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PubMedDate not supplied

[Calcitonin and parathyroid hormone secretion and calcium metabolism in patients with diffuse toxic goiter during treatment with lithium carbonate].

Seventy-six patients (6 males and 70 females) with diffuse toxic goiter, stages I-II, received lithium carbonate as a thyrostatic drug. The drug dose ranged from 900 to 1500 g depending on the degree of the disease clinical symptoms. The treatment with lithium lasted 45 days. Before drug administration and on days 7, 15, 30 and 45 of treatment the content of triiodothyronine (T3), thyroxine (T4) and calcitonin was measured in the thyroid, that of parathyroid hormone (PTH) in the parathyroid gland, and that of thyrotropic hormone (TTH) in the pituitary. The concentration of ionized calcium in the serum, calcium excretion with urine, and tubular calcium reabsorption were measured concurrently. In patients with diffuse toxic goiter treated with lithium, calcium excretion with urine substantially reduced, whereas tubular reabsorption of calcium and phosphates increased. However, serum calcium concentration did not rise, remaining within normal during all the treatment periods. In the author's opinion, this was favoured by two factors: the lithium-induced increase in interstitial calcium absorption on the one hand and compensatory increase in PTH secretion on the other one. The decreased content of thyronines in the hemocirculation (T3, T4), a short-term elevation of TTH and calcitonin elevation in the blood and steady increase in PTH secretion were characteristic features of the time course of the hormonal parameters in patients with toxic goiter treated with lithium.

Adult↗
PubMedDate not supplied

[Free amino acid spectrum and cathepsin activity in the blood serum of patients with diabetes mellitus combined with diffuse toxic goiter].

Clinicobiochemical studies were performed to determine the spectrum of free aminoacids and cathepsin activity in the blood serum of 96 patients with the moderate stage of diabetes mellitus, diffuse toxic goiter, accompanied by normo- or hyperglycemia and in combined pathology: diabetes mellitus and diffuse toxic goiter. Pronounced hyperaminoacidemia in moderate diabetes mellitus, moderate hyperaminoacidemia in diffuse toxic goiter with normo- or hyperglycemia and increased cathepsin activity were revealed. In combined pathology mild thyroid hyperfunction diminished hyperaminoacidemia and cathepsin activity in patient with diabetes mellitus, apparently rendering a positive effect on protein-aminoacid metabolism.

Adolescent↗
PubMed1994

[HLA haplotypes and the predisposition to diffuse toxic goiter].

The results of the family immunogenetic study compared to HLA-typing on the population-genetic level have established a population positive association which was more strong with HLA system regions B and DR (antigens B17, B35, DR5). Haplotype HLA A3, B35, DR5 may be considered as the haplotype of predisposition to diffuse toxic goiter. The strength of the association DT3 with antigens A3, B35, DR5 in the family study was superior to that in the population one. A new association of antigen HLA B44 with family variant of the goiter was revealed as was the fact that the proband's parents carry the predisposition haplotype, the segregation being from the parents to sibs and the proband's children. Registration in the children of the proband of the predisposition haplotype or separate antigens (B17, B35, B44, DR5) suggests the risk of diffuse toxic goiter in the proband's children.

Adolescent↗
PubMed1997

[Does decreased preoperative diagnosis in goiter surgery present special challenges for the surgeon? What stays indispensible? What is superfluous?].

Patient history, clinical examination, basal TSH, and ultrasound are the crucial factors for the indication of surgical treatment of the goiter. In our study, additional scintiscan failed to locate additional nodules found by intraoperative digital examination of the thyroid in 10.3%, and therefore leads to no additional security in determining the extent of thyroid resection (exception: autonomous goiter). Intraoperative inspection and palpation of both thyroid lobes remains the most important factor in preventing goiter recurrence.

Diagnosis, Differential↗
PubMed1985

Comparison of serum angiotensin-converting enzyme in Graves' disease, toxic nodular goiter, and other thyroid conditions.

Angiotensin-converting enzyme (ACE) was measured in plasma of patients with Graves' disease and with toxic nodular goiter, as well as in their treated counterparts and in normal controls. A significant elevation of ACE levels and a positive correlation between ACE, thyroxine, and triiodothyronine levels was found in both groups of thyrotoxicosis. Parallel fluctuations of triiodothyronine and ACE levels, albeit with a certain lag of the latter, was observed in patients in whom multiple measurements were taken. ACE levels, which were also determined in hypothyroid patients and in patients with euthyroid goiter on suppression therapy, were in the same range as normal controls and as in treated thyrotoxic patients. We conclude that the pathogenesis of thyrotoxicosis does not play a role in ACE elevation but that increased thyroid hormone seems to induce elevation of ACE. ACE elevation in thyrotoxicosis may constitute an integral part of the renin-angiotensin axis.

Adolescent↗
PubMedDate not supplied

[Euthyroid goiter in puberty--a harmless illness?].

An investigation was carried out in to thyroid hormones (TSH, T3, T4) and lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride) in 136 adolescents (94 femals, average age 13 years). An iodine deficiency (grade II-II) with respect to the daily urine excretion per 1,73 m2 BSA was found in 75%. With few exceptions the serum levels of TSH and T4 were in the normal range. In 36% of the patients we noticed compensatory elevated T3 levels. Correlations between thyroid hormones TSH, T4, renal iodine excretion and the volume of thyroid glands were not detectable, only T3 showed a dignificant positive correlation to the thyroid gland volume. The average values of lipids in patients were found to be higher than in normals. We consider the changed lipids as a sign of a disturbed efficacy of thyroid hormones. The regional insufficient iodine supply causes goiters and to a high degree the observed hyperchole-sterolemia, too. Our results underline the necessity of a common iodine salt prophylaxis as well as the treatment of "harmless" goiters in puberty.

Adolescent↗
PubMed1986

Unilateral multinodular toxic goiter: scintiscan mimicking solitary toxic nodule.

A 58-year-old man presented with hyperthyroidism. By palpation, the left lobe of the thyroid was diffusely enlarged, and the right lobe was normal. Radioactive iodide scintiscan demonstrated homogeneous uptake that was localized to the enlarged left lobe, with near total suppression of uptake on the right. TSH stimulation led to clear visualization of a normal appearing right lobe, findings most consistent with an autonomously functioning solitary nodule on the left. Left hemithyroidectomy cured the hyperthyroidism. However, no single dominant nodule was found in the left lobe. Rather, there was diffuse thyroidal hyperplasia of the micronodular variety, consistent with multinodular toxic goiter. Thus, in this patient with a usually diffuse form of thyroid disease, the autonomously functioning hyperactive follicles were localized predominantly to one thyroid lobe. This variant expands the clinical spectrum of multinodular toxic goiter, and further emphasizes the extent of asymmetry in the distribution of hyperactive follicles than can occur in this disorder.

Adult↗
PubMed1999

131I therapy of toxic and non-toxic goiters.

For more than 50 years, 131I has been recognized as an effective tool for controlling thyroid hyperplasia and hyperactivity. The fixed dose administration is the simplest method with doses of 111-370 MBq (3 to 10 mCi) 131I being administered. More sophisticated methods aiming to deliver a well-defined amount of 131I per gram of thyroid tissue are handicapped by problems related to the evaluation of the goiter size and the prediction of the sensitivity of thyroid cells to radiation. The use of 131I in nontoxic multinodular goiter is to be reserved for specific situations.

Adenoma↗
PubMedDate not supplied

[Cervico-mediastinal goiter].

We analyzed 824 patients treated by thyroidectomy in our Institute from January 1995 to December 2000. We observed the presence of cervicomediastinal goiter in 117 patients (14.9%), 92.7% of whom presented euthyroidism. Sternotomies were performed in 15 patients (10 midline and 5 hemi-clamshell). On the basis of our own experience and the reports in the literature, we analyse the diagnostic and surgical approach to the therapy of cervicomediastinal goiter.

Diagnosis, Differential↗
PubMed1989

[Surgical treatment of nodular and mixed euthyroid goiter].

The results of surgical treatment of 308 patients with nodular and mixed goiter are analysed. Because of increasing incidence of nodular goiter malignization, the extended resection of the thyroid gland versus the previously used sparing resection is suggested. To prevent activation of thyrotropic function of the pituitary body after the operation, we recommended the use of thyroidin. The incidence of disease recurrence was 1.3%, stable hypothyrosis--1.6%.

Adult↗
PubMed1985

[Tactics in the surgical treatment of nodular formations in the thyroid gland in an endemic goiter region].

The extrafascial method of operation was used because of high risk of malignization of nodular endemic goiters. The extrafascial hemithyroidectomy with an isthmus is considered by the authors to be the major and minimum operation volume in patients with nodular goiters. The method was used in 76,8% of the patients. In patients with thyroid carcinoma the operation of this volume was fulfilled in 66,5% of cases.

Evaluation Studies as Topic↗
PubMed1984

[Goiter surgery in endemic regions].

From 1976 07 01 to 1981 06 30 we performed 882 operations of goiter. It seems to be essential, that the nodular goiter dominates respectively not decreases significantly in spite of iodized salt prophylaxis. An exact preoperative diagnosis and preparation decides about the postoperative success. The postoperative complications are described and analysed. Relating to the recurrence goitre prevention we execute a careful instruction to the GPs and to the patients.

Adenoma↗
PubMed1995

[Cervico-mediastinal goiters. Clinical aspects].

Among 660 cases of thyroid pathology diagnosed by the 2nd Institute of Clinical Surgery, Policlinico San Matteo, IRCCS, Pavia, during the period 1984 to 1993, 34 cases of cervical-mediastinal goiter were observed with an incidence of 5%. After a careful analysis of the main contributions to the study of cervical-mediastinal goiters, paying special attention to their classification, pathogenesis, methods of growth, and unique symptomatic manifestations, the authors focus on current radiological and instrumental studies, which are widely regarded as being useful for the diagnosis of the site and nature of this disease. They review the routes for aggressive surgery and appropriate techniques for the exeresis of the mediastinal mass. Having empasised the absolute indication for surgery the authors recommend quasi-total or total thyroidectomy as the elective form of surgery.

Adolescent↗
PubMed2001

Minimally invasive open parathyroidectomy in an endemic goiter area: a prospective study.

HYPOTHESIS: Single-gland disease identified by preoperative localization studies in combination with rapid intraoperative parathyroid hormone monitoring seems to allow a limited exploration of the neck in sporadic primary hyperparathyroidism. Minimally invasive open parathyroidectomy by lateral approach (oMIP) in sporadic primary hyperparathyroidism seems feasible in an endemic goiter region. DESIGN: One hundred consecutive patients with sporadic primary hyperparathyroidism underwent preoperative double-phase technetium Tc 99m sestamibi scanning with single-photon emission computed tomography and high-resolution ultrasonography with color Doppler imaging of the cervical region. All patients were operated on with the use of quick parathyroid hormone assay to confirm the surgical success "on-line." Patients with localized single-gland disease, irrespective of additional ipsilateral thyroid disease requiring surgery, were selected for oMIP. Success of the preoperative localization studies, postoperative (at least 6 months) serum calcium levels, and operating time were analyzed. SETTING: University hospital, section of endocrine surgery. RESULTS: Of 100 patients, 83 (83%) were considered suitable for oMIP. In 69 patients, oMIP was finished successfully. Nine of these had had previous neck surgery, and another 24 underwent additional ipsilateral thyroid resection. Permanent normocalcemia was achieved in 67 (97.1%) of 69 patients and 98 (98%) of 100 patients. CONCLUSION: The oMIP in combination with quick parathyroid hormone assay may become the treatment of choice for sporadic primary hyperparathyroidism in an endemic goiter region in centers with high experience in thyroid and parathyroid surgery. It allows treatment of concomitant ipsilateral thyroid disease and is feasible in reoperations.

Adolescent↗
PubMed1998

The relative roles of endemic goiter and socioeconomic development status in the prognosis of thyroid carcinoma.

BACKGROUND: It generally is accepted that the prognosis of thyroid carcinoma is more severe in areas in which goiter is endemic. It could be assumed that this prognosis also is less favorable in developing countries. METHODS: Clinical features and tumor histology of 1000 consecutive patients were studied: Patient data from the endemic area (EA) were compared with those from the nonendemic area (NEA). In addition, patients from the years 1966-1981 (P1) were compared with those from 1982-1991 (P2). It is obvious that the country's socioeconomic status and health care system improved between the two periods. RESULTS: The anaplastic and follicular types of thyroid carcinoma were more frequent in EAs (14% and 42.13%, respectively) than in NEAs (6.25% and 38.40%, respectively). The frequency of the anaplastic carcinoma during P1 (16.03%) decreased by half during P2 (7.79%), whereas the frequency of follicular carcinoma remained stable (35.85% and 40.46%, respectively). Clinically, more advanced stages (tumor size, local and distant disseminations) were observed in the study country than in developed countries. A clearcut improvement was observed during P2 whereas differences between the EA and NEAs were few. Survival rates (follicular and papillary types only) were not found to be different between EAs and NEAs (5-year survival: 81.44% and 75.32%, respectively; 10-year survival: 67.93% and 69.52%, respectively). A significant (P < 0.01) increase was observed between P1 and P2 (5-year survival: 72.69% and 84.80%, respectively; 10-year survival: 58.77% and 83%, respectively). CONCLUSIONS: Compared with endemic goiter, low socioeconomic status appeared to be the major factor accountable for the high prevalence of advanced stage cases and anaplastic carcinomas. Iodine deficiency appeared to play a specific role in the increased prevalence of follicular types of thyroid carcinoma.

Adenocarcinoma, Follicular↗
PubMed1993

Multinodular goiter of the thyroid mimicking malignancy: diagnostic pitfalls in fine-needle aspiration biopsy.

A case of multinodular goiter with multicentric papillary hyperplasia is presented with cytologic features suggestive of thyroid papillary carcinoma. While the cytologic criteria for papillary thyroid carcinoma is well defined, occasional diagnostic difficulties can arise. Cytologically, the presence of focal papillary aggregates, the presence of a psammoma body within a background of copious colloid and scattered follicular cells led to diagnostic confusion. Histologically, the presence of secondary follicles in the papillae and protrusion of the papillary structures into colloid lakes supported the diagnosis of goiter. It is our opinion that most, if not all, of these difficulties can be circumvented by the incorporation of all major and some minor cytologic criteria for papillary carcinoma in the analysis of such lesions. Single criteria for papillary carcinoma, either major or minor, is not sufficient.

Aged↗
PubMed2002

Pendred's syndrome with goiter and enlarged vestibular aqueducts diagnosed by PDS gene mutation.

BACKGROUND: Pendred's syndrome (PS) is an autosomal recessive disorder characterized by goiter and congenital sensorineural hearing loss. Recent advances in molecular biology revealed the gene responsible for PS (PDS) and provided an important aid for the diagnosis of this condition. METHODS: A case of PS with huge goiter and congenital hearing impairment was diagnosed by mutational analysis of the PDS gene. RESULTS: Physical examination and computer tomography CT revealed a diffuse swelling of the thyroid gland. Thyroid function tests were normal, and the perchlorate discharge test was negative. Audiologic examination confirmed sensorineural hearing loss, and temporal bone CT revealed bilateral enlarged vestibular aqueducts. The mutational analysis revealed that the patient was homozygous for His 723 Arg (2168A-->G) in exon 19, a missense mutation. CONCLUSIONS: The results of thyroid function tests in PS patients are usually normal, and the positive perchlorate discharge test has been used for the diagnosis. However, this is a nonspecific test and is not sensitive enough for PS. In our case, despite a negative perchlorate test, the patient was diagnosed by mutational analysis and received total thyroidectomy to relieve respiratory distress caused by thyroid enlargement. This is the first report of a mutation detected in the thyroid tissue and clearly shows that the mutation caused histopathologic change in that gland.

Aged↗
PubMed2006

Thyroid MALT lymphoma in patients with a compressive goiter.

BACKGROUND: Mucosa-associated lymphoid tissue (MALT) lymphomas account for less than 1% of all primary thyroid malignancies. They typically arise as neoplastic transformations within areas of autoimmune thyroiditis. Although they tend to have an indolent course, these lymphomas present a diagnostic challenge requiring a high level of suspicion in patients at increased risk of development. METHODS: We retrospectively reviewed 3 cases of primary MALT thyroid lymphoma discovered in patients with a compressive goiter. This represents the experience at a single institution from 1996 to 2005. Hospital and clinic records were reviewed to identify the workup, treatment, and outcome. RESULTS: One of 3 patients underwent preoperative fine-needle aspiration (FNA). All patients underwent total thyroidectomy to relieve compressive symptoms, and the final pathology revealed MALT lymphoma. Two patients subsequently underwent radiation therapy. All patients are alive without evidence of disease recurrence. CONCLUSIONS: These cases are notable for the unexpected presentation of MALT lymphoma within a compressive goiter.

Adult↗