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PubMed1978

Thyroglobulin complementary DNA as a means to investigate congenital goiters with impaired thyroglobulin synthesis.

A congenital goiter with impaired thyroglobulin synthesis has been investigated for the presence of messenger RNA coding for thyroglobulin. Using complementary DNA to beef 33 S thyroglobulin mRNA as a probe, we have found that thyroglobulin related sequences are present in the goiter but at a concentration lower than in normal human thyroids. We conclude that the disease is not due to a complete deletion of thyroglobulin gene.

Animals↗

PubMed1983

Substernal and intrathoracic goiter. Reconsideration of surgical approach.

Thirty-one patients were operated on for benign thyromegaly extending to the thorax in an 11-year period at the University of Alabama in Birmingham. Neck mass (65%), dysphagia (36%), and dyspnea (32%) were the most common symptoms. All patients were euthyroid. Five patients had previous thyroid surgery. A thyroid scan was performed on 24-patients. Fourteen (58%) suggested a thoracic extension while ten (42%) failed to identify a thoracic extension. The indications for resection were increasing symptoms, increasing size despite the use of dessicated thyroid therapy, and to establish a diagnosis. The left thyroid lobe extended into the thorax more frequently (70%) than the right. Most patients had multinodular goiter (94%). Three patients had occult carcinoma (10%) and two patients had Hashimoto's disease. Median sternotomy combined with a collar incision to provide exposure for excision of intrathoracic thyroid extension was used in six patients. There was no operative mortality. There was no increase in operative morbidity and a slight increase in average stay from 5.3 days with a collar incision alone to 6.8 days with the combined incisions. Median sternotomy does not increase morbidity or mortality. Specific indications for more liberal use of sternotomy extension of a collar incision are proposed for the management of substernal and intrathoracic goiters.

Adult↗

PubMedDate not supplied

Structure-function relationship in euthyroid goiter (an electronmicroscopical study.

The authors studied the structure-function relationship at the ultrastructural level in euthyroid goiter. Following results were found: small and short microvilli at the apical cell surface: irregular, elongated cisternae of rough endoplasmic reticulum and lysosomes of varying size, sometimes associated with globules or colloid droplets in form of phagolysosomes; irregular, swollen mitochondria, sometimes with a central empty area or an electron-dense amorphous core. The authors concluded that the euthyroid goiter is characterized by a slightly impaired hormone synthesis in the rough endoplasmic reticulum, a damaged mechanism of hormone transport within the cell and respiratory disturbances of the thyreocyte.

Adult↗

PubMed1978

[The current status of endemic goiter in Upper Adige and the necessity for iodine prophylaxis].

That the province of Bolzano is still endemic for goiter is shown by its low drinking water (0.75 microgram/1) and food iodine values, and the observation of goiter in 48% of its school-children, coupled with a mean urinary iodine level of 35.95 microgram/g creatinine. Prophylaxis with iodinated salt (2 g/100 Kg) is being undertaken. Legislative provisions designed to render this more effective by encouraging its diffusion are proposed.

Goiter, Endemic↗

PubMed1995

[May recurrent goiter be resected bilaterally? Value and results of intraoperative laryngoscopy].

Operations for recurrent goiter are considered to range among the most difficult procedures in thyroid surgery and are marked by unusually high subsequent damages of the recurrent nerve. Results from 89 patients with recurrent goiter operated over the last six years and our own experiences with intraoperative laryngoscopy are presented. This procedure is applicable in 60% of all cases with true bilateral thyroid recurrency and accounts for a realistic help in deciding whether to continue the operation with simultaneous resection of the contralateral side.

Cicatrix↗

PubMedDate not supplied

[Endemic goiter in Moscow and Moscow region].

Goiter prevalence and iodine excretion levels were assessed in schoolchildren aged 9 and 13 in the city of Moscow (n = 91) and the Moscow region, 60 km East of Moscow (n = 92). Goiter prevalence was evaluated by ultrasonography. In Moscow it was found to be 31.1% among children aged 9 and 17.5% among those aged 13. The respective values in the Moscow region were 47.2 and 39.3%. Medium urinary iodine levels were 6.9 to 7.5 micrograms/dl in Moscow and 4.1 to 5.4 micrograms/dl in the region. According to modern criteria, iodine deficiency in Moscow may be regarded as mild and in the region as moderate. Control programs are urgently needed tc prevent development of iodine deficiency disorders.

Adolescent↗

PubMedDate not supplied

Surgery for thyroid goiter in western India. A prospective analysis of 334 cases.

334 consecutive cases of thyroid swellings operated by a single surgical unit over 9 years have been analysed prospectively. There was a female preponderence (4.39:1). The swellings were clinically differentiated into uninodular (39.52%), multinodular (47.31%) and diffuse (13.17%). Hyperthyroidism was manifested in 49 cases (14.67%). Pressure symptoms were present in only 1.5% cases. FNAC detected malignancy in 14 of 162 cases (8.64%). The initial 100 cases were operated upon by standard Lahey's technique and the latter 234 by modified technique described by Bapat et al for benign thyroid disease. Operations performed included nodulectomies (5.39%), hemithyroidectomies (41.92%), partial thyroidectomies (25.75%), subtotal (25.45%) and near total thyroidectomies (1.5%). Post-operative complications were higher in the first group and included unilateral cord palsies-5 (5%). hypocalcemia-4 (4%) hypoparathyroidism-1 (1%) haemorrhage-1 (1%) and mortality-1 (1%) vis a vis cord palsies-2 (0.85%), hypocalcemia-3 (1.28%), hypoparathyroidism-1 (0.43%) and there was no mortality. Histopathology revealed 83 (24.85%) colloid goiters, 193 (57.78%) nodular goiters, 21 (6.29%) follicular adenomas, 7 (2.10%) cases of thyroiditis and 30 (8.98%) malignancies. This study reveals the lower incidence of RLN palsy after modified thyroidectomies, and a low incidence of malignancy.

Adolescent↗

PubMed1993

A case report of substernal goiter.

A case of substernal goiter is reported. A 78-year-old female was admitted to our hospital with no symptoms. Chest roentgenography on admission showed that a mass of 3 by 5 cm in size with calcification located in the substernal region. Computed tomography of the chest and aortography revealed that the mass was attached to the trachea, but the connection to the great vessels was not clear. Pathological findings of the incisional biopsy specimen showed thyroid tissue with no evidence of malignancy. Our clinical diagnosis was substernal goiter. Surgery was not carried out in this case, based on the literature. Surgery is indicated in case of malignancy or in cases with severe illness such as respiratory disorder and superior vena cava syndrome.

Aged↗

PubMed1993

[Effects of iodized salt in the treatment of endemic goiter in school children in a rural environment in Cameroon].

The efficiency of iodized salt in Cameroon has been tested during 7 months in school children living in an endemic goitrous area. The salt contained 150 mg of iodine per kilogramme of salt when it left the production site. The regression rate of goiter was 84.0% and was not different from that obtained with a single oral administration of 240 mg of iodized oil to an age and sex matched population. Excretion of iodine in urine increased significantly (P < 0.05). Eight biochemical cases of thyroid dysfunction (7 cases of hypothyroidism and 1 case of hyperthyroidism) were observed. However these observations do not preclude the use of iodized salt in the prevention and the treatment of goiter in endemic areas.

Adolescent↗

PubMed1994

[Diffuse hyperthyroid goiter associated with occult papillary carcinoma of the thyroid. Report of 2 cases].

The association of diffuse hyperthyroid goiter and thyroid cancer is rare and interesting, considering that both diseases affect the same organ but have different pathogenesis and prognosis. We report two patients that consulted for diffuse hyperthyroid goiter and were subjected to a subtotal bilateral thyroidectomy due to antithyroid drug failure. Pathological study revealed the coexistence of diffuse gland hyperplasia and a papillary thyroid carcinoma of less than 7 mm phi. In both cases, the thyroid remanent was ablated with radioactive iodine during the postoperative period and thyroid substitution was started.

Adult↗

PubMed1994

[Scintigraphy of parathyroid adenomas with 99mTc-sestamibi in an endemic goiter area].

Recently 99mTc-Sestamibi (MIBI) has been introduced into parathyroid imaging. The purpose of this study was to evaluate the MIBI scan in an endemic goiter area. 25 patients with primary and 9 with secondary hyperparathyroidism (HPT) underwent a MIBI scan one day prior to surgical exploration of the neck. Cervicothoracic planar scintigraphy was performed 5, 15 and 120 min after i.v. injection of 444 MBq of 99mTc-Sestamibi. The MIBI scan correctly detected 20 of 25 adenomas in 25 patients with pHPT. In only 6 of 9 patients with parathyroid hyperplasia a focal uptake was found. The cause of one false-positive result in the control group was an increased MIBI uptake by a follicular adenoma of the thyroid. Parathyroid scintigraphy using 99mTc-Sestamibi as a single radiopharmaceutical is as sensitive in detecting and localizing parathyroid adenomas as the Tl/Tc-scintigraphy. Due to a high prevalence of thyroid adenomas in an endemic goiter area a higher rate of falsely positive results may be expected.

Adenoma↗

PubMed1993

[An experimental study on casein in the prevention of excessive iodide induced goiter].

We systematically studied the effect of 50% casein diet on iodide goiter by surveying the changes of thyroid weight, thyroid iodine content, thyroid histology, thyroid peroxidase activity, serum thyroid hormones and TSH concentration in mice fed with excessiodine water. The results showed that 50% casein diet could significantly inhibit iodide goiter. The probable mechanism could be related to the casein which reduces the excess iodine entrance into the thyroid cells and decreases the excess colloid formation in the follicular lumen.

Animals↗

PubMedDate not supplied

[The usefulness of thyroxine treatment after subtotal thyroidectomy for endemic goiter].

The aim of the present study was to assess the appropriateness and value of prophylactic thyroxine therapy in the treatment of postoperative complications (relapse, postoperative hypothyroidism) following subtotal thyroidectomy for endemic goiter. The study was carried out in a group of 139 patients undergoing subtotal thyroidectomy for endemic goiter between 1978 and 1987. Clinical follow-up included hematochemical and scintigraphic analyses. Patients were divided into two groups. The first group included 74 patients who received postoperative hormone replacement therapy. The second group of 65 patients did not receive any treatment. results show that hormone replacement therapy is unnecessary in most cases since the majority of patients require euthyroid values a few months after operation. Thyroxine therapy was indicated, however, in cases of clinically evident postoperative hypothyroidism which persisted during follow-up.

Adult↗

PubMed1993

[Human thyroid gland DNA methylase in nodular and diffuse goiter].

The heterogeneity and some properties of DNA-methylases isolated from nonmalignant human thyroid formations--nodular and diffuse goiters--have been studied. Isoelectrofocusing of methylase preparations produced 6-7 distinct activity peaks distinguished by pI, activity towards Ca2+ and Mg2+, sensitivity towards dithiothreitol and capacity to methylase cytosine into mono-, di- and tripyrimidine blocks in vitro. The degree of DNA methylation in vivo depended on the origin of of the goiter. Analysis of several methylase fractions by two-dimensional electrophoresis performed according to O'Farrell revealed the presence of major polypeptides having similar molecular masses (approximately 36 kDa). Besides the major component, all the preparations under study contained 6-10 characteristic minor components. The data obtained are suggestive of a structural and functional heterogeneity of human methylases.

DNA Modification Methylases↗

PubMed1996

Optimal laboratory testing for diagnosis and monitoring of thyroid nodules, goiter, and thyroid cancer.

Optimal use of laboratory tests to diagnose and monitor patients with goiter, thyroid nodules, or thyroid cancer requires an appreciation of the pathophysiologic factors implicated in thyroid hyperplasia and neoplasia: growth factors (especially thyrotropin, TSH), growth-stimulating immunoglobulins, activating mutations of the TSH receptor, and other oncogenic transformations. In patients with diffuse goiter and thyroid nodules, serum TSH measurement in a highly sensitive assay excludes both primary hypothyroidism and common causes of thyrotoxicosis. In selected patients, screening for anti-thyroid peroxidase with or without anti-thyroglobulin antibodies can confirm the diagnosis of autoimmune thyroiditis. Serum calcitonin measurement is appropriate only when medullary thyroid carcinoma (MTC) is clinically suspected. Laboratory testing is essential in management of thyroid carcinoma patients after primary surgical therapy. Serum TSH measurement is vital to ensure that thyroxine replacement and TSH suppression are adequate in treatment of epithelial cancers. Serial monitoring of serum thyroglobulin (Tg) can detect tumor recurrence and quantify tumor burden. Interpretation of serum Tg results requires an appreciation of certain technical considerations (e.g., anti-Tg antibody interference) and the patient's concurrent TSH status. Periodic serum Tg measurements and 131I scans are complementary monitoring techniques. Serum calcitonin measurement and screening for ret protooncogene mutations are both valuable for identifying individuals with MTC.

Diagnosis, Differential↗

PubMedDate not supplied

[Interventional radiology in postoperative recurrent goiter].

Roentgeno-endovascular functional thyroidectomy was used to suppress the pathological activity of the thyroid in postoperative recurrent goiter. The method consists in vascular isolation of hyperplastic stump of the thyroid by catheterization of the left and right thyroid arteries, followed by their material occlusion. For embolization, a wide spectrum of nonlysed synthetic, organic, and inorganic materials were used. The results of roentgeno-endovascular functional thyroidectomy in 14 patients with postoperative recurrent goiter are analyzed. The advantages of roentgeno-endovascular occlusion of the thyroid arteries before subtotal thyroidectomy are emphasized. A stabile clinical and hormonal remission and reduction of the thyroid in size to stage 1 were observed during three years following roentgeno-endovascular intervention.

Adolescent↗

PubMedDate not supplied

[Total thyroidectomy in the treatment of multinodular toxic goiter].

The Authors report their experience in the management of 201 patients with multinodular toxic goiter (MTG): 122 (60.7%) underwent subtotal thyroidectomy (STT), while 79 (39.3%) underwent total thyroidectomy (TT). Through a retrospective study the patients were stratified into two groups according to the type of operation (TT or STT). Overall, neither operative mortality nor recurrent nerve damage were encountered. Permanent hypocalcemia was observed in 7 patients (5.7%) who underwent STT and in 6 patients (7.5%) who underwent TT (p=N.S.), while transitory hypocalcemia was observed in 12 cases (9.8%) in group I and 11 cases (13.9%) in group II (p=N.S.). All patients were followed every 4 months for the first year and every 6 months thereafter. Average and median follow-up period were, respectively, 72 and 74 months. The Authors conclude that total thyroidectomy is the surgical treatment of choice in multinodular toxic goiter (MTG). A thorough anatomical-surgical evaluation is essential in order to prevent the complications characteristic of this type of surgery (inferior laryngeal nerve injury and hypoparathyroidism).

Adolescent↗

PubMed1995

[Non-toxic nodular goiter: treatment and follow-up].

Between 1982 and 1993, 224 patients (196 females and 28 males) with benign lesion of the thyroid underwent surgery. This group included: 1) 210 pts with p multinodular goiter or solitary nodule with normal serum levels of T3, T4, FT3, FT4, TSH (Thyroid stimulating hormone; 2) 14 pts with a hyper-functioning goiter; 3) 12 pts with recurrent nodules following surgery which had been carried out in another hospital. In this study only those pts with solid cold (hypofunctioning) nodules which had not been treated previously were evaluated. The minimal follow-up was 18 months. It consisted of serologic studies (86 cases), ultrasonography (70 cases) and ultrasonography and scintigraphy (5 cases). We performed isthmusectomy in 2 cases, total lobectomy in 42 cases and subtotal thyroidectomy in 42 cases. Out of the 86 pts evaluated, 70 (81.3%) were treated with post-surgical hormone suppressive therapy (Levothyroxin 100 gamma daily). The endogenous thyroid stimulating hormone (TSH) was suppressed in 50 cases (71%), while 20 pts (28.5%) remained within the norm. Thyroid ultrasonography demonstrated recurrent nodules in 14 out of the 86 evaluated (16.2%). All these pts received thyroxine therapy. Among the 50 pts who had been treated with an adequate dose of thyroid hormone, 5 had recurrences (10%), as compared to 3 out of the 20 cases (15%) who had been administered thyroxine dosage not high enough to suppress THS and to 6 pts out of the 16 (33.5%) who had not been administered thyroid hormone. One out of the 20 pts (5%) who had undergone total lobectomy and post-surgical suppressive hormone therapy developed recurrence as compared to 6 out of the 24 pts (25%) who had under gone lobectomy and had been administered a hormone dosage which was not high enough to suppress TSH. Four out of the cases (13.3%) who had under gone subtotal thyroidectomy and post-surgical suppressive hormone therapy had recurrence as compared to 3 out of the 12 (25%) who had undergone subtotal thyroidectomy without TSH suppression. We conclude that treatment with thyroid hormone decreases the risk of benign recurrences only when undergone a long thyroxine therapy in doses high enough to suppress endogenous TSH.

Aged↗