SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The authors report the dramatic regression in endemic goiter that has taken place in the Spanish provice of Castellón de la Plana, comparing data obtained in 1958 and 1974 with present-day data. They stress the fact that the plenomenon has occurred without a previous prophylaxis program.
Epidemiologic study was carried out concerning the level of goitrous morbidity in the growing up individuals aged from 3 to 14 years, permanently living in a settlement with increased nitrate content in the drinking water and natural Iodine deficiency. The data for the incidence of the goitrous morbidity were compared with those of a control group of children. The investigation included a total of 325 children. A high percentage of goitrous morbidity was recorded in the observed by us settlement with increased nitrate content in the drinking water, respectfully 35% versus 8.1% in the control settlement. Low degree of juvenile goiter predominated with slight prevalence of the female sex. A statistically reliable difference (p < 0.001) in the incidence of goitrous morbidity in the observed by us settlement and the control settlement.
In iodine deficiency regions such as Germany, more than 50% of toxic thyroid adenomas and some toxic goiter nodules harbor activating mutations in the TSH receptor or Gs-alpha gene. These mutations cause cellular hyperfunction and hyperthyroidism but are not sufficient to generate thyroid adenomas and nodules. In the pathogenesis of these tumors, other primary and secondary molecular mechanism are operative, including overexpression of growth factors, their receptors and of signaling proteins. Expression of some of these growth factors is regulated by TSH-dependent pathways. However, iodine deficiency and its effect on thyroid growth remains the most important pathogenetic factor for these diseases. Therefore, toxic adenomas as well as the majority of nonfunctioning and eufunctioning thyroid nodules and adenomas are relatively rare in regions with high iodide intake of the population.
Over a period of 8 years, thin needle biopsies of hypofunctional, scintigraphically cold goiter nodules were performed in 4555 patients. 1076 underwent surgery and cytological diagnoses were thereby histologically confirmed. In 715 patients with normal or degenerative cytological findings, the diagnosis was correct in 95.1%. On the other hand, 8 malignancies, 13 Hürthle-cell adenomas, and 26 cases of Hashimoto's thyroiditis were misdiagnosed. The 8 diagnostic errors in the malignancies were due to puncturing of the wrong nodule in 3 cases and, in 5 cases, due to highly differentiated, partially degenerated, follicular carcinomas. In 322 cases with suspect or malignant cytological findings, 129 malignancies (40%) were confirmed. In most cases, false positive diagnosis was due to histologically atypical adenomas, e.g. Hürthle-cell adenomas. Hashimoto's thryoiditis could be readily diagnosed only in the advanced stage. The clinical diagnosis of de Quervain's thyroiditis can be verified by cytological examination.
A patient with chronic cough and recent dysphagia was found to have a retrotracheal mass extending into the mediastinum on chest radiography. A computed tomographic scan confirmed a retrotracheal posterosuperior mediastinal lesion which was believed to have a neurogenic origin. A thyroid 131I scan revealed no uptake of tracer in the chest and results of thyroid function tests were normal. A large retrotracheal colloidal nodular goiter was excised through a right thoracotomy. The diagnostic approach and the safety of surgical access by thoracotomy for thyroid lesions in this unusual site are discussed.
Personality and intellectual characteristics were examined in 76 patients with iodine-deficiency goiter (IDG). Subclinical hypothyroidism forming as early as IDG of the 1st degree impairs abstractive and integral thinking, psychological maladaptation to the disease, high anxiety, neurotism, diminished intellectual performance, deterioration of memory, attention, predominance of thinking of concrete-action type. To prevent intellectual disturbances, IDG patients should receive replacement therapy with adequate doses of thyroid hormones preparations.
Cowden's Disease is an autosomal dominant genodermatosis associated with abnormalities of the breast, thyroid gland, gastrointestinal tract. We describe a 23-year-old girl who was diagnosed with this disease when she consulted for evaluation of a multinodular goiter. Further investigations revealed breast lesions, gastric polyposis and parotid cancer. Recognizing Cowden's disease is important for prompt screening for malignancies. Skin lesions are markers of precancerous development.
In order to assess the main complications following surgical treatment of multinodular goiter (total thyroidectomy) a prospective historical study was made in 179 patients operated between 1985 and 1997 in our Department. Permanent hypocalcemia was encountered in 2.2 percent of our cases and permanent recurrent paralyses in 0.5 percent, being null and void the mortality rate. Other complications evaluated include: serohematoma, postoperative bleeding, wound infection and pulmonary embolism. To sum up, total thyroidectomy is a relative safe procedure in experienced hands for both patient and surgeon.
AIM: The study of osteoarthrosis (OA) course in the region of goiter endemia regarding thyroid status. MATERIAL AND METHODS: The examination of 62 females with OA included enzyme immunoassay of blood TTH, T4, T3 and ultrasound investigation of the thyroid. RESULTS: OA patients were found to have subnormal levels of thyroid hormones and low thyroid index. Blood TTH rose with thyroid size. Joint changes were also directly related to thyroid size. CONCLUSION: Alterations in the thyroid status influence the course of degenerative-dystrophic process in the joints.
The problems concerning surgical goiter treatment are discussed, particularly the morbidity of total thyroidectomy and possible injury to recurrent nerves in comparison to the partial resection of the gland. We discuss our case material and review the literature. We conclude that total thyroidectomy seems to be the most effective surgical procedure with lower morbidity than subtotal thyroidectomy.
This is a retrospective study of 47 near total and 30 total thyroidectomies for multinodular goiter, Graves' disease and thyroid cancer. Complications are rare: one permanent recurrent nerve palsy out of 154 nerves at risk, one definitive hypoparathyroidism. For a benign pathology, the former bilateral sub-total thyroidectomy should be replaced by a near-total thyroidectomy which leaves one unilateral thyroid remnant the size of a cherry. Using this technique, we did not observe any recurrence. Among 42 patients controlled after more than one year 1/3 have a normal thyroid function. Systematic substitution is not indicated. Thyroxine should be used only if hypothyroidism develops after the operation or if an increase of the thyroid remnant is demonstrated. Thyroid cancer should be treated by total thyroidectomy, except for noninvasive papillary cancer without node metastasis for which a total lobectomy is sufficient.
Substantiation of use of laser radiation Nd:YAG (1064 nm) and diode (805 nm) for destruction of thyroid tissue was the purpose of this study based on experimental research of reparative and adaptive processes in thyroid gland. The influence of high-intensity laser radiation was studied in vivo in thyroid gland of 41 dogs. The optimal modes of laser radiation ensured focal destruction of thyroid gland without damage of surrounding organs were selected. The developed modes were used in the treatment of 18 patients with recurrent nodal and multinodal euthyroid goiter. Exposure was performed by puncture method without denudation of thyroid gland. There were no complications during irradiation and nearest postoperative period. In dynamic ultrasonic examination over 2 years the decrease of nodes sizes was revealed in all the patients.
Neurological diseases are one of the main causes of high mortality and morbidity in developing countries. The prevention of these diseases is possible if they are well known. The purpose of this study was to evaluate the prevalence and the distribution of the main neurological affections in two rural districts. WHO research protocol for measuring the prevalence of neurological disorders in developing countries was used by the same staff. The first survey was conducted in Kloto from July to August 1989 on 19,241 inhabitants and the second in Akébou from January to February 1995 on 4182 subjects. Akébou was known as endemic goiter district. The prevalence of epilepsy was 12.3@1000 in Kloto and 13.1@1000 in Akébou. That of stroke was 2.4@1000 in Kloto versus 1.7@1000 in Akébou. The prevalence of Parkinson's disease was 0.2@1000 in Kloto and 0.2@1000 in Akébou. That of psychomotor retardation was 3.2@1000 in Kloto versus 8.1@1000 in Akébou. The prevalence of neurological cretinism was 97@1000 while that of myxoedematous cretinism was 31@1000 in Akébou. Apart from neurological disease, the prevalence of goitre was 43% in females and 26.1% in males in Akébou. Mental retardation and cretinism were frequent in Akébou, a district endemic for goitre. Besides stroke and febrile convulsions which predominated in Kloto, the main neurological disorders were most prevalent in Akébou. Community based care for epilepsy is provided in these districts as is the prevention of iodine deficiency in the Akébou district with the intention of reducing neurological affections.
Peroxydase activity in various benign thyroid diseases has been investigated. In hyperthyroid patients treated with antithyroid drugs, the observed increase in iodide-peroxydase activity (7 times that of normal tissue) is double than that of the DNA content. In goiter, the activity is 3 times that of normal tissue while the DNA content is unchanged. These results are in agreement with those obtained in rats maintained on a low iodine diet suggesting that high cellular enzymatic activity is due to specific enzyme induction in excess of cell proliferation and protein synthesis.
Eight female patients are studied, four of them without hyperthyroidism. The following were measured before and after surgery = hormonal iodine by column, serum concentrations of T T3, AF T3, TSH, total T3 distribution space, T3 pool size T3 fractional turnover rate. T T3 is measured in the serum of peripheral venous blood, nodular venous blood and of jugular venous blood of the opposite side of the adenoma. Before surgery, the mean of T T3 in patients with hyperthyroidism is increased in serum obtained from brachial and not nodule venous blood. Are also increased AF T3 and T3 production rate. In patients without hyperthyroidism, T T3, AF T3 are increased in two subjects only, but T3 production rate is rised among three of them. After surgery the previous values are not different with normal values. These data are in good agreement with the hypothesis that, in patients without thyrotoxicosis, there is an increase in T3 production from not nodular goiter. There phenomena may explain unresponsiveness to TRH test and inactivity of normal thyroid. Absence of hyperthyroidism may be due to a lack of sensitivity of peripheral tissues to the increase of T3.
Vegetative tonicity, reactivity and provision were studied in 88 patients with endemic goiter (EG) aged 18 to 40 years. Vegetative dystonia syndrome (VDS) in EG develops as parasympathicotonia. Subjective symptoms of vegetative dysregulation are more pronounced in high reactive and personality anxiety, in neurotism, they do not depend on extra- or introversion. VDS in EG deteriorates mental and physical performance, attention. Vegetative reactivity in EG becomes hypersympathicotonic. Vegetative dystonia affects reaction to the disease. Prolapse of heart valves often seen in EG patients results rather from hypothyroid edema of the myocardium than from VDS. Therefore, treatment of such patients with beta-adrenoblockers is not grounded. Vegetative dysregulation gradually attenuates in response to replacement hormone therapy with thyroxine.
It is well known that non-toxic goiter is not uncommon in acromegaly, but hyperthyroidism only occasionally occurs. In addition, the risk for the development of a malignant process is increased, the most often seen is carcinoma of the colon. Thyroid carcinoma is not frequent, nevertheless the rate in these patients is higher than general population. In this article, a case of hyperthyroidism, papillar carcinoma and acromegaly is presented. We reviewed the literature an discussed the possible pathogenesis.
The present opinions on the therapy with L-thyroxine (L-T4) of single non-toxic thyroid nodules, as well as of multinodular non-toxic goitre are rather divergent. This treatment is based on the suppression of TSH secretion from the pituitary. There are no doubts that FNAB performance is the first and--at the same time--the most significant diagnostic procedure in the case of thyroid structural lesions (nodules, goitre, thyroiditis). FNAB performance should--by all means--precede the beginning of L-T4 application for the treatment of thyroid nodules. The simplicity, clearness and high efficacy, with comparable results in each case, are the core of good diagnostic algorithm. Unfortunately, non all diagnostic algorithms concerning thyroid nodules and multinodular goiter, fulfill these important criteria.