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PubMed1983

Computed tomography of intrathoracic goiters.

Ten patients with intrathoracic goiters were evaluated by computed tomography (CT). In comparison with chest radiographs, CT showed additional features helpful in suggesting the correct diagnosis. These observations included: (1) clear continuity with the cervical thyroid gland (8/10 cases); (2) well defined borders (9/10); (3) punctate, coarse, or ringlike calcifications (8/10); (4) nonhomogeneity (9/10) often with discrete, nonenhancing, low-density areas (6/10); (5) precontrast attenuation values at least 15 H greater than adjacent muscles (4/10) with more than 25 H after contrast enhancement (8/8); and (6) characteristic patterns of goiter extension into mediastinum.

Adult↗
PubMed1990

Intrathyroidal lymphocytes from non toxic multinodular goiter: no evidence for production of thyroid stimulating antibodies.

Although an autoimmune pathogenesis for non toxic goiter has been suggested, reports concerning circulating antibodies to TSH receptor structures have been conflicting. Intra thyroid lymphocytes, capable of secreting IgG, have been shown to be involved in the pathogenesis of Graves' and Hashimoto's diseases; therefore, the ability of conditioned media obtained from intra thyroid lymphocyte culture, and of IgG purified from these media, to stimulate cAMP accumulation and [3H]-Thymidine (TdR) uptake in FRTL-5 cells was investigated. The activity of IgG produced "in vitro" was compared with that of circulating IgG. Thyroid tissue samples were obtained at surgery from 21 patients with non toxic multinodular goiter (MNG), 5 patients with active Graves' disease (GD), and from 10 normal subjects, undergoing neck surgery for non-thyroidal pathology. IgG purified from media of GD lymphocyte cultures stimulated both cAMP accumulation and [3H]-TdR in 5 out of 5 cases: all of the IgG purified from control or MNG lymphocyte culture media was not active in either assay. Circulating IgG did not affect cAMP accumulation or [3H]-TdR in any of the non toxic MNG cases: controls showed no changed at all. However, both activities represented were increased by GD IgG. Conditioned media from intra thyroid lymphocyte cultures significantly inhibited basal cAMP accumulation in 7 out of the 21 non toxic MNG samples and totally abolished the response in all GD patients. [3H]-TdR was not affected by IgG of any of the controls, but it had an inhibitory effect on 8 out of 21 non toxic MNG patients, and significantly stimulated [3H]-TdR in all GD patients. In conclusion, present data demonstrate that intra thyroid lymphocytes from non toxic MNG do not produce antibodies capable of mimicking TSH actions through the adenylate cyclase cascade. Conversely, soluble factors interacting in TSH-mediated functions of FRTL-5 cells are present in conditioned media of intra thyroid lymphocytes of GD and MNG thyroid lymphocytes of GD and MNG thyroid cultures.

Adolescent↗
PubMed1999

MAGE-1, GAGE-1/-2 gene expression in FNAB of classic variant of papillary thyroid carcinoma and papillary hyperplasia in nodular goiter.

Differentiation of the papillary variant of papillary thyroid carcinoma (PTC) from papillary hyperplasia in nodular goiter may be difficult in fine-needle aspiration biopsy (FNAB) by means of morphology alone. To improve cytodiagnostic accuracy the occurrence of MAGE-1, GAGE-1/-2 gene expression was analyzed by means of RT-PCR. The genes investigated are recognized by autologous T lymphocytes and are expressed in carcinomas of various sites e.g. lung, ovary, colon but not in non-neoplastic tissue except testis. Routinely obtained smears with cytologic diagnosis of PTC confirmed by histology (n=20) and diagnosis of nodular goiter (n=10) were investigated. The MAGE-1, GAGE-1/-2 PCR products were found in 6/20 of the carcinomas but in none of the benign lesions. To identify PCR products automatic gene-sequencing in all positive cases was performed. The data indicate that MAGE-1, GAGE-1/-2 gene expression may give additional information to delineate PTC from papillary hyperplasia in FNAB.

Antigens, Neoplasm↗
PubMedDate not supplied

Significance of radioiodine uptake at 72 hours versus 24 hours after pretreatment with recombinant human thyrotropin for enhancement of radioiodine therapy in patients with symptomatic nontoxic or toxic multinodular goiter.

OBJECTIVE: To report the effects of pretreatment with recombinant human thyrotropin (rhTSH) on radioiodine uptake (RAIU) and subsequent radioiodine therapy in 30 patients with symptomatic nontoxic or toxic multinodular goiter. METHODS: Patients received a single injection of rhTSH (0.1 mg in 21 and 0.3 mg in 9 patients). Thyroid function tests were performed before and 72 hours after rhTSH administration. Both 4-hour and 24-hour RAIU studies were done after rhTSH administration and repeated at 48 to 52 hours and at 72 hours, respectively. Then all patients were treated with 30 mCi of 131 I. RESULTS: All study patients experienced symptomatic relief by 1 to 2 months. In addition to the previously reported twofold increase over the baseline RAIU at 24 hours, we found that a second 24-hour RAIU showed a further twofold increase (quadrupling of the RAIU over baseline) at 72 hours after administration of 0.1 mg of rhTSH (from 22% to 43%; P<0.001) and 0.3 mg of rhTSH (from 16% to 37%; P = 0.002), with no significant difference between doses on the RAIU at 24 hours or at 72 hours. Additionally, the RAIU value at 4 hours and 52 hours after administration of 0.1 mg and 0.3 mg of rhTSH revealed a fourfold increase for each dose--from 7% to 28% (P<0.001) and from 5% to 21% (P = 0.002), respectively. CONCLUSION: In patients with symptomatic toxic or nontoxic multinodular goiter, 0.1 mg and 0.3 mg of rhTSH were equally efficacious at inducing a quadrupling of the low or low-normal baseline RAIU values at 72 hours after injection. Subsequent radioiodine therapy alleviated compressive and thyrotoxic symptoms in all 30 treated patients. Future studies should help determine doses of rhTSH and radioiodine therapy that are optimal in iodine-sufficient and insufficient regions of the world.

Aged↗
PubMedDate not supplied

Thyroid carcinoma in single cold nodules and in cold nodules of multinodular goiters.

OBJECTIVE: To examine the frequency of malignant growth in a nonfunctioning solitary thyroid nodule (SN) and in multinodular goiter (MNG). METHODS: We performed fine-needle aspiration biopsy (FNAB) of cold nodules in 154 patients. Eight patients with unsatisfactory FNAB specimens were excluded from the study. Of the remaining 146 patients, 95 (89 women and 6 men) had MNG. The other 51 patients (46 women and 5 men) had SN. The overall age range was 25 to 86 years (mean, 52). RESULTS: Of the 95 patients with MNG, 16 had abnormal cytologic findings and underwent surgical excision. Of these 16 patients, 12 had thyroid cancer (6 papillary, 3 follicular, and 3 Hürthle cell). Of the 51 patients with SN, 8 had suspicious cytologic findings, and 5 had surgical histologic evidence of thyroid cancer (3 papillary and 2 follicular). Four patients with papillary thyroid cancer (three from the MNG group and one from the SN group) had a history of exposure to neck irradiation. After exclusion of the patients with a history of neck irradiation, the rate of malignant involvement in cold nodules in the MNG group was 9.78%, in comparison with 8% in the group with SN (P = 0.89). Within the MNG group, 25% of the thyroid malignant lesions were of the Hürthle cell type. CONCLUSION: Multinodularity of a goiter should no longer be considered an indicator of probable benign disease. In the assessment of all thyroid nodules, both SN and those in MNG, a thyroid scan can be helpful, and it should be followed by FNAB and cytopathologic examination of any nonfunctioning lesions. The incidence of malignant involvement in cold nodules of MNG does not differ significantly from that found in SN.

Adult↗
PubMedDate not supplied

Amyloid goiter: report of two cases and review of the literature.

OBJECTIVE: To describe two recent cases of amyloid goiter that occurred in two patients with a history of diffuse enlargement of the thyroid gland, progressing over several years' time. METHODS: We reviewed the medical histories as well as the histologic, immunohistochemical, and electron microscopic findings in these patients. RESULTS: Assessment of the clinical records of a 59-year-old man and a 64-year-old woman revealed histories that included chronic psoriasiform arthritis and asthma in conjunction with chronic obstructive pneumonia and bronchiectasis. In both cases, total thyroidectomy was performed. On histologic examination of both thyroid glands, the appearance was characterized by moderate to severe distortion of the normal thyroid architecture by amyloid in a perifollicular distribution and focally abundant interfollicular adipose tissue. In both cases, the amyloid stained intensely positive with Congo red, which bleached after treatment with potassium permanganate. Immunohistochemical staining patterns were consistent with AA amyloid, and electron microscopy showed nonbranching 9-nm fibrils consistent with amyloid. CONCLUSION: The diagnosis of amyloid goiter should be suspected in patients with a diffusely enlarging thyroid gland and an appropriate clinical history.

Amyloidosis↗
PubMed2000

Amyloid goiter with parathyroid involvement: a case report and review of the literature.

Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, diffuse enlargement of the gland secondary to infiltration by amyloid is infrequent. We report the pathologic findings in a case of primary amyloid goiter with involvement of a parathyroid gland in an euthyroid patient who presented to his physician with an enlarged thyroid, upper airway obstructive symptoms, and dysphagia. The clinical features of amyloid goiter, including difficulties in preoperative diagnosis and management, are discussed.

Adult↗
PubMed1977

Painless thyroiditis and transient hyperthyroidism without goiter.

Eight women had painless thyroiditis, transient thyrotoxicosis, and low radioactive iodine uptakes but were without goiter; they constituted 15% of all thyrotoxicosis cases that we saw during the past year. Standard antithyroid antibody tests by tanned erythrocyte hemagglutination, complement fixation, and colloid and microsomal fluorescence, if present initally, were only weakly psotivie and became negative by 9 months. However, human antithyroglobulin antibody levels by a sensitive radioimmunoassay were elevated initially in all patients. In general, these radioimmunoassayable antibody levels fell, but they had not returned to normal by 9 months. Serial thyroid function tests and standard antithyroid antibody tests were most compatible with subactue thyroidtis. However, the persistence of radioimmunoassayable antithyroblobulin antibodies and recent reports of histologic evidence of lymphocyte thyroiditis in similar patients with goiter leaves open the possibility that this is a previously unrecognized presentation of chronic lymphocytic thyroiditis. Neither the cause nor the ultimate course of this syndrome is known.

Adult↗
PubMed2006

Primary intrathoracic goiter -a rare mediastinal tumor.

Primary intrathoracic goiter is a rare presentation of thyroid disease. Its removal usually necessitates thoracotomy or sternotomy. This patient having a primary intrathoracic goiter presented with posterior mediastinal mass that was removed through a right lateral thoracotomy.

Diagnosis, Differential↗
PubMed1998

[Prenatal diagnosis of fetal goiter revealing iodine utilization defect].

We report on a case of fetal goitrous diagnosed on ultrasonogram done at 31 weeks of gestation. Thyroid maternal function was normal and no therapeutic was responsible. Hormonal test done on cord blood supported diagnosis of prenatal hypothyroidism. The infant was born prematurely at gestation age of 34 without antenatal treatment. He was eutrophic with clinical and biological signs of hypothyroidism and a large goiter. Therapy with thyroxine was instituted on the third day of life. At 9 months, growth and development are normal. Congenital hypothyroidism has an incidence of approximately 1 in every 4000-5000 live births. Rarely fetal goitrous hypothyroidism have been attributed to thyroid hormone dyshormonogenesis. When fetal goiter is diagnosed on ultrasonography, without maternal hypothyroidism or therapeutic and when hypothyroidism is confirmed on fetal blood, this diagnosis must be suspected.

Female↗
PubMed1998

[Epidemiology of endemic goiter in Tuscany].

In the present study, the data of epidemiological surveys carried out in Tuscany from 1981 to 1993 in schoolchildren population (6-14 years) residing in extraurban hilly and mountain areas are reported. Mild iodine deficiency and high prevalence of goiter were documented in the epidemiological surveys carried out up to 1990. An increase in urinary iodine excretion with a dramatic decrease in goiter prevalence was documented in the more recent surveys, independently from iodine prophylaxis. The results observed in Garfagnana and in Val Tiberina after the implementation of iodized salt confirmed the necessity to promote prophylaxis programs extended to the entire population.

Adolescent↗
PubMed1998

[Widespread endemic goiter and iodine deficiency in the province of Avellino].

1352 schoolchildren between 6-14 years old (699 males and 653 females) and 943 adults (176 males and 767 females) from eight villages of the province of Avellino were studied. All subjects were examined for thyroid size by at least two expert examiners. In most of them urine samples were collected for iodine determinations. 387 schoolchildren and 161 adults from Flumeri and Villanova were evaluated by thyroid echography. The prevalence of goiter was from 23.5 to 52.2% and the median urinary iodine excretion was from 42.3 to 66.2 micrograms/l in schoolchildren. In adults the prevalence of goiter was from 41.2 to 86.7% and the median urinary iodine excretion was from 37.1 to 53.7 micrograms/l. Our data showed a degree of iodine deficiency from low to moderate. The echography permitted to point out a greater prevalence of nodules than the thyroid palpation.

Adolescent↗
PubMed1999

Minireview: discussion about the limit between normal thyroid goiter.

Although the goitre seems to be well defined at least from clinical point of view, it is virtually impossible to find the precise definition of the opposite side of what should be the normal thyroid as concerns its size, histological structure and namely the level of growth stimulation by the external factors (such as TSH) and intrinsic tissue growth factors. Theoretically, the normal thyroid should be able to cover the requirements of the organism for the hormone in a reasonably large range without being stimulated to grow by any external or internal factors. So far, the search for normal thyroid has been conducted by several ways: 1. by post mortem thyroid weight, 2. by palpation, 3. by ultrasound. As based on post mortem thyroid weight, until the middle of this century a typical thyroid gland was considered to be about 20-25 g with the accepted upper normal size of 30 g, while more recent studies in iodine replete population have reported mean weights of about 10 g and an upper normal size 20 g. According to several classifications for thyroid palpation the unpalpable thyroid should be allotted to the Grade 0 which is defined as "normal gland", "no goiter at all", "absence of goiter" etc. The first recommendation of normal thyroid volume for children and adolescents as estimated by ultrasound has been developed by Gutekunst and Teichert (1994). However, this was later challenged by the findings of considerable number of thyroid volumes which were higher than the upper limit of that recommendation as found in the countries with satisfactory values of urinary iodine (Delange et al. 1997). Nevertheless, recently it appeared that about 10-15 percent of adolescent thyroids show increased thyroid growth rate which significantly differs from the majority and which might be related to different tuning of molecular growth mechanism presumably of genetic origin (Tajtakova et al. 1998; Langer et al., in press). From, this follows that a certain number of enlarged thyroids apparently should not be included into a normal range.

Adult↗
PubMed1998

[Prevalence of simple sporadic goiter in relation to other non-neoplastic thyroid pathologies in an internal medicine department].

BACKGROUND AND AIM: Thyroid pathologies, in particular goiter, are commonly found in everyday clinical practice in hospitalised patients. METHODS: The authors carried out a prospective type survey lasting 80 months in a mountain community with about 30,000 inhabitants with uniform socio-demographical characteristics. A total of 8,034 subjects (4,131 males and 3,903 females) were included in the study who were hospitalised in an Internal Medicine Department. All patients underwent screening using standard diagnostic criteria. RESULTS: Thyroid pathology was identified and classified into its various forms. There was a net prevalence of goiter which, owing to the unique features identified by the study, was defined as the sporadic form. The study demonstrated a marked prevalence in females, the familial pattern, the homogeneity of distribution throughout the area, the progression of disease with age and its evolution into immersed forms, the prevalence in both sexes in adults, the frequent use of surgery and its inherent problems, the inadequacy of treatment. CONCLUSIONS: The authors affirm that this pathology is regularly underestimated because it is not adequately identified, treated and monitored. They suggest a clinical and methodological approach based on a correct nosological definition, adequate diagnostic and prognostic stratification, an appropriate therapeutic protocol and clinical controls performed over time.

Adult↗
PubMed1999

[Pathogenesis, surgical treatment and prophylaxis of goiter recurrence].

The causes of the nontoxic goiter recurrency occurrence, the prophylactic methods and the results were analysed according to the data obtained while examination and treatment of 115 patients. The autoimmune damage of a leaved thyroidal gland remnant constitutes one of the causes of the genuine recurrency of goiter.

Adult↗
PubMed1999

[The iodine allowance and the prevalence of goiter among the children in organized collectives in the city of Kemerovo].

Nutritional value of diets given to children attending kindergartens and schools in Kemerovo according to specified menu (proteins, vitamins, minerals) has been studied. The unbalance in diet ration leading to development of iodine deficiency in children of these institutions is responsible for high incidence of goiter. The level of iodine deficiency is 34.0% in kindergartens and 78.2% in boarding schools. High occurrence of goiter in children's institutions should be considered in planning antigoiter preventive measures.

Child↗
PubMedDate not supplied

[An acute superior mediastinal syndrome with critical tracheal stenosis due to benign multinodular goiter complicated by intracystic hemorrhage].

Large benign goiter with a cervical and intrathoracic retrotracheal location is uncommon, but troublesome, since it affects the upper mediastinum and usually causes dyspnea, dysphagia or vascular obstruction; on the other hand, a large mediastinal cyst of thyroid origin complicated by a massive, spontaneous hemorrhage is an exceptional event, implicating vital prognosis through an acute tracheal compression. A 45-year-old-man presented all these complications of a previously neglected nodular-cystic goiter, causing an acute respiratory distress. An emergency diagnosis and consequent surgery, in delayed urgency, were performed. This case is presented because of its rarity. Its clinic management is discussed, in the framework of the existing literature.

Acute Disease↗