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PubMed2002

Insulin-like growth factor-I and insulin-like growth factor binding protein-3 levels of children living in an iodine- and selenium-deficient endemic goiter area.

Serum insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels were investigated in 31 children living in an endemic goiter area and 33 healthy subjects living in an nonendemic area. Serum IGF-I and IGFBP-3 levels of iodine- and selenium-deficient children were found to be lower than those of control subjects (p<0.001). There was a positive correlation between the IGF-I with chronological age and body mass index. There was also positive correlation between the IGF-I and IGFBP-3. No significant difference was found between the goitrous and nongoitrous children. These results suggest that IGF-I and IGFBP-3 levels are affected by thyroid dysfunction as a result of iodine and selenium deficiency. However, IGF-I and IGFBP-3 levels are not associated with goiter.

Child↗
PubMed2000

Large goiter and multiple rib tumors.

We report an interesting case of a 47-yr-old who had a large goiter and multiple rib tumors. The patient was initially suspected of having thyroid cancer, which had metastasized on the ribs, based on imaging studies. However, laboratory tests revealed a high level of ionized calcium and parathyroid hormone (PTH). The large goiter was diagnosed as having parathyroid tumors owing to the high level of PTH in the tissue fluid. The biopsy specimen from a rib tumor was diagnosed as containing brown tumors associated with primary hyperparathyroidism (PHP). The patient also had prolactinoma and pancreatic gastrinoma. Her daughter had both prolactinoma and PHP, and her brother and her father had PHP. Thus, the patient was diagnosed as having multiple endocrine neoplasia type 1.

Adult↗
PubMed2005

Surgical treatment of multinodular goiter in young patients.

The objectives of this study were to analyse the results of surgical treatment of multinodular goiter (MG) in a population with under 30 yr of age; (2) to determine the incidence and evolution of related thyroid carcinomas; and (3) to evaluate the rate of relapse. Eighty-one patients operated for MG and under 30 yr of age were analyzed. The control group used consisted of 510 patients between 30 and 60 yr of age, operated on for MG. Cervical surgery for thyroidectomy was performed in all patients. The main outcome measures were postoperative morbidity and mortality; related thyroid carcinoma (number, type and evolution); remission of symptoms; and relapse of goiter. There were neither cases of hypoparathyroidism nor definitive recurrent lesions. In patients with symptoms, there was total remission of these. Although more than half were treated on suspicion of malignancy, only 9% were related to a carcinoma and most were papillary microcarcinomas. The average follow-up was 124 +/- 68 mo. Of the 48 patients with partial surgery, 40% had relapse (n=19). After 5 yr, the rates of relapse were 11% for the Dunhill technique, 20% for bilateral subtotal thyroidectomy, 17% for hemithyroidectomy, and 50% for unilateral subtotal hemithyroidectomy. These rates increased by 25%, 50%, 44%, and 60% respectively, after 10 yr, and up to 33%, 50%, 62%, and 70% after 15 yr; 89% of the cases of relapse were operated on-there were two hypoparathyroidisms and two recurrent lesions, one of the cases of recurrent lesion becoming definitive. MG in young people is mainly treated because of the suspicion of malignancy, although this occurs in less than 10% of cases. Surgery can be carried out with a low rate of morbidity, although the results are only definitive with total thyroidectomy, with a high level of relapse when partial techniques are used given that these are patients with long life expectancy.

Adult↗
PubMedDate not supplied

Ectopic thyroid tissue in the lower neck with a coexisting normally located multinodular goiter and brief literature review.

Ectopic thyroid tissue in the lower neck with a coexisting normally located multinodular goiter is a rare entity. We present a 27-year old asymptomatic woman with a recent history of a painless mass in the left side of her lower neck. Thyroid function tests were normal. An ultrasound of her neck showed a multinodular goiter and a 3.4 cm solid mass in the left lower cervical area. These findings were confirmed by an MRI scan of her neck. The Tc99m Pertechnetate scan showed the presence of a functioning area under the left lobe of the thyroid gland. The patient underwent surgery. The cervical mass was identified as a structure separate from the left lobe of the thyroid, without any attachments to the body of the gland and was uniformly resected. A subtotal thyroidectomy was also performed. The histology revealed that the separate structure represented ectopic thyroid tissue. The patient had an uneventful postoperative recovery, subsequent to which she was euthyroid and had normal calcium levels.

Adult↗
PubMed2000

Thyroxine prophylaxis after bilateral subtotal thyroidectomy for multinodular goiter.

In this study, we investigated the value of thyroxine administration to prevent recurrence after bilateral subtotal thyroidectomy for multinodular goiter. Patients that had benign multinodular goiter were operated on with the same surgical principles: ligation of both superior and inferior thyroid arteries on both sides, bilateral subtotal resection of thyroid gland including all visible nodules. On the 3rd postoperative day, the patients were divided into two groups: with 100 microgram 1-thyroxine daily (Thyroxine group) or no therapy (Control group). No recurrences were encountered among 40 patients followed up for 6 months and 20 patients for at least one year. One patient in the control group developed manifest hypothyroidism (5.3%). The mean TSH level of the control group was significantly higher than that of thyroxine group at 1st, 2nd, 3rd, 4th, 5th, 6th, and 12th months. At the end of the first year, the mean TSH level of the control group was four times that of the normal. On the other hand, the mean TSH level of the thyroxine group was within normal limits but not suppressed. In conclusion, we found that the pituitary-thyroid axis did not become normal spontaneously one year after thyroidectomy. Therefore, postoperative thyroxine administration seems to be of value, especially in endemic regions like Turkey.

Adolescent↗
PubMed2005

Synchronous occurrence of a follicular, papillary and medullary thyroid carcinoma in a recurrent goiter.

The simultaneous occurrence of different types of thyroid carcinoma in a single patient is an unusual event. We report the case of a 52-year-old man with the history of two previous thyroid operations for benign goiters, who developed a recurrent goiter. The patient was referred to our department for thyroidectomy. In the pathohistological examination the specimen showed a 5 cm follicular carcinoma and a 0.3 cm papillary microcarcinoma in the right lobe as well as a 1.5 cm medullary carcinoma in the left lobe. All tumors were clearly separated from each other, representing the pure entity of each type. Postoperatively, RET germline mutation was ruled out by sequence analysis of peripheral blood leucocytes. Postoperative I-131-radioiodine scan showed multiple lung and liver metastases, while calcitonin was negative. There is no known common cause of these three different tumor types and they developed most independently from each other. The personal history of our patient was interesting in two aspects: (1) he suffered a period of severe staphylococcal sepsis with temporal immunosuppression and (2) he worked for long years as a coremaker in a foundry. This work represented possible long term exposure to inhalative carcinogenous toxins like hydrazine, which caused thyroid parafollicular cell adenomas in an animal model.

Adenocarcinoma, Follicular↗
PubMed1985

Congenital iodide organification defect accompanied by a large nodular goiter: a case report.

A girl who had a nontoxic diffuse goiter with a congenital organification defect of iodide was first seen at the age of 8 years, and since then she has been followed up for a long period. The nodularity of the thyroid gland had gradually progressed, because of intermittent failure of ingestion of thyroid hormone preparation which was followed by excess TSH secretion. 18 years later, a nodular goiter developed and the patient underwent subtotal thyroidectomy. In order to prevent the development of nodular change in the thyroid gland in this disorder, supplemental thyroid hormone medication should be started as soon as the diagnosis is confirmed, and the therapy should be carried out regularly.

Adult↗
PubMed1986

Further data supporting episodic degenerative discharge of thyroid hormone from nodular goiters.

To elucidate the features of thyroid hormone secretion under conditions of impaired circulation, blood samples were withdrawn at operation from thyroid and peripheral veins of 23 patients with thyroidal and non-thyroidal diseases. They were taken from the respective veins simultaneously, when the arterial supply to the thyroid tissue was partially occluded by surgical manipulation. It was found that triiodothyronine was preferentially, as compared with thyroxine, secreted from the thyroid, irrespective of the disease. Serum levels of thyroglobulin were also markedly elevated in the thyroid vein. These results suggest that episodic degenerative discharge of thyroid hormone from nodular goiters may be a cause of impaired or blunted TSH response to TRH, frequently observed in patients with common nontoxic nodular goiters.

Goiter, Nodular↗
PubMed1987

Papillary carcinoma of the thyroid arising from dyshormonogenetic goiter.

A case of thyroid papillary carcinoma associated with dyshormonogenetic goiter is reported. The patient, a 35-year-old male, has been on thyroid hormone therapy since the age of three because of familial dyshormonogenetic goiter. He developed a distinct tumor in the right lobe, which was suggestive of carcinoma upon physical as well as ultrasonographic examination. Total thyroidectomy was performed, since a frozen section disclosed a focus of papillary carcinoma and the possibility of future development of further malignancy in any remaining thyroid tissue was considered. The patient is currently well with complete thyroid hormone supplementation one and a half years after the operation.

Adult↗
PubMedDate not supplied

Neonatal goiter caused by expectorant usage.

A female newborn was admitted with the symptoms of mild respiratory distress, protruding tongue, hypotonicity, cutis marmorata, sclerema, myxedema, abdominal distension, and feeding problems on the first day of life. She had a huge neck mass, a large anterior and posterior fontanel, and hoarse cry. She had no umbilical hernia or jaundice. A history of maternal potassium iodine (expectorant) usage without doctor's advice was obtained; the mother had not attended a clinic throughout the pregnancy. On ultrasonographic examination, the thyroid right lobe was 53 x 31 mm and the left lobe was 34 x 31 mm. The results of thyroid hormone tests on the first day were as follows: T3 20 ng/dl (normal: 32-216 ng/dl), T4 0.9 microg/dl (11.8-22.6 microg/dl), TSH 120 mIU/l (2.5-13.3 mIU/l). This patient is presented to emphasize the role of hypothyroidism in drug-induced neonatal goiter and to discuss the possibility of a life-threatening effect of congenital goiter, i.e. respiratory tract obstruction.

Expectorants↗
PubMedDate not supplied

Amyloid goiter in a child with familial Mediterranean fever.

A 7 year-old Turkish boy presented with a euthyroid goiter, which was noted during evaluation of familial Mediterranean fever. Amyloid deposits in the thyroid were found on fine-needle aspiration biopsy. Slight involution of the goiter within seven months may be attributed either to colchicine therapy or to treatment with levothyroxine and iodide.

Child↗
PubMed1996

Activated and interferon-gamma producing thyroid-derived T cells are detected in Graves' disease, thyroid autonomy as well as in non-toxic multinodular goiter.

The relative numbers of activated and interferon gamma (IFN-gamma)-producing peripheral blood lymphocytes (PBL) and thyroid-derived lymphocytes (TL) were determined using double surface and intracellular labeling techniques in flow cytometry. Cells were analyzed from 10 patients with Graves' disease (GD), eight patients with thyroid autonomy (TA) and five patients with non-toxic multinodular goiter (NTG). A maximum of 1% IFN-gamma+ cells were detected both in unstimulated PBL and TL. Stimulation caused a two- to threefold higher number of IFN-gamma+ cells in TL (GD, 48 +/- 12%; TA, 48 +/- 11%; NTG, 50 +/- 15%) as compared to PBL (GD, 15 +/- 7%; TA, 16 +/- 8%, NTG, 18 +/- 10%) of the same patients. Nearly all IFN-gamma+ TL in GD were CD3+ T cells, whereas 10-20% of IFN-gamma+ TL in TA and NTG were NK cells. In PBL 80% and in TL almost 100% of IFN-gamma+ cells were antigen-primed CD45RO+ cells. Only 25-35% of IFN-gamma+ thyroid-derived T cells expressed the CD4 antigen. About 42 +/- 10% thyroid-derived T cells in GD, 33 +/- 11% in TA and 34 +/- 13% in NTG expressed the HLA-DR molecule but not the interleukin 2 (CD25) or the transferrin receptor (CD71). Forty per cent of these HLA-DR+ T cells showed an intracellular staining for IFN-gamma and half of them co-expressed the activation antigen CD69. Immunofluorescence double labeling on thyroid cryostat sections demonstrated that HLA-DR+ T cells were also present in situ. The presence of activation antigens on thyroid-derived T cells not only in patients with GD but also in TA and NTG suggests failsafe mechanisms such as anergy, suppression or cytokine regulation in so-called non-immunogenic goiter.

Adult↗
PubMed2001

Development of the parafollicular cells in recurrent goiter.

OBJECTIVE: To provide more data for the discussion on whether thyroid hormones, iodide and other factors controlling the thyroid also influence the parafollicular (PF) cells, as the answer is of great importance for optimization of the medical treatment of medullary thyroid carcinoma (MTC) after surgery. DESIGN: We compared the density of the PF cells in patients who underwent surgery for the second time due to recurrent goiter with that in normal-sized thyroid glands after the first operation. METHODS: In 20 patients with only one operation, all specimens were taken from morphologically and functionally normal lobular thyroid parenchyma. The second group consisted of 30 patients who had already undergone a nearly total resection of at least one thyroid lobe several years before. Then another surgery of the same side was performed due to recurrent goiter. Immunohistochemical staining of the PF cells was performed using primary antibodies to calcitonin and chromogranin. RESULTS: An average of 78 PF cells (median 12.5) was found in the sections with the highest density of the first group. The average number of PF cells in the second group was just 5 (median 0). The Wilcoxon test revealed a highly significant difference in the total PF cell content between the groups (P < 0.001). CONCLUSIONS: Our study suggests that the stimulating factors that lead to growth of the thyroid parenchyma do not influence the PF cells. Hence a non-suppressive thyroid hormone replacement seems to be sufficient after resection of an MTC.

Adult↗
PubMed2001

Impact of protein energy malnutrition on thyroid size in an iodine deficient population of Gujarat (India): Is it an aetiological factor for goiter?

OBJECTIVE: To assess the severity of protein energy malnutrition (PEM) in iodine deficient subjects and to assess the impact of PEM on thyroid size. METHODS: 1002 subjects (530 school-aged children and 472 adults) were assessed for PEM by direct anthropometric measurements of height, weight, triceps skinfold (TSF) thickness, mid upper arm circumference (MUAC) and thigh circumference (TC), and derived indices of body surface area (BSA), body mass index (BMI), and Z-scores for weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ). Severity of PEM was based on the World Health Organization (WHO) criteria and the threshold on the Waterlow classification. Thyroid size was measured by ultrasonography to determine the thyroid volume (TV). Linear regression analysis was performed between TV and anthropometric parameters. RESULTS: Children had severe PEM as evident from the WHO percentage prevalence of stunting (HAZ<-2SD)=64% (where <-2SD is the Z-score deficit), wasting (WHZ<-2SD)=43%, underweight (WAZ<-2SD)=82% and BMI<16 kg/m=90%. Waterlow classification showed that children were either stunted or wasted, or stunted and wasted, or stunted and obese. Nearly 100% (529/530) of the children had goiter as evidenced from enlarged TV-for-BSA when compared with the WHO reference. There was a weak but statistically significant (P<0.05) positive correlation between TV and BSA, weight, height, MUAC, TC and HAZ but a negative correlation between TV and WHZ, BMI and TSF (r=-0.1-0.2). Adults had PEM as evident from BMI<18.5 kg/m in 54% subjects. Median MUAC=22.7 cm reveals prolonged severe PEM. Eighty-two percent had enlarged TV (>20 ml). There was a significant (P=0.01) negative correlation between TV and MUAC. CONCLUSIONS: (i) The severity of acute (wasting) and chronic (stunting) PEM is very high in Gujarati children. They are stunted or wasted, or stunted and wasted, or stunted and obese. Gujarati adults are thin with low protein and fat reserves. (ii) Anthropometric parameters showed a significant (P<0.001) correlation (r=0.1-0.2) with thyroid size. (iii) Higher prevalence of goiter may be due to macro-nutrient malnutrition (PEM) in the face of micro-nutrient malnutrition (iodine deficiency disorders, IDD).

Adolescent↗
PubMed2001

Retrospective analysis of the association of nodular goiter with primary and secondary hyperparathyroidism.

BACKGROUND: The association of hyperparathyroidism (HPT) with thyroid disease has long been known, but the mechanisms underlying such an association have not yet been clarified. OBJECTIVE: To elucidate the main factors determining this combination of endocrine diseases, in a retrospective multicenter study. METHODS: We retrospectively reviewed all patients referred for parathyroid scintigraphy in the period 1990-1999. A total of 487 patients in the age range 17-65 years were selected for the analysis (339 women and 148 men); group A included 241 patients with primary and group B 246 patients with secondary HPT. RESULTS: A total of 124/241 patients in group A (51.5%), but only 92/246 patients in group B (38.2%) had thyroid disorders (notably nodular goiter) associated with HPT (P=0.0035). Thyroid disorders were evenly distributed throughout the entire 17-65 years age range in group A, but 17-40-year-old patients in group B had significantly fewer thyroid disorders than the older patients of the same group (15.5% compared with 43.3%, P<0.002), as expected in a general population. In patients with primary HPT there was no difference in the prevalence of thyroid disease between women and men, whereas the ratio of women to men in secondary HPT patients with thyroid disease was about 3:1. CONCLUSIONS: These results demonstrate an increased prevalence of nodular goiter in patients with primary rather than secondary HPT, and are consistent with a possible role of increased endogenous calcium concentrations (a hallmark of primary, but not of secondary, HPT) as a goitrogenic factor in patients with HPT.

Adolescent↗
PubMed2001

Sodium/iodide symporter (NIS) and pendrin are expressed differently in hot and cold nodules of thyroid toxic multinodular goiter.

OBJECTIVE: The expression of two iodide transporters, the sodium/iodide symporter (NIS) and pendrin, was analyzed in thyroid tissues of patients with toxic multinodular goiter (TMNG) and non-toxic multinodular goiter (MNG). METHODS: The levels of NIS and pendrin proteins were analyzed in total protein extracts from nodular and non-nodular tissues by Western blot. RESULTS: In tissue samples from TMNG, we found an increased expression of NIS (2.5-fold) in the hot nodules, and similar levels between cold nodules and non-nodular tissues. In contrast, the levels of pendrin were slightly increased in both hot and cold nodules from TMNG, and decreased (about twofold) in cold nodules from MNG. We also noticed that there was no relationship between NIS and pendrin expression. CONCLUSIONS: Our data demonstrate that hot nodules from TMNG express a higher number of iodide transporters (mainly NIS), whereas cold nodules from TMNG, but not from MNG, show levels of the two proteins comparable with normal tissue, suggesting a role in vivo of TSH in maintaining the expression of NIS and pendrin protein in normal thyroid tissue. Finally, different mechanisms are involved in the regulation of NIS and pendrin expression.

Actins↗
PubMed2004

Thyroid cystadenoma, colloid goiter, and hypothyroidism in an American black bear (Ursus americanus).

A 178-kg, 14-yr-old captive female American black bear (Ursus americanus) was examined because of lethargy, inappetance, obesity, and alopecia. Serum chemistry and complete blood count values were within normal limits. Based on serum levels for total thyroxine (T4), free T4 by equilibrium dialysis (fT4ED), and canine thyroid-stimulating hormone concentrations, using assays validated for domestic dogs, hypothyroidism was diagnosed presumptively, and therapy with levothyroxine sodium (0.022 mg/kg p.o. b.i.d.) was initiated. Haircoat, body weight, appetite, and activity level improved within 30 days. The levothyroxine dose was decreased twice (to 0.018 mg/kg p.o. b.i.d. and then to 0.011 mg/kg p.o. b.i.d.) during the course of treatment based on monitoring of serum T4 and fT4ED concentrations. After euthanasia for severe refractory lameness, postmortem examination revealed bilateral thyroid lobe enlargement and a fluid-filled cyst within the right lobe. Histologically, colloid goiter was present in both lobes, and a follicular cystadenoma had replaced one third of the cranial pole of the right lobe. The goiter and cystadenoma likely contributed to the hypothyroid condition in this bear and fT4ED was a more sensitive indicator of hypothyroidism than was T4. The recommended canine dosage of levothyroxine may be too high for the treatment of hypothyroidism in American black bears; 0.011 mg/kg p.o. b.i.d. may be a more appropriate dosage.

Animals↗
PubMed1996

Pituitary apoplexy after subtotal thyroidectomy in an acromegalic patient with a large goiter.

A case of pituitary apoplexy occurring after subtotal thyroidectomy in an acromegalic woman with a large adenomatous goiter is described. The patient had severe apnea because the large goiter was causing airway compression. Prior to the planned hypophysectomy, a subtotal thyroidectomy was performed to relieve tracheal stenosis. Shortly after the operation, the patient developed a headache that lasted for several days. The serum levels of growth hormone and somatomedin-C spontaneously normalized seventeen days after this episode and have remained normal for two years. Pituitary apoplexy was thought to have caused the observed results without deterioration of the pituitary function.

Acromegaly↗