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Preoperative diagnosis of thyroid pathology was improved following a cytological examination of punctates from nodulated formations of the thyroid in patients living in goiter-endemic regions. Diagnosis of thyroid cancer was confirmed preoperatively in 78% of cases, which, in turn, warranted application of adequate surgical procedures.
Cyclic AMP concentrations in a non-toxic nodular goiter were measured by means of the radiocompetitive protein-binding assay. It has been shown that cold thyroid nodules contain a higher concentration of cAMP than the macroscopically normal, extra-nodular thyroid tissue.
This case report deals with a 40 year-old female with goiter, elevated levels of peripheral thyroid hormones without the clinical picture of hyperthyroidism, and an exaggerated response to TSH and TRH. The fact that a feedback conversion appeared after progressive doses of T3 is outlined. Taking into account the elevated T3/T4 ratio, the high rT3, and the fact that all other pituitary hormones remained normal in the presence of increased levels of thyroid hormones, it is concluded that the case was one of incomplete universal resistance of the thyroid hormone receptors. Other individual and familial reported cases are reviewed, and emphasis is made on the fact that the receptors have been normal when studied.
An epidemiological study involving 616 subjects carried out in the Man region, Côte d'Ivoire, showed endemic goiter in 54,5% of the group overall and in 80% of females. Thyroid function of subjects chosen at random in the goitrous and non-goitrous group (105 G and 71 NG respectively) was identical. Compared with a French control group T4 was significantly lower but T3 and TSH were higher. TBG level is high with low iodine elimination. High levels of TSH are not necessarily associated with low T3 or T4 levels, or with clinical signs of a hypothyroid condition. They are probably the result of a transient reaction. T4-TSH and T3-TSH correlations for NG subjects were (-0,40) but the T3-TSH correlation for the G subjects was significantly lower (-0,23). These differences could be explained by the simultaneous high levels of T3 and TSH more frequently rencountered in G subjects and by the fact that serious hypothyroid conditions are more frequent in the NG group (6 out of 9). The percentage of hypothyroid conditions is high in both clinical and biological investigations. No anti-thyroglobulin antibodies were found in any of the hypothyroid cases with goitre. The histograms illustrate the clinical and biological heterogeneity of a homogeneous non-medicalised population.
The study was carried out on 46 patients operated for simple goiter. The statistical analysis of data of TRH test on a sample of 57 healthy volunteers has permitted an evaluation of the upper limits of the normal thyrotropin response; the secretory area (As) was shown to be more discriminating. The patients were divided on the basis of response to TRH (evaluated by As) and incidence of recurrence in the group of patients with an abnormal curve with respect to patients with a normal curve was shown to be highly significant (77% v.s. 33%; p less than 0.01). The study underlines the limits of conventional methods of follow-up which should avoid the appearance of recurrence and suggests the validity of TRH test in the screening of subjects to be treated by opotherapy for prevention of recurrence.
Increased TSH values (greater than or equal to 20 microU/ml) were found in 422 of 168,660 neonates born in Southern Bavaria. In 40 neonates the diagnosis of congenital hypothyroidism was confirmed (1: 4,200). The iodine excretion of healthy neonates and their mothers was on average significantly lower in the Munich than the Hamburg region. No relationship between iodine supply and congenital hypothyroidism was demonstrated. On the other hand, iodine excretion in children with neonatal goiter (17% of those with hyperthyrotropinaemia detected by screening) and their mothers was significantly lower than in control groups in the same regions. In addition, there was a significant correlation between iodine excretion of the mothers and neonates. The results confirm the need for iodine prophylaxis which should also take into account the higher needs during pregnancy. Apart from prophylactic aspects, these measures would also be in the interest of greater effectiveness and selectivity of TSH screening since it would reduce the number of cost-intensive follow-up examinations.
The available literature data and the author's observations do not support the view that nodular goiter or adenoma constitute an indispensable stage of carcinogenesis in human thyroid gland. They also suggest that the chances of malignant transformation of single nodular formations in the thyroid gland are sometimes exaggerated. Therefore, radical approach to treatment of single nodular formations should be sometimes revised and indications for surgery may be limited to a reasonable degree.
Air esophagograms have been described in normal individuals and in association with esophageal disease or respiratory distress. In a study of neck radiographs in 160 patients with goiter, air esophagograms were observed in 24 (15%). The continuous irritation of the enlarged thyroid on the trachea is thought to excite intermittent aerophagy, and accounts for the frequent demonstration of air within the esophagus.
Results of the surgical treatment of 2033 patients with thyrotoxic goiter were analyzed. The postoperative lethality was 0,49%. The author recommends a program of examining the patients consisting of three steps. Plasmapheresis proved to be an effective method of preoperative preparing the patients with thyrotoxicosis.
Iodine-123 thyroid scintigraphy allows the diagnosis of a functioning retrosternal goiter in a patient with a mediastinal mass. The case report of a 60-yr-old lady demonstrates this. The correlative values of nuclear magnetic resonance imaging and thyroid scintigraphy in the initial evaluation and continued management of patients with thyroid mediastinal mass are presented. In addition, this observation demonstrates the ability of nuclear magnetic resonance to identify retrosternal thyroid tissue. This may obviate the need for TCT evaluation, which involves both ionizing radiation and iodinated contrast enhancement.
We selected 5 patients, between 18 and 31 years of age, presenting menstrual irregularities and thyroidal goiter with no apparent functional change (normal, T4 and T3 tests). These patients underwent further examinations: TSH (basal and after TRH stimulation), HPRL (basal-circadian rhythm and after TRH stimulation), FSH and LH (basal and after Gn-RH stimulation), thyroidal scintiscan, search for antithyroid antibodies. Basal and post-stimulation TSH was fundamental in 2 cases of subclinical hypothyroidism. The positive antibody search confirmed the antoimmune origin. In the same patients, the HPRL circadian rhythm and TRH test highlighted a secondary hyperprolactinemia which would not have been revealed by a single basal sample.
We treated a 43-year-old woman who had multiple thyroid cysts and coexistent toxic nodules localized to the left lobe. After surgical excision of this lobe, the patient's right lobe proceeded to function normally, displaying no evidence of nodules, cysts, or hyperfunction. Since toxic multinodular goiter is usually a diffuse process involving the whole gland, this case is unique and underlines the wide variability in the manifestation of this disorder.
Intact and iodine-treated thyroglobulin from normal thyroid gland and from nodular euthyroid goiter were studied by means of circular dichroism to detect differences in the protein secondary structure. Contents of alpha- and beta-structures in thyroglobulins were differentiated only by several per cents but artificial iodination of the protein increased markedly the difference between thyroglobulins of various origin. Extrapolation of the data to "zero" content of iodine-containing amino acids demonstrated that the initial steps of thyroglobulin synthesis occurring before iodination "in vitro", appears to be also responsible for alterations in the protein secondary structure.
The role of cassava was investigated in particularly severe endemic goiter area (Ubangi). Dietary intake of cassava induces an increase of plasma thiocyanate concentration and an increase of urinary excretion of stable iodine. Generalized iodine deficiency induces very high thyroid uptakes; the other parameters of thyroid function are more or less affected according to the dietary intake of thiocyanate. When thiocyanate intake is high an adaptation is obtained only at the expense of a drop of plasma T4 level and very high increase of plasma TSH.
A case of goiter in a 8 year-old child is reported. It resulted from a protracted treatment with lithium at high daily dose. The blood level of lithium was very high. Blood iodine and thyroid hormones were normal. This fact points out the importance of careful anamnestic investigation.
The dynamics of endemic goiter morbidity in Timiş county is evaluated comparing the studies carried out 30 years ago with the present-day ones. A positive correlation is found between the extension and severity of the endemic, on the one hand, and the iodine content of the drinking water sources, on the other. Eradication of the endemic has been achieved by borin gartesian wells (having a higher iodine content than dug wells), by intensive iodine prophylaxis and therapy as well as by the socioeconomic changes characterized by a high degree of pre-urbanization of the country-side.
We report on a case of fetal goitrous hypothyroidism confirmed by the study of fetal thyroid function. Two injections of intra amniotic levo-thyroxine were performed at 35 and 36 WA. The serial ultra sonographic examination showed the disappearance of the fetal goiter. A healthy baby were delivered by cesarean section at 37 WA. At birth, the thyroid gland was slightly enlarged and the neonatal thyroid hormones were within the normal range. This case suggests that cordocentesis is a reliable method of assessing the status of the fetal thyroid, and that even as early as 35 WA a prenatal treatment of fetal goitrous hypothyroidism is possible by amniocentesis.
Methods of iodine fortification were tested among women of child bearing ages in four villages of Khon Kaen province, an endemic area of goiter in northeast Thailand, Ban Wang Pa Dum, Ban Pa Klauy and Ban Non Chart received iodine fortified in fish sauce, salt and drinking water respectively, whereas, Ban Non Sa-aad served as a control village. Urine iodine concentrations were investigated before supplement and after three and six months of the experimental period. Three months after supplement, urine iodine levels of villagers from Ban Non Chart and Ban Non Sa-aad were higher than those of Ban Wang Pa Dum and Ban Pa Klauy. Six months later, subjects from Ban Wang Pa Dum and Ban Pa Klauy who had received fortified fish sauce and iodinated salt respectively had significantly higher urine iodine concentrations than those of the other two villages. The result implied that fortified fish sauce and iodinated salt were well accepted by the villagers. However, fortified fish sauce might be the best and most feasible method because villagers use fish sauce more constantly in cooking and salting dishes.