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PubMed1996

Thyroid nodules and the detection of thyroid cancer.

Although thyroid nodules are common and cause concern about possible malignancy, relatively few are thyroid cancers, and relatively few thyroid cancers are lethal. These considerations justify a selective approach in recommending surgical excision of nodules. Selection of patients should be based on assessment of cancer risk factors in the history and physical examination, and most importantly on fine-needle aspiration biopsy of the thyroid with cytologic examination. Other testing in most cases should be limited to serum thyroid-stimulating hormone and antithyroid antibodies and a thyroid sonogram. With the results of this evaluation a recommendation can be made for either immediate surgery or observation. This approach should reduce the number of operations for benign thyroid nodules and avoid excessive diagnostic testing.

Adult↗

PubMedDate not supplied

[Thyroid cancer and Hashimoto's thyroiditis].

In a 45 years old women affected by Hashimoto's thyroiditis appeared a thyroid nodule that at the cytologic and than at the histologic examination proved to be a papillar carcinoma. Concerning this problem the authors make a thorough analysis of the literature. Regarding the possible associations between these two diseases, they observe how there is an extreme discordance of opinions on considering statistically significant the relationship between thyroid cancer and Hashimoto's thyroiditis. They make the hypothesis that the association of these two diseases is not casual: several etiological factors could be considered, but the chronic stimulus of TSH on the thyroid tissue affected by the autoimmune disease and progressively hypofunctioning, could be the main factor responsible for the development of the neoplasia. Then they give some advice to recognise patients at high risk for thyroid carcinoma. The patients at higher risk for thyroid cancer are those that present a single or prevalent nodule; the growth of a nodule on suppressive treatment with levothyroxine is also a negative prognostic index. Patients with an enlarged gland without nodules or with nodular goiter without a prevalent nodule are at low risk for cancer.

Carcinoma, Papillary↗

PubMed1997

Effect of post-operative thyroid hormone therapy on the recurrence of benign thyroid nodules. A study in Thai patients.

The efficacy of postoperative thyroid hormone treatment in prevention of recurrent thyroid nodule is still controversial. In order to investigate this effect in Thai patients, a retrospective study was performed on files of 321 post-operative patients with benign thyroid nodules, who were either on thyroid hormone treatment or not after surgery, and were followed-up for at least 1 year. The longest follow-up period was 15 years after surgery. The recurrence of nodules was determined by palpation. It was found that the recurrent rate in patients with adenoma who did not receive post-operative thyroid hormone treatment was 20 per cent (16/82 cases) while there was no recurrence at all (0/25 cases) in the treatment group (p < 0.05). The recurrent rate was 22 per cent (31/141 cases) in patients with nodular goitre who did not receive post-operative thyroid hormone treatment and 7 per cent (5/73 cases) in those with treatment (p < 0.001). In the group of patients without post-operative thyroid hormone treatment, for both the group of patients with adenoma and that with nodular goitres, the recurrence was found to occur as late as more than 10 years after surgery.

Adenoma↗

PubMed1998

IFN-gamma-deficient mice develop severe granulomatous experimental autoimmune thyroiditis with eosinophil infiltration in thyroids.

To study the role of IFN-gamma in the development of granulomatous experimental autoimmune thyroiditis (EAT), DBA1 mice with a disrupted IFN-gamma gene were used for adoptive EAT induction. Effector cells from either IFN-gamma(+/+) or IFN-gamma(-/-) donor mice activated with mouse thyroglobulin and anti-IL-2R mAb induced severe granulomatous EAT. A predominant infiltration of the thyroid by eosinophils was observed in recipients of IFN-gamma(-/-) effector cells but not in recipients of IFN-gamma(+/+) cells. Compared with wild-type mice, thyroids of recipients of IFN-gamma(-/-) effector cells had decreased expression of mRNA for Th1 cytokines and inducible nitric oxide synthetase. Expression of Th2 cytokine mRNA was comparable to that of IFN-gamma(+/+) mice, and expression of eotaxin was increased in the thyroids of recipients of IFN-gamma(-/-) effector cells. Activation of cells from either IFN-gamma(+/+) or IFN-gamma(-/-) donors in the presence of IL-12 also induced severe granulomatous EAT. Eosinophil infiltration in recipients of IFN-gamma(-/-) cells was unaffected when effector cells were activated with IL-12, and thyroids expressed predominantly Th2 cytokines. The extent of fibrosis of recipient thyroids was generally greater when donor IFN-gamma(+/+) and IFN-gamma(-/-) cells were activated with IL-12. Compared with IFN-gamma(+/+) mice, IFN-gamma(-/-) mice produced lower levels of mouse thyroglobulin-specific autoantibodies after immunization with MTg and LPS. These results indicate that cells from both IFN-gamma(+/+) and IFN-gamma(-/-) donors can induce severe granulomatous EAT. However, damage of thyroid follicles by IFN-gamma(-/-) and that by IFN-gamma(+/+) cells appear to involve different mediators of inflammation.

Animals↗

PubMed1998

[Triggering role of emotional stress and childbirth. Unexpected occurrence of Graves' disease compared to 96 cases of Hashimoto thyroiditis and 97 cases of thyroid nodules].

98 patients with Graves' disease have been compared to 95 patients with Hashimoto's thyroiditis and to 97 patients with benign thyroid nodules (control group) in order to evaluate the triggering role of major stressors and pregnancy in the occurrence of autoimmune thyroid diseases. A stress factor has been encountered in 11% cases of Graves' disease and in 6% of Hashimoto's and thyroid nodes (chi 2 test, not different). Graves' disease occurred after a pregnancy in 25% of the women in child bearing age versus 10% of the cases of Hashimoto's (p < 0.05) and 13% of the thyroid nodes. The role of stressors, if any, in triggering Graves' disease seems to be weak and dubious compared to the role of pregnancy and post-partum. It is assumed that the decrease of immunosuppressive hormones occurring after stress or delivery could induce a rebound autoimmune reaction responsible for the thyroid disease. In Hashimoto's thyroiditis, stress and pregnancies do not seem to have any triggering role.

Adult↗

PubMed1987

Prevalence of thyroid disease and abnormal thyroid function test results in patients with systemic lupus erythematosus.

Although thyroid disease has been associated with other autoimmune conditions, it is not well recognized in systemic lupus erythematosus (SLE) patients. We found that in 332 SLE patients hospitalized during a 5-year period, the overall prevalence of diagnosed thyroid disease (7.5%) was similar to that in other female populations, but the prevalence of diagnosed hypothyroidism (6.6%) was unexpectedly high. There was also a high frequency of abnormal thyroid function test results in 175 SLE patients without diagnosed thyroid disease who underwent laboratory screening. More than 45% of these patients had elevated levels of thyroid-stimulating hormone, 34% had low T3 determinations, and 18% had high antimicrosomal antibody titers. When patients were categorized into "functional groups," some showed evidence of the "euthyroid sick syndrome" (15%), but many more had laboratory test results suggestive of true (5%) or incipient (39%) primary hypothyroidism. We conclude that abnormal thyroid function test results are common in patients with SLE and that hypothyroidism, especially, should be considered when evaluating symptoms and signs in SLE patients.

Adolescent↗

PubMedDate not supplied

A case of Resistance to Thyroid Hormone without mutation in the thyroid hormone receptor beta.

BACKGROUND: Resistance to Thyroid Hormone (RTH) is a condition caused by tissue hyposensitivity to the effects of circulating thyroid hormone, and may be misdiagnosed as hyperthyroidism. AIMS: We report the first case of RTH in an Irish patient highlighting the clinical features and the pathophysiological mechanism underlying the characteristic laboratory abnormalities found in the condition. METHODS: We describe an isolated case of RTH initially misdiagnosed as hyperthyroidism, and detail the investigations which ultimately led to the correct diagnosis. Genetic screening of the thyroid hormone receptor beta gene was performed. RESULTS: Thyroid function tests including T3 suppression test and TRH-stimulation test suggested a diagnosis of RTH. Genetic testing failed to demonstrate a mutation in the thyroid hormone receptor. CONCLUSION: RTH is a rare inherited condition that may be misdiagnosed as hyperthyroidism. The case we describe most likely results from a de novo mutation in an as yet undiscovered gene. RTH should be considered in patients with elevated thyroid hormone levels and normal TSH so that unnecessary and potentially harmful treatment can be avoided.

Adult↗

PubMed2026

Fibrotubular Tumors of the Thyroid: An Emerging Thyroid Neoplasm Characterized by Distinctive Morphology and Recurrent OCLN::PRKCI Gene Fusions Spanning the Adenoma-Carcinoma Spectrum.

The histopathologic and genomic landscape of thyroid tumors is well characterized, although new genetic alterations and tumor types are being described. We present 2 cases of thyroid tumors originating from follicular cells that had highly unusual and distinct morphologic features and carried an OCLN::PRKCI gene fusion. These tumors were well circumscribed, encapsulated, and composed of irregularly shaped tubular and follicular structures surrounded by layers of distinct fibrocollagenous basement membrane material positive for type IV collagen and laminin; they showed no definitive nuclear features of papillary carcinoma. Importantly, whereas one of the tumors had no invasive growth, the other demonstrated tumor capsule invasion, compatible with the adenoma-carcinoma spectrum seen in thyroid follicular and oncocytic tumors. Gene expression profiles of these tumors differed from those of common types of papillary thyroid carcinoma. The unusual and reproducible histopathologic characteristics and unique molecular profiles of these tumors support their designation as a distinct type of thyroid neoplasm that exists in noninvasive and invasive forms and, therefore, can be designated as fibrotubular adenoma and carcinoma. Recognition of this distinct entity is important for improving diagnostic accuracy and avoiding overtreatment of this likely indolent type of thyroid neoplasia.

Humans↗

PubMed1992

Expression of the thyroid hormone receptor, the oncogenes c-myc and H-ras, and the 90 kD heat shock protein in normal, hyperplastic, and neoplastic human thyroid tissue.

Expression of the thyroid hormone receptor (TR beta), the 90 KD heat shock protein (HSP 90), and the oncogenes H-ras and c-myc mRNA in normal hyperplastic, and neoplastic human thyroid tissue was investigated by Northern blot and slot blot analyses. The TR beta mRNA was present in all normal and neoplastic thyroid tissue samples. The levels were significantly higher in normal and hyperplastic tissues (7.91 +/- 0.48 and 7.60 +/- 0.68 arbitrary units, respectively) than in neoplastic tissues (3.82 +/- 0.67) (p < 0.001). H-ras and c-myc mRNA were also detected in glandular tissue specimens, but no significant difference was observed in their expression levels. Furthermore, there was a tendency to a negative correlation between the level of TR beta and c-myc mRNA (p = 0.06). In normal thyroid tissue, HSP 90 mRNA levels were significantly higher than in hyperplastic and papillary carcinoma tissue specimens (p < 0.001). These results indicate that mRNA of TR beta and HSP 90 (the latter only in papillary thyroid carcinoma) are expressed in relation to the degree of cellular differentiation. Furthermore, the presence of TR beta in normal thyroid tissue implies that T3 and T4 may be involved in the regulation of their own production via TR beta activated feedback mechanism(s).

Adult↗

PubMed1992

Thyroid nodules associated with Hashimoto thyroiditis: assessment with US.

Sonographic findings in 109 thyroid nodules in 104 patients with Hashimoto thyroiditis were retrospectively analyzed. Sixty patients underwent ultrasound (US)--guided fine-needle aspiration (FNA) biopsy (65 nodules, 24 palpable, 27 surgically confirmed), 14 of whom also underwent palpation-guided FNA (14 nodules, all palpable, all surgically confirmed). Forty-four patients (44 nodules, 25 palpable) underwent diagnostic US followed up with surgery. US-guided FNA helped differentiate between benign (n = 11) and malignant (n = 16) diseases (sensitivity, 100%). Two papillary carcinomas were falsely diagnosed as Hashimoto thyroiditis with palpation-guided FNA. Eight malignancies were not palpable, and correct diagnosis was obtained with US-guided FNA. Hyperechoic nodules were usually benign, and isoechoic nodules had a low frequency (13%) of malignancy. Most carcinomas were found in hypoechoic masses, and almost all lymphomas were found in markedly hypoechoic masses. Lymphoma was indistinguishable from pseudotumor in Hashimoto thyroiditis or adenomatous hyperplasia at US. US-guided FNA is helpful in making the histologic diagnosis in thyroid nodules associated with Hashimoto thyroiditis. US-guided FNA is clinically beneficial because it can help select patients who need surgery, avoiding unnecessary surgery for patients with nonneoplastic disorders.

Adenoma↗

PubMed1995

[Detection of thyroid stimulating antibodies and TSH binding inhibitor immunoglobulins in patients with thyroid diseases and its clinical applications].

Thyroid stimulating antibodies (TSAb) and TSH binding inhibitor immunoglobulins (TBII) were assessed in patients with thyroid diseases. The activity of TSAb and TBII was significantly higher in patients with untreated Graves' disease (GD) as compared with that in patients with remitted GD and Hashimoto's thyroiditis, while the latter two groups had higher TSAb and TBII activity than patients with thyroid adenoma or control subjects. Of 24 patients with untreated GD, TSAb and TBII were detected in 22 and 19 respectively. The positive rates of TSAb and TBII in patients with remitted GD or Hashimoto's thyroiditis were 0.48 and 0.44 or 0.231 and 0.615. Both TSAb and TBII were negative in patients with thyroid adenoma or controls. No statistical correlation was found between TSAb and TBII activity, suggesting the coexistence of heterogeneous populations of TSH receptor antibodies.

Adenoma↗

PubMedDate not supplied

Thyroid hormones homeostasis and TSH in autonomic thyroid nodule.

Thirty patients with autonomic thyroid nodules were studied. Thyroid scintigram, iodine uptake at 2 and 24 hrs, PBI, total thyroxine, serum T3(RIA), basal TSH and 30 minutes after TRH administration were performed. A lack of concordance was found between the clinical signs and the laboratory data. According to the data obtained the patients were grouped into 3 categories: having 1) autonomic thyroid nodules with normal PBI, T4t, T3 values and absent or diminished TSH response to TRH; 2) autonomic thyroid nodules with increased T3 secretion and no response to TRH despite a normal T4 and iodine uptake, 3) hyperfunctional autonomic nodules in which PBI, T4t, T3 and iodine uptake are increased. TSH response to TRH is the most sensitive test for hyperthyroidism, more sensitive than the circulating thyroid hormones assay, and best fitted for adequate therapeutic management. Serum triiodothyronine was found to be increased in 95% of the patients. Thus, there is a T3 thyreotoxicosis in most of the autonomic nodules. TRH test and serum T3 assay being essential elements in starting the treatment, they have to be included among the tests used in autonomic thyroid nodules investigation.

Adenoma↗

PubMed1996

[Increased secretogranin II protein and mRNA expression in C cells of the thyroid in Hashimoto's thyroiditis].

Secretogranin II (chromogranin C) has been demonstrated in normal and hyperplastic C cells of the thyroid as well as in medullary thyroid carcinoma. Both by immunohistochemistry and immunoblotting it was found that C cells and medullary thyroid carcinomas contain substantially less secretogranin II when compared to chromogranins A and B. Secretoneurin, a biologically active protein endoproteolytically processed from secretogranin II, has been found to have a potent chemotactic activity towards monocytes. This and the finding that histamine specifically induces secretogranin II mRNA in cultured bovine chromaffin cells may indicate a possible role of this peptide in inflammatory conditions. The aim of the present study was to investigate secretogranin II both on the mRNA and protein level on routinely processed tissues from 18 cases with Hashimoto's thyroiditis. In contrast to normal, hyperplastic, and neoplastic C cells, the C cells in cases with Hashimoto's thyroiditis showed increased secretogranin II mRNA as well as protein (secretogranin II and secretoneurin) expression. Our results support the concept that secretogranin II/secretoneurin may be involved in inflammatory conditions. Further studies are necessary to elucidate whether secretogranin II is of biological relevance in Hashimoto's thyroiditis.

Animals↗

PubMed1977

Microfollicular thyroid carcinoma with amyloid rich stroma, resembling the medullary carcinoma of the thyroid (MCT).

A human thyroid tumor is described which, on light microscopy, exhibited the features of medullary carcinoma of the thyroid (MCT). The cells were arranged in solid lobules or trabeculae, and the stroma was abundant and gave positive reaction for amyloid as assessed by congo red, crystal violet and thioflavin T stains. However, there was microfollicular differentiation in certain portions of the tumor even where the tumor was invasively growing. On electron microscopy, numerous microfollicles were identified even where unsuspected by light microscopy. There were junctional complexes, the cells possessed well developed rough endoplasmic reticulum, prominent Golgi and numerous dense bodies obviously derived from the Golgi vesicles, which were of the same morphology as "secretory" granules described previously by some authors in MCT. However, we find this kind of cytology typically in microfollicular thyroid carcinomas. Presence of about 100 A thick fibrils in the stroma was consistent with histochemically positive amyloid. The biochemical data were compatible with the differentiated follicular cell origin of the tissue. The homogenate contained poorly iodinated thyroglobulin, and thyroid peroxidase activity. Calcitonin was undetectable by a sensitive radioimmunoassay. It is concluded that this tumor was follicular thyroid carcinoma with amyloid rich stroma. The presence of amyloid and dense bodies with homogenous electron dense contents is insufficient for making conclusions about histogenesis of thyroid tumors. The so called MCT with amyloid stroma probably represents a heterogenous group of thyroid tumors, at least some of them derived from follicular epithelium.

Adenocarcinoma↗

PubMed2002

Anaerobic thyroid abscess from a thyroid cyst after fine-needle aspiration.

BACKGROUND: Anaerobic abscess formation within a thyroid cyst is rare but still possible, although aerobic thyroid abscess formation in the thyroid gland after fine-needle aspiration (FNA) has been observed in immunocompromised patients. METHODS: This study describes the clinical manifestations, thyroid echography, cytologic finding, culture outcome, and treatment course of an anaerobic abscess formation within a thyroid cyst after FNA in a healthy subject. RESULTS: A 53-year-old male subject had rapid enlargement of a left thyroid cyst develop after second FNA. Frank pus was obtained through third FNA. The culture outcome was Propionibacterium acnes, which was rich in saliva and one of the pathogens causing periodontitis and gingivitis. After adequate antimicrobial therapy, the abscess gradually diminished. CONCLUSIONS: This article reported, for the first time, on the formation of an anaerobic thyroid abscess after FNA in a healthy subject. We recommended careful aseptic procedure and adequate isolation processes, such as wearing a mask to avoid an unfavorable outcome as a result of a bacterial infection.

Abscess↗

PubMed1997

Regulation of superoxide anion radical-superoxide dismutase system in the avian thyroid by TSH with reference to thyroid hormonogenesis.

This study shows that superoxide dismutase is present in the thyroid gland of pigeons as a constitutive enzyme serving as an antioxidant against oxygen toxicity. Exogenous administration of thyrotropin induced thyroidal superoxide dismutase with a simultaneous burst in superoxide anion radical levels during the initial phase of hormone treatment. The superoxide radical generated was completely scavenged by SOD during the late phase of TSH-treatment, presumably as an adaptive measure to check the oxygen burst. TSH failed to augment serum T3 levels, although the thyroxine level in the serum was elevated. The peak level of SOD activity profile in the thyroid gland correlated very well with the peak level of thyroxine concentrations in the serum of pigeon. It is reasonable to postulate that the thyroidal SOD in homeotherms serves a dual role, firstly as a strategic antioxidant enzyme to protect the thyroid gland against the degenerative influence of toxic oxyradicals and secondly to provide H2O2 for thyroid hormone biosynthesis. Our results confirm the previous observations that TSH is mainly thyrotropic in birds and that it has no influence on the peripheral activation of thyroxine to triiodothyronine by stimulating the extra thyroidal 5'-deiodinase activity.

Animals↗

PubMed2002

Coexpression of susceptible and resistant HLA class II transgenes in murine experimental autoimmune thyroiditis: DQ8 molecules downregulate DR3-mediated thyroiditis.

Experimental autoimmune thyroiditis (EAT) can be induced in genetically susceptible mice by immunization with the self antigen, thyroglobulin (Tg). Since susceptibility is linked to H2 class II molecules, we have generated human leukocyte antigen (HLA) class II transgenic mice to study potential HLA associations with Hashimoto's thyroiditis. DR3 (HLA-DRA/DRB1*0301) and DQ8 (HLA-DQA1*0301/DQB1*0302) transgenes were introduced into class II-negative Ab(0)/B10 and Ab(0) nonobese diabetic (Ab(0)/NOD) mice. Previous work had shown that DR3 transgenic mice were susceptible to both mouse Tg and human Tg-induced EAT, whereas DQ8 transgenic mice were moderately susceptible only to human Tg induction. In this report, we examined the effect of DQ8 transgene on mouse Tg- and human Tg-induced EAT in double transgenic DR3/DQ8 mice. After mouse Tg induction, thyroiditis in DR3(+)DQ8(+) Ab(0)/B10 mice was significantly less severe than in DR3(+) mice but more severe than in DQ8(+) mice. No difference in thyroiditis was observed between DR3(+) and DR3(+)DQ8(+) mice in another background strain, Ab(0)/NOD. However, after immunization with human Tg, DQ8 coexpression downregulated thyroiditis severity, compared to DR3(+) mice, whereas thyroiditis was more extensive than in DQ8(+) mice. Thus, depending on the background strain and the Tg used to induce disease, the presence of the DQ8 transgene can reduce thyroiditis mediated by DR3 molecules.

Animals↗

PubMed1986

Critical evaluation of serum thyroglobulin (Tg) levels during thyroid hormone suppression therapy versus Tg levels after hormone withdrawal and total body scan: results in 291 patients with thyroid cancer.

Serum thyroglobulin (Tg) levels were measured during thyroid-hormone suppressive therapy in 291 patients who had been treated for well-differentiated thyroid carcinoma. The findings were compared with those of a subsequent total body scan (TBS) and with Tg levels measured after thyroid-hormone withdrawal. Of the patients with low Tg levels during suppressive therapy, 91.6% were subsequently shown to be free of disease or to have only remnants in the thyroid bed, whereas 8.4% had metastases (false-negative). Of the patients with false-negative findings, 89.3% had nodal metastases; 60.8% of the patients with nodal metastases exhibiting radioiodine uptake and only 23% of those with nonfunctioning nodal metastases had low Tg levels during suppression therapy. After thyroid-hormone withdrawal, all but 1 of the patients with nodal metastases had high Tg levels. All but 2 of the patients with distant metastases had high Tg levels during suppression therapy; 1 of these 2 patients exhibited high Tg levels after T3 withdrawal. No differences between Tg levels in patients with functioning and non-functioning metastases were found. Our study indicates that Tg assays performed during suppressive therapy have a fairly good predictive value and can be used as a general guide in the follow-up of thyroid cancer. However, since most differentiated metastases produce Tg only when stimulated by thyroid-stimulating hormone, measurements of Tg levels after the discontinuation of suppressive therapy would also seem to be necessary.

Adolescent↗