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At least 1,189 records · Page 66Linked to original sources
PubMed1985

Environmental iodine intake affects the response to methimazole in patients with diffuse toxic goiter.

The response to methimazole [1-methyl-2-mercaptoimidazole (MMI)] therapy was evaluated in 18 patients with diffuse toxic goiter residing in an area of iodine deficiency (Tehran) and in 18 patients residing in an area of iodine sufficiency (Boston). The mean free T4 index (FT4I) decreased from 22.9 +/- 4.8 (+/- SD) to 4.9 +/- 4.3 in Tehran and from 23.8 +/- 5.2 to 17.0 +/- 4.1 in Boston after 4 weeks of MMI administration (10 mg, three times daily). The mean free T3 index (FT3I) decreased from 489 +/- 124 to 117 +/- 58 in Tehran and from 512 +/- 250 to 368 +/- 152 in Boston. In patients residing in Tehran, the FT4I was normal in 9 (less than 6.3 in 6), above normal in 1, and subnormal in 8 (44%) after 4 weeks of MMI treatment. In 4 of 8 patients with subnormal FT4I, serum TSH was also above normal, and clinical findings of hypothyroidism were evident. MMI (10 mg, twice daily) was then given to 15 additional patients with diffuse toxic goiter in Tehran. Mean FT4I values were 22.7 +/- 6.8, 12.1 +/- 2.5, 10.8 +/- 2.8, and 6.0 +/- 4.3 before and 8, 14, and 28 days after treatment, respectively. Corresponding mean FT3I values were 415 +/- 90, 196 +/- 36, 162 +/- 44, and 117 +/- 46. At 28 days, FT4I was subnormal in 7 (46%) patients, of whom 1 had increased TSH. These results indicate that treatment with recommended doses of MMI rapidly causes hypothyroidism in patients residing in Tehran, an area of iodine deficiency. Furthermore, they support the hypothesis that the dosage of thionamide compounds and the duration of therapy with the initial doses necessary to induce euthyroidism may vary in various parts of the world.

Adult↗
PubMedDate not supplied

Triiodothyronine antibodies in patients with goiter.

OBJECTIVE: To investigate the prevalence of triiodothyronine (T(3)) antibodies in patients with goiter, the influence of these antibodies on the results of thyroid hormone measurements, and the potential relationship between T(3) antibodies and thyroid autoantibodies. METHODS: We undertook a study of 100 healthy control subjects (80 female and 20 male subjects) who had no clinical or biochemical evidence of thyroid disease and 100 patients (81 female and 19 male patients) with goiter. Serum concentrations of total T(3), total thyroxine, free T(3), and free thyroxine were measured by radioimmunoassay kits with a coated tube method. An immunoprecipitation method was used to detect anti-triiodothyronine auto-antibodies. RESULTS: Patients with a T(3) antibody binding ratio +3 standard deviations (SD) above the mean for the normal control group were considered to have T(3) antibodies. Normal control group binding was 2.4 +/- 1.3%. On the basis of +3 SD, seven patients had T(3) antibodies. The mean serum total T(3) level was 1.61 +/- 0.1 nmol/L in patients with binding ratios above +3 SD, whereas the mean serum total T(3) level was 2.23 +/- 0.3 nmol/L in patients without T(3) antibodies. Thus, patients with a binding ratio above +3 SD had a significant decrement in total T(3) levels. No correlation was found between the presence of T(3) antibody and antimicrosomal and antithyroglobulin antibodies. CONCLUSION: When serum thyroid hormone concentrations are measured with a coated tube-radioimmunoassay method, antibodies can result in low T(3) concentrations. T(3) antibodies should be suspected whenever a discordance is noted between the measured thyroid hormone concentrations and the clinical status.

Journal Article↗
PubMed1976

Development of malignant goiter by defatted soybean with iodine-free diet in rats.

Hyperplastic goiters were observed frequently in female rats of Wistar strain when given defatted soybean under iodine deficiency for 6 to 12 months. The findings in the thyroid were those of malignant tumors in which the features of thyroid carcinomas were seen, accompanied with metastasis in the lungs of some animals. Enlargement of the thyroid was completely inhibited in rats when a small amount of iodine was added to the diet. The role of soybean factor(s) which causes enlargment of the thyroid is discussed in relation to the development of malignant goiter, together with pathological findings in the animals.

Adenocarcinoma↗
PubMed1976

[Extra-adrenal pheochromocytoma associated with bilateral diffuse-nodular hyperplasia of the adrenal cortex and micro-macrofollicular goiter].

At autopsy there was found extra-adrenal pheochromocytoma, bilateral diffuse-nodulous and adenomatous hyperplasia of the adrenal cortex in a female patient who had suffered for a long time from high arterial pressure. In the enlarged thyroid gland there was revealed micro-macrofollicular colloid goiter with basedowification. The morphological changes and results of an investigation of the liquor (drop in the content of potassium) justify the assumption that in this case there is a combination of extra-adrenal pheochromocytoma with hormonally active rearrangement of the adrenal cortex--primary hyperaldosteronism and basedowified goiter.

Adrenal Cortex↗
PubMed2000

[Lymphocytic colitis: hypopotassemia as a complication and an association with toxic multinodular goiter].

Lymphocytic colitis is a rare clinicopathologic syndrome, characterized by chronic watery diarrhea, diffuse inflammatory changes in the colonic mucous in spite of normal findings on colonoscopy and marked intraepithelial lymphocytic infiltration on biopsy. Although the physiological mechanism of diarrhea is not clear, patients do not usually present hydroelectrolytic alterations and the results of routine laboratory investigations are usually normal. The association between lymphocytic colitis and thyroid disease, possibly autoimmune, in the form of hypo- or hyperthyroidism is relatively common. We report a 61-year-old woman with a history of multinodular toxic goiter, whose previously uninvestigated chronic diarrhea became more acute and led to the diagnosis of lymphocytic colitis. Results of laboratory investigations revealed only a significant hypokalemia with an associated nonfunctioning bilateral adrenal incidentaloma. The patient evolved well when treated with sulfasalazine. Hypokalemia as a complication of lymphocytic colitis and an association between lymphocytic colitis and toxic multinodular goiter does not seem to have been previously described.

Acute Disease↗
PubMed1999

[The surgical treatment of toxic goiter in middle-aged and elderly patients].

Of 128 patients, ageing more than 60 years, polynodular toxic goiter was diagnosed in 84, diffuse toxic goiter--in 34, toxic adenoma--in 10. The nodules in thyroid gland (TG) were revealed in 94 patients, cancer--in 3. There were following indications for the operation: the lack of the thyreostatic therapy efficacy, the malignant-like nodules presence, compression of cervical and mediastinal organs. After the euthyreotic state achievement all the patients were operated on using endotracheal narcosis. Subtotal resection of TG was performed in 91 patients, thyroidectomy--in 27, hemithyroidectomy--in 10. The frequency of specific complications (n. recurrence damage, bleeding, hypoparathyroidism, the wound purulent complication) was 4.7%.

Aged↗
PubMed2001

[Electro-impulse therapy in combined treatment of patients with thyrotoxic goiter complicated by cardiac fibrillation].

Cardiac fibrillation was revealed at admission in 260 (5.2%) of 4996 patients who were to undergo subtotal resection of thyroid gland for toxic goiter. In 114 (43.8%) patients sinus rhythm was restored with drugs in preoperative period. Electroimpulse therapy was carried out in other 146 patients which was effective in 89% cases. Efficacy of electroimpulse therapy depended mainly on the arrhythmia duration. Restoration of sinus rhythm before operation in patients with toxic goiter improves conditions of preoperative preparation and decreases the risk of surgical treatment. There were no lethal outcomes.

Adult↗
PubMed2000

[The evaluation of goiter frequency and iodine prophylaxis efficiency in children population in Wielkopolska area from 1992 to 1998].

The aim of the study was to compare the current state and efficiency of iodine prophylaxis during the last six years. The study included 800 children from the rural and urban area (462 children in 1992 and 338 children in 1998) with the proportional sex and age (8-13 years) distribution, 24.936 newborns (9875 in 1992/1993 and 15.061 - mostly in the early part of 1998). The thyroid size (by USG), serum thyroglobulin (TG) concentration, urinary iodine (UI) concentration, %age of neonatal-TSH above 5 micro U/ml were evaluated using current ICCIDD and WHO criteria. The prevalence of goiter detected in children population in 1992 was 26% (recount by current criteria), in the early part of 1998 it was reduced to 21%. Parallelly, mean urinary iodine concentration increased from 49 micro g/l to 79 micro g/l. The reduction of goiter prevalence was associated with the reduction of mean serum thyroglobulin concentration from 26 ng/ml to 18 ng/ml. In the group of newborns the %age of TSH results above 5 micro U/ml decreased from 6 to 2.6%. Generally, the study proved significant increase of iodine prophylaxis efficiency in Wielkopolska Region in the period of the last six years, but it is still the area with mild iodine deficiency, which suggests the necessity of using other forms of iodine prophylaxis except for salt iodization. The obtained results suggest the necessity to extend the study on the role of other goitrogenic factors, which are probably present in the whole Wielkopolska Region.

English Abstract↗
PubMed1992

[The pathogenetic and clinical grounds for the advantages of nondrug procedures in the preoperative preparation of patients with diffuse toxic goiter].

An analysis of 615 patients operated upon for diffuse toxic goiter is presented. In 148 of them (24%) preoperative preparation was made with the help of nonmedicamental methods (extracorporal hemosorption, hyperbaric oxygenation (HBO), plasmapheresis). The state of euthyroidism was controlled according to their clinical symptoms and was verified by radioimmunological studies of triiodothyronine (T3), thyroxin (T4), thyrotropine (TTG). Indicators of corticosteroid hormones, thyrostimulating antibodies, antigenic HLA structure and antioxidative activity of different media of blood were also determined. The estimation of the data obtained as compared with results of morphological examinations allowed a conclusion that the above nonmedicamental methods in patients with diffuse toxic goiter are pathogenetically substantiated. Clinical expedience of their use is obvious. No lethal outcomes or complications resulted from using hemosorption and HBO. Single complications took place resulting immediately from catheterization of large venous vessels. Long-term results from 3 to 9 years have shown that recurrences of the disease in patients given nonmedicamental preoperative preparation were met much more rarely as compared with patients who obtained routine preparation (1.4% and 5.4 correspondingly).

Combined Modality Therapy↗
PubMedDate not supplied

[The characteristics of craniocerebral trauma in diffuse toxic goiter].

The specific features of craniocerebral trauma in diffuse toxic goiter were studied from analysis of 34 cases. The craniocerebral trauma aggravated the course of diffuse toxic goiter with the development of thyreotoxic crises in the first days after the trauma in one of five patients. The therapeutic tactics in thyreotoxic crisis and the preoperative and postoperative management of patients are discussed.

Adult↗
PubMedDate not supplied

[Diffuse toxic goiter].

Diffuse toxic goiter is a common disease of the thyroid gland. As organospecific autoimmune condition the disease is not infrequently combined with endocrine ophthalmopathy and in this connection a more precise preparation of the patients to surgery is found to be mandatory. Elderly persons demonstrate atypical patterns of the disease course (insignificant enlargement of the gland, manifest depression, isolated cardial disorders without other symptoms of thyrotoxicosis, resistance to thyrostatic treatment). The patients need a life-long dispensary follow-up as diffuse toxic goiter is a condition of a relapsing type.

Aged↗
PubMed1992

[A case of complete mediastinal thyroid cancer: aberrant goiter].

A 65-year-old man was admitted with the chief complaints of hoarseness and an abnormal mass shown by chest x-ray films. CT scan, MRI, thyroid scintigram, and angiogram showed a right upper mediastinal tumor. This was histologically diagnosed as malignant mediastinal goiter by percutaneous needle biopsy. Operation was performed using a collar incision and median sternotomy. The tumor was located in right upper mediastinum and had no relation to the cervical thyroid gland. It was 7 x 5 x 3.5 cm in size. Histological examination revealed papillary adenocarcinoma of the thyroid gland. To our knowledge, 17 cases of complete mediastinal malignant goiter have been reported in Japan, including our case. These 17 patients are reviewed with regard to their clinical features in this article.

Adenocarcinoma, Papillary↗
PubMedDate not supplied

A somatic mutation in the thyrotropin receptor gene in a patient with an autonomous nodule within a multinodular goiter.

Thyrotropin (TSH) is the prime regulator of thyroid cell growth and function and acts through the thyrotropin receptor (TSHR) located on the surface membrane of thyrocytes. Somatic heterozygous mutations that cause TSHR activation in the absence of TSH have been found in toxic adenomas and in hot nodules of multinodular goiters. Clinically and histologically heterogeneous nodules can share common gain-of-function mutations. Mutation prevalence varies greatly and is inversely related to iodine intake of the population. We report a Greek patient presenting with subclinical hyperthyroidism due to a fast-growing autonomous hyperplastic nodule in a long-standing multinodular goiter. Direct DNA sequencing showed that the hot nodule harbored a somatic heterozygous activating TSHR mutation: substitution of glutamine for leucine in the third transmembrane helix. This mutation (L512Q) was recently described in two solitary toxic adenomas. This report expands the spectrum of mutations shared by dissimilar hot nodules, supporting a common mechanism for nonautoimmune thyroid autonomy. The identification of the L512Q substitution demonstrates that gain-of-function TSHR mutations are encountered in Greece, although iodine deficiency has been significantly corrected over the last three decades.

Journal Article↗
PubMed1990

[Thyroid-stimulating immunoglobulins and the incidence of postoperative hypothyroidism in patients with diffuse toxic goiter].

Thyroid function was studied in 38 patients with diffuse thyroid goiter after subtotal thyroidectomy (3.82 and 25.9 months after surgery. Postoperative hypothyroidism developed less frequently in diffuse goiter patients who showed before treatment thyro-stimulating antibodies in the blood. The authors recommend a differential approach to the volume of thyroidectomy depending on the presence and absence of thyroid-stimulating antibodies before the operation.

Adolescent↗
PubMed1990

[Cytochrome oxidase activity of peripheral blood leukocytes in patients with diffuse toxic goiter].

Patients with diffuse toxic goiter showed a distinct reduction of the cytochromoxidase activity in the peripheral blood leucocytes. The degree of reduction of the cytochromoxidase activity in the leucocytes depended on the severity of the clinical course and degree of increase of the thyroid gland. Results of determination of the cytochromoxidase activity of leucocytes in patients with diffuse toxic goiter in association with other clinico-laboratory data reflect the severity of the clinical course of the disease, the hypoxia degree and efficacy of instituted treatment.

Adult↗
PubMed1990

Possible relations between sensitivity to phenylthiocarbamide and goiter.

Taste sensitivity to phenylthiocarbamide (PTC) using the Harris-Kalmus method was studied in 193 patients with thyroid disease and in a control sample of 311 individuals living in the Emilia area of Italy. The patients were classified according to the morphology of struma (mononodular, polynodular, diffuse) and to the toxic and nontoxic forms of goiter. Eighteen percent were nontasters in the control sample; 37.2% were nontasters in patients with polynodular goiter (toxic and nontoxic forms). Highly significant differences between the two groups were observed. The results obtained on this Italian sample agree with the conclusions of other studies.

Adult↗
PubMed1990

[Antithyroid antibody dynamics in patients with Hashimoto's goiter receiving conservative treatment and after surgical interventions].

The content of antithyroid antibodies (AtAb) in the blood of patients with Hashimoto's goiter was studied over time, namely during the treatment with thyroid drugs and after surgical interventions of different scope. The patients' groups with diverse changes in the AtAb titers during the conservative treatment were revealed. The analogous types of the time-course of changes in antibodies to thyroglobulins (AbTg) were discovered after a surgical intervention irrespective of the operation scope whereas the persistence of antibodies to microsomal antigen (AbMa) after the operation depended on the mass of the remaining thyroid tissue. A correlation was found between the high titers of AbTg (rather than AbMa) and the elevated content of thyrotropic hormone in untreated patients with Hashimoto's goiter and after large-scope surgical interventions.

Adolescent↗
PubMedDate not supplied

[The HLA system in diffuse toxic goiter].

The paper is concerned with the determination of class I antigens of the HLA system in 104 patients with diffuse toxic goiter and in 643 donors. A study was made of the distribution of antigens, haplotypes and phenotypes of the HLA system. An increase in the frequency of antigens A28 and B8, haplotype [correction of haploptin] A1-B8 and phenotype B7, B8 and a decrease in the frequency of antigens B13, B17 and Cw4 were revealed. Immunogenetic indices showed no correlation with clinical, hormonal and immunological manifestations of the disease, neither did they influence the therapeutic prognosis of diffuse toxic goiter. A great genetic difference was revealed between patients with a relapse (decompensation) and those at remission.

Adolescent↗