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PubMed1999

[Total thyroidectomy in surgical treatment of euthyroid goiter].

BACKGROUND AND AIMS: The aim of this study was to compare the experiences and results achieved by a single surgeon using total thyroidectomy and partial exeresis in the treatment of uni- and multinodular euthyroid goiter. METHODS: The results of two groups of operations performed at two different periods were analysed: a more recent group (1995-97) in which management tended to prefer total thyroidectomy, and a retrospective group (1984-1994) in which a more conservative attitude was adopted to benign thyroid pathology. RESULTS: An analysis of the results and complications in each group showed that there were no statistically significant differences between the percentage of recurrent and parathyroid lesions during total thyroidectomy and partial exeresis. In practice, the risk of these lesions is higher during redo surgery for cancer and/or recurrence. The recidivation of goitrogenic pathology is high, amounting to around 29% of total cases. The most significant findings, however, which further justifies the use of total thyroidectomy is the increasingly frequent observation of "occult carcinomas" within the benign pathology, registered in the retrospective group (13.27%) and in the more recent one (12.35%). CONCLUSIONS: On the basis of this analysis, the authors confirm their support for the use of total thyroidectomy on principle as the correct and rational treatment for euthyroid goiter, and reserve the use of conservative treatment for single nodular lesions where it is possible to perform a correct hemithyroidectomy and isthmectomy following the patient's informed choice.

Adult↗
PubMed1997

[Surgery of substernal thyroid goiter].

A retrospective study on 87 substernal thyroid nodules operated between 1965 and 1994 was made. Among them 73.6% were goiters, 14.9% adenoma and 11.5% malignancy. Resection via cervical collar incision was performed in 70% of all cases, sternotomy in 16% and thoracotomy in 14%. A cervical collar incision was adequate in 91% of 43 cases after 1985, only one goiter was completed by sternotomy. Morbidity rate of complications was 41.4%, while the rate of recurrent laryngeal nerve paralysis was 20.7%. Surgery via cervical collar incision for all retrosternal thyroid nodules was advised and sternotomy or thoracotomy are suggested.

Adenocarcinoma, Follicular↗
PubMed2000

[A case of ascending aortic aneurysm with intrathoracic goiter].

A case of the successful operation for ascending aortic aneurysm and intrathoracic goiter was described. A 71-year-old woman was admitted to our hospital for the treatment of ascending aortic aneurysm disclosed by the examination in another hospital. Preoperative chest CT showed ascending aortic aneurysm as large as 8 cm in diameter, and an upper mediastinal tumor compressing the main bronchus. The tumor was continuous with the right lobe of the thyroid. The excision of the tumor was performed through median sternotomy with cervical collar incison. After that, the replacement of the ascending aorta was carried out under cardiopulmonary bypass and hypothermic circulatory arrest. The histological examination of the resected specimen revealed adenomatous goiter without malignancy.

Aged↗
PubMed2000

[Treatment with (131)I of toxic multinodular goiter. Assessment of a fixed dose protocol].

OBJECTIVE: Present the results of treatment with 131I in a cohort of 119 patients diagnosed of toxic multinodular goiter (TMG) from a specific geographic area who had been treated with fixed doses of isotopes (555 MBq). The indication for the administration of the 131I was hyperthyroidism correction in all of the cases. MATERIAL AND METHODS: 111 of the 119 patients treated were women (93%) and 8 were men (7%) and their ages ranged from 38 to 88 years. The follow-up periods were always greater than one year (1.78 +/- 1.05 years). Treatment with thyroid medication was discontinued in all of the patients at least 7 days prior to the administration of the isotope. RESULTS: 93 (78.1%) of the 119 patients remained euthyroidic, 10 (8.4%) presented hypothyroidism, 11 (9.2%) hyperthyroidism and 5 (4.2%) had sub-clinical levels of hyperthyroidism at the end of the follow-up period. No statistically significant relationship were found between hypothyroidism, gender and previous administration of thyroid medication. CONCLUSIONS: The use of 131I is an alternative to the treatment of TMG produced hyperthyroidism. The fixed doses of 555 Mbq that we propose are comfortable, make it unnecessary for the patients to travel in extensive geographic areas and produce a low rate of hypothyroidism. In our opinion, the differences in the iodine content of the diets that continue to exist are one of the factors that could influence in the differences in results observed in the different series, although other factors, such as the size of the goiter and the heterogeneity of the radioisotope uptake can contribute to the variations found in our patients.

Adult↗
PubMedDate not supplied

Effect of different drugs on the level of DNA-hydrolyzing polyclonal IgG antibodies in sera of patients with Hashimoto's thyroiditis and nontoxic nodal goiter.

BACKGROUND: DNA-hydrolyzing IgG antibodies have been detected recently in the sera of patients with several autoimmune diseases. MATERIAL AND METHODS: The relative activity of DNA-hydrolyzing IgG from the sera of patients with Hashimoto's thyroiditis and with non-toxic nodal goiter as a function of the patient's condition were measured. The effect of different drugs on the level of DNA-hydrolyzing IgG, functional activity of thyroid gland, and improvement of clinical condition of two groups of patients were analyzed. RESULTS: We demonstrate here for the first time that IgG from peripheral blood of patients with Hashimoto's thyroiditis (65%) and non-toxic nodal goiter (38%) possesses DNAse activity. The relative level-specific activity of IgGs in hydrolysis of DNA increases with the enhancement of the relative amount of antibodies against thyroglobulin and all patients with hypothyroidism (namely a reduced concentration of thyroxine and triiodothyronine and enhanced level of thyrotropic hormone) are characterized by a high level of catalytic antibodies. CONCLUSIONS: The very widely used therapy of patients with thyroxine led only to a temporary change of the hormone concentration in the blood but did not affect the level of DNA-hydrolyzing antibodies. However, treatment with an immunosuppressive drug plaquenil (7-chloro-4(beta-diethylamine-alpha-methylbutylamie)quinoline), significantly decreased the DNA-hydrolyzing activity of Abs, which correlated with enhancement of thyroid hormone concentrations, elevation of functional activity of the thyroid gland, and improvement of the clinical state of the patients.

Antibodies, Antinuclear↗
PubMed1975

Substernal goiter with superior vena caval obstruction.

Substernal goiter with vena caval obstruction remains an interesting diagnostic and therapeutic problem. Since 85 to 90 percent of superior vena caval obstructions are due to a malignant disease, an intrathoracic goiter represents one of the benign, curable causes of this syndrome. This report describes the clinical course of a 44-year-old woman who presented with this entity and was successfully corrected by surgical intervention. A discussion of diagnostic, operative, and prognostic considerations is presented.

Constriction↗
PubMed1975

[Acute respiratory insufficiency caused by plunging goiter (author's transl)].

Acute respiratory insufficiency and unconsciousness are symptoms which may lead to misinterpretation. In cases of unclear acute respiratory insufficiency one should think of the rare plunging goiter with acute tracheostenosist, especially in female patients over 40 years. Diagnosis can easily be found if the patient is thoroughly observed. Resection of the retrosternal struma is the only possible therapy. One case of plunging goiter is described here.

Acute Disease↗
PubMedDate not supplied

[Treatment of euthyroid goiter in the elderly].

PURPOSE: A study was conducted to evaluate the effectiveness of the medical therapy with synthetic hormone levothyroxine (L-T4) in the elderly subjects with multinodular euthyroid goiter. PATIENTS AND METHODS: 187 elderly subjects (34 males and 153 females) ranging between 63 and 85 years of age with multinodular euthyroide goiter were examined. For each subject has been calculated the index of body mass (BMI) which has consented the identify two groups of subjects: the elderly patients with normal weight and the obese subjects. RESULTS: In the mostly of the patients (82%), both normal weight and obese, the L-T4 therapy has not determined significant changes either of the dimensions or the number of the nodules. In the obese subjects the L-T4 therapy has not caused decrease of weight at least to the 20% of the initial body weight. CONCLUSIONS: The results of the research have proved the limited effectiveness of the suppressive therapy with levothyroxine in the reduction of the volume and/or of the number of the nodules, without however denying the usefulness in the preventing the worsening of the nodular disease of thyroid. The study also has revealed that the therapy with levothyroxine is ineffective for the body weight reduction in the obese subjects.

Aged↗
PubMed2001

Amyloid goiter--a case report.

Microscopic infiltration of the thyroid gland by amyloid is an uncommon but well recognized phenomenon and significant enlargement of the thyroid due to deposition of amyloid is rarely seen. This condition has to be distinguished from other types of goiters and at times from malignancy. In spite of extensive involvement of the gland by amyloid, thyroid function usually remains normal. Here, we describe a rare case of amyloid goiter without amyloid deposits in any other organs of the body. The case presented in an unusual clinical settings of relatively rapid enlargement of thyroid with pressure symptoms and was unassociated with any immuno-proliferative or chronic diseases.

Amyloidosis↗
PubMed2001

[Recurrence of poly-nodular euthyroid goiter].

Results of surgical treatment of 93 patients with polynodular euthyroid goiter were studied. Influence of the operative intervention volume, morphological form of goiter and postoperative hormonal therapy conduction on the frequency of the recurrency occurrence was noted.

Adult↗
PubMed2002

[Esophageal transit and esophageal motility disorders in patients with nontoxic goiter and recurrent dysphagia].

Esophageal motor function was studied in 14 patients affected with diffuse and (multi)nodular nontoxic goiter, with dysphagia and neck discomfort, and in 10 age-matched controls without thyroid and/or gastroesophageal diseases. Esophageal manometry was employed to evaluate upper esophageal sphincter pressure (UESP) and lower esophageal sphincter pressure (LESP), amplitude, duration and propagation velocity of peristaltic contractions and the presence of simultaneous deglutitive pressure waves. Esophageal transit was evaluated by radioisotopical method, at different times, in proximal, middle and distal esophagus. LESP was significantly lower (p < 0.001) in goitrous patients compared with controls. No difference was, on the contrary, found in the UESP, esophageal peristaltic wave amplitude and duration. Significantly (p < 0.05) increased propagation velocity of the peristaltic contractions and the presence of simultaneous deglutitive pressure waves in distal esophagus were observed in goitrous patients. Esophageal transit delay was found early in proximal and middle, and, at all times, in distal part of the esophagus of nontoxic goitrous patients. It is concluded that esophageal transit delay, early in the upper and prolonged in the lower part of the esophagus, represents the main findings of the esophageal dysfunction in the patients with nontoxic goiter and dysphagia.

Adult↗
PubMed2002

Limited sensitivity of parathyroid imaging with (99m)Tc-sestamibi/(123)I subtraction in an endemic goiter area.

UNLABELLED: Double-phase single-tracer scintigraphy with (99m)Tc-sestamibi is now generally used for parathyroid imaging but, at least in endemic goiter areas, complementary thyroid scintigraphy is recommended. Although (123)I-sodium iodide is considered to be the optimal thyroid agent, it is hardly ever used because of high costs and logistic difficulties. Our study presents the results of using the (99m)Tc-sestamibi/(123)I subtraction technique in a region with a high goiter prevalence. Special attention was paid to the changes in sensitivity and specificity and their relationship to thyroid volume as well as to autonomous and nodular thyroid disease. METHODS: One hundred three scintigraphic parathyroid examinations on 96 patients were included in this study. Fifty-eight of all patients had concomitant morphologic or functional alterations of the thyroid. Initially, 10 MBq (123)I-sodium iodide were injected. Then, 150 MBq (99m)Tc-sestamibi were administered after 3-5 h, followed by planar scintigraphic imaging of the neck and upper chest region using a double-isotope technique. RESULTS: An area with increased tracer uptake on the subtraction image was found in 44 cases. Forty-three of them proved to be true-positive. No suspicious lesions were detected scintigraphically on the remaining 59 examinations. However, histologic examination revealed a parathyroid adenoma or hyperplasia in 11 of these cases. The mean parathyroid volume of these false-negative patients was 0.9 mL. Secondary hyperparathyroidism with multiple enlarged parathyroid glands was found in 4 of these cases. The sensitivity of the parathyroid scintigraphy was 80% (43/54) and the specificity was 98% (48/49). There was a distinct difference in the sensitivity between the subgroups with thyroid volumes of >15 mL and <15 mL (76% vs. 88%), although the resected parathyroid glands had a similar size in both subgroups. The specificity was 97% and 100%, respectively. No significant difference in the sensitivity and specificity was observed between the subgroups with and without morphologic or functional alterations of the thyroid (80% vs. 79% and 96% vs. 100%, respectively). CONCLUSION: The sensitivity of parathyroid imaging with (99m)Tc-sestamibi/ (123)I subtraction depends mainly on the thyroid and parathyroid volumes rather than on the presence of nodular or autonomous thyroid disease.

Female↗
PubMed2002

[Early results after minimal lobectomy for benign nodular goiter].

Following traditional operations (enucleation and subtotal resection) for benign nodular goiters recurrences may develop. Reoperations for this condition can cause complications, such as hypoparathyroidism and damage of the recurrent laryngeal nerve. That is why total thyroidectomy is recommended by many specialists in benign thyroid disease. We performed lobectomy on one side, and, if necessary, partial resection on the other side. Lobectomy was performed on one side in 31 cases, with partial resections on the other side in 73 patients. We tried to identify the parathyroid glands and both recurrent laryngeal nerves. Postoperative complications were evaluated. Temporary dysfunction of the recurrent laryngeal nerve was detected in 2.3%, permanent damage in 1.1%. Temporary hypocalcaemia developed in 16.4%, permanent hypocalcemia in 1.9%. Two reoperations were necessary for bleeding. Because of the low postoperative complication rate we recommend this method as an alternative to thyroidectomy for benign nodular goiters. We know that our favourable results can be compared with traditional subtotal resection and thyroidectomy when long term results of thyroid function and data about nodular recurrences will be collected.

Adult↗
PubMed1975

[Goiter with multiple recurrences].

An analysis of treatment of 38 patients with multiple recurrences has demonstrated that these are caused by various factors, a combination of several causes and predisposing factors being noted in the majority of patients. Most frequently, multiple recurrences develop in persons operated upon in young age. The clinic of multiply recurrent goiter is characterized by a great variety, and its diagnosis should be established basing on the complex investigation, using all up-to-date methods of study. A predominance of nodular forms of goiter in patients with multiple reocurrences and their frequent malignant transformation necessitate active surgical tactics.

Adult↗
PubMed2003

Influence of iodine deficiency and iodine prophylaxis on thyroid cancer histotypes and incidence in endemic goiter area.

The aim of the study was to evaluate the correlation between thyroid cancer histotype and incidence rate (IR) and iodine nutrition level in two endemic goiter areas: the districts of Krakow and Nowy Sacz. The suspension of iodine prophylaxis in Poland in 1980 resulted in increased goiter prevalence in schoolchildren and adults and elevated TSH levels in newborns in the early 1990s. Since 1992 a rise in thyroid cancer IR was observed. Thyroid cancer IR in the Krakow population was 2.22 in 1986; 3.62 in 1995 and 6.02 in 2001; in Nowy Sacz: 1.52; 2.59 and 3.88 respectively. In 1986 papillary/follicular cancer ratio in both areas was about 1.0--the value typical of iodine deficient areas. After restoring the obligatory iodine prophylaxis in 1997, a significant decrease in elevated TSH concentration in newborns and urinary iodine concentration increase in schoolchildren were observed. A relative rise in the incidence of papillary thyroid cancer and decrease in follicular cancer, resulting in rise in papillary/follicular thyroid cancer ratio up to 5.9 in 2001 was also observed. Since 1999 no further thyroid cancer IR increase was noted. In conclusion, a significant increase in differentiated thyroid cancer IR was observed in association with the iodine prophylaxis suspension. Changes in thyroid cancer histotypes in 1986-2001 and a significant decrease in incremental rate of differentiated thyroid cancer probably reflect the influence of effective iodine prophylaxis. The significant difference between IR of thyroid cancer incidence in the districts of Krakow and Nowy Sacz may be related to differences in the exposure to radiation after the Chernobyl accident.

Adult↗
PubMed2003

Thyroid abscess associated with a substernal goiter. Case report.

An abscess associated with an intrathoracic goiter is an extremely rare condition. The authors report a case of a thyroid abscess complicated by acute dyspnea and asphyxia in a patient of geriatric age with a substernal goiter. Surgical therapy was necessary to obtain a correct diagnosis and an effective treatment.

Abscess↗
PubMed2003

[Surgery of substernal thyroid goiter: 32 cases reported].

OBJECTIVE: To probe into the surgical approaches and operative techniques for substernal thyroid goiter. METHOD: In the way with operating on thyroid retrosternal thyroid tumour were removed via cervical collar incision and substernal thyroid cancer was partly removed via "perpendicular" shape cervical incision and tracheotomy. RESULT: The operations via cervical collar incision on 31 cases with substernal thyroid goiter have been carried out successfully. One thyroid cancer was partly moved via "perpendicular" shape cervical incision and tracheotomy, radiation therapy and isotope was adopted after operation, the patient survived above 5 years. Syndrome occurred in 9 cases (28.1%); recurrent laryngeal nerve were damaged in 5(15.6%), hemorrhage in 3(9.4%). CONCLUSION: Resection via cervical collar incision for all retrosternal thyroid nodules was advised and surgery for malignancy needs to be investigated.

Adenoma↗
PubMedDate not supplied

Clinical value of calcifications in thyroid carcinoma and multinodular goiter.

BACKGROUND: To confirm the predictive value of calcifications in thyroid nodules as a risk factor for malignancy and to detect aspects specific for tumours. MATERIALS AND METHODS: In a set of 196 patients (33 differentiated thyroid carcinoma, 9 follicular adenomas and 154 multinodular goiters with dominant nodule) calcifications were detected by ultrasound scan. RESULTS: Calcifications were significantly more frequent in differentiated thyroid carcinoma (DTC) than in benign diseases (DTC 39.4%, adenoma 11.1%, goiter 20.1%) but their considered characteristics (size, number, position, location in the gland, sonographic features of the nodule) did not show any particular difference between DTC and benign diseases. The frequency of calcifications in our series was higher in older patients (mean age 59.4 +/- 13.7 vs. 52.1 +/- 13.1 in patients without calcifications, p < 0.001) and this could imply that their onset is time-dependent. CONCLUSION: Calcifications can be a useful indicator of enhanced risk, to be considered in the overall diagnostic process.

Adenoma↗