls) of age between 6 ad 13 years, living in the cities and villages of coastal and lowland region were studied. The examination included interview in the form of a standard questionnaire, physical examination of the thyroid according to the WHO criteria, ultrasonographic evaluation of thyroid volume and determination of iodine concentration in single urine specimen. It appeared that only 11.2% of children used to consume iodized salt. Mean iodine concentration in urine was 76.2 micrograms/l both in children consuming and not consuming iodized salt, indicating dietary iodine deficiency. The incidence of goiter in country population of children (12.9%), indicated that the region of north-western Poland should be considered as an area of mild goiter endemy. These results suggest a need for iodine supplementation of edible salt in this region of Poland.

Adolescent↗
PubMed1993

Urine iodine concentration and prevalence of goiter among rural women of child bearing ages in Northeast Thailand.

Iodine deficiency was investigated in 575 women from 12 villages of Pupaman, Si Chomphu and Amphoe Chum Phae in Khon Kaen province in a project survey under Thai-German cooperation entitled "Promotion of Health and Nutrition Status of Rural Women in Northeast Thailand". The prevalence of goiter (grades 1A, 1B, 2 and 3) were 71.6 per cent in Pupaman, 58.4 per cent in Amphoe Si Chomphu and 35.1 per cent in Amphoe Chum Phae. However, the percentage of urine iodine deficiency of the women from these districts, is reversely with the palpation grading of thyroid gland. The high prevalence of goiter in Pupaman might occur due to goitrogenic effects, although the urine iodine concentration was lower than other districts. Further study about the determination of thiocyanate should be suggested in the high prevalence of goiter.

Adolescent↗
PubMed1994

[Hypothyroidism and simple goiter in pregnancy].

The incidence of hypothyroidism during pregnancy is 2.5%. Failure to diagnose the problem causes serious complications both to the mater and to the fetus. This pathological condition is verified on the basis of clinical analysis and above all in the laboratory. Autoimmunity is frequently the cause of hypothyroidism whereas this condition is rarely provoked as a result of surgery and therapy with I131. Pregnancy causes a definite deterioration of a pre-existing euthyroid goiter, so as it requires a careful monitoring of woman at risk. If the goiter is found to be neoplastic, its histotype and size must be studied carefully in order to provide for surgery. Therapy with L-thyroxine is essential to avoid damage to both mater and fetus and to monitor the glandular growth in the euthyroid goiter.

Female↗
PubMedDate not supplied

[Fine needle puncture biopsy and methods to image the thyroid gland in the diagnosis of nodular goiter].

A retrospective analysis of the findings of fine needle puncture biopsy of the thyroid in 256 patients operated on for nodular goiter is presented. Cytologic findings coincided with the histologic in 84.8% of cases. The coincidences were the most frequent in (multiple) nodular colloid goiter and thyroid cysts (95.7 = 100%) and the least so in solitary adenoma (65.4%) predominantly of a follicular structure. In thyroid cancer the data correlated in 75% of cases. The presence of cystous changes in adenoma made the investigation less informative. Findings of ultrasonic examination of the thyroid coincided with operative findings in 87.5% of patients with (multiple) nodular goiter and in 86.1% of those with adenomas. Ultrasonography as a method for thyroid imaging is preferable to scintigraphy (scanning) and is an optimal supplement to puncture biopsy of the thyroid.

Adenoma↗
PubMed1993

Reevaluation of the results of iodine prophylaxis in eradication of endemic goiter in Macedonia.

In order to reevaluate effectiveness of iodine prophylaxis in Macedonia, epidemiological, ultrasonographic studies and estimation of urine excretion were performed. The results from the epidemiological survey in nongoitrogenic regions demonstrated goiter between 12.8% and 18%. Much higher prevalence of goiter was found in goitrogenic regions, between 20.8% and 60.8%. The incidence of goiter increased with age, and its prevalence is higher in girls when compared with the boys of the same age group. The thyroid volume estimated by ultrasonography was higher in children from goitrogenic regions when compared to nongoitrogenic. There was a good correlation between ultrasonographic volumetry data and size of the thyroid estimated by palpation. Urinary iodine excretion demonstrated low values in children from goitrogenic regions as indicator of iodine deficiency.

Adolescent↗
PubMedDate not supplied

[Biological aspects of endemic goiter in the Pyrennes Atlantiques (author's transl)].

In an endemical goiterous area (Oloron Sainte-Marie 64, France) a thyroid investigation has been realised on a certain number of people having a goiter (G) and those without goiter (N.G.). Various explorations such as T4 D, R T3 U, TSH RIA, T3 RIA. Achilles' Reflex, cholesterol have shown no significant difference nor any abnormality inspite of a global deficit in iodine (35 ng/24 h). It can only be retained an absence in negative corelation T3 TSH (P less than 0.05).

Achilles Tendon↗
PubMedDate not supplied

[Goiter surgery].

In the course of 26 years at the 3o Surgical Department of University of Rome "La Sapienza" 6,009 patients with thyroid diseases were operated on since 1970 through September 1995. There were 3,473 goiters and in 373 of them a carcinoma was found. The great majority of patients with goiter was treated by subtotal thyroidectomy. Total thyroidectomy was performed in the 373 patients with thyroid cancer and in diffuse nodular goiters interesting the whole gland. No perioperative mortality is reported. No recurrent laryngeal nerve iatrogenic palsy was observed. The incidence of temporary hypoparthyroidism had a percentage of 10% after total thyroidectomy and of 0.1% after unilateral lobectomy plus istmectomy or bilateral subtotal resections.

Goiter↗
PubMed1996

[Iodine in school children. Relationship with incidence of goiter, socioeconomic group and salt intake].

In order to evaluate iodine daily intake in 5-14 year-old school children urinary iodine excretion was measured in morning urinary samples of 134 school children. This value was corrected to microgram/ 24 h according to Jolin and Escobar del Rey's formula. Thyroid size was evaluated by two expert examiners following WHO criteria. Coincidence between both examiners was indispensable to establish goiter diagnosis. We evaluated urinary samples of 134 school children (117 normal and 17 goitrous). Urinary iodine excretion mean values were significantly different between Normal: 140.04 +/- 86.28 micrograms/24 h and Goitrous: 98.24 +/- 47.91 micrograms 24 h; p < 0.005). Goiter prevalence was found to diminish significantly when urinary iodine excretion was greater than 150 micrograms/24 h (p < 0.05). Similar mean urinary iodine excretion was observed in different socioeconomic groups. No significant differences were detected in the evaluation of two most common salt trademark consumer groups. In conclusion 1) iodoprophylaxis efficacy was assessed by urinary iodine excretion, a valid means to estimate iodine intake. Acceptable mean levels of iodine intake were found in the group under study, but the individual variability was important; 2) goitrous schoolchildren showed an iodine intake lower than normal and 3) the important variability observed in the evaluated data, the assessed relation between goiter and lower iodine intake, and the high frequency of insufficient iodine intake should justify a better control of iodoprophylaxis and a more widespread information dissemination among the population and perhaps iodine supplements in specific groups.

Adolescent↗
PubMed1997

[Results of reoperations for goiter].

We report 47 reoperations for benign thyroid goiters between February 1994 and October 1995 out of a total of 1125 thyroidectomies. These operations concerned 42 women and 5 men with an average age of 54 years. The mean time between the 2 operations was 19 years. On 45 occasions, the reoperation included a totalisation of the previous partial thyroidectomy. In 2 cases a near total thyroidectomy was performed leaving a minimal thyroid remnent on one side. The mean weight of the resected gland was 73 grs. The morbidity included 2 temporary recurrent laryngeal nerve palsies resolving within 2 months and 7 cases of temporary hypocalcemia without permanent hypocalcemia. In the case of repeated surgery, the risks of recurrent laryngeal nerve damage and parathyroid gland resection are typically increased. The risk varies according to the initial surgical resection: unilateral lobectomy versus bilateral subtotal lobectomy. Surgical risks can be significantly decreased with a safe surgical technique. Indications for reoperations in case of benign thyroid goiter are rare and can probably still be reduced. Treatment with thyroxin is sometimes ineffective and is questionable after sub total thyroidectomy for nodular goiter. A primary total thyroidectomy can be indicated in such selected cases.

Female↗