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PubMedDate not supplied

[Echographic evaluation of goiter recurrence].

Ultrasound is mandatory in the follow up of patients surgically treated for benign thyroid diseases. In this study the Authors have examined 87 patients who underwent different surgical treatments for goiter over 40 years. Ultrasound allowed a more accurate study of residual thyroid, particularly evaluating thyroid tissue morphology in symptomatic patients (43.6%) and detecting many recurrences in asymptomatic patients (37.3%). This study also confirms the advantage of a more extensive surgery to reduce recurrences without increasing complications.

Adult↗
PubMed1994

[The surgical treatment of hyperthyroid goiters--the current approach and the trends].

Proceeding from the analysis of 848 patients with hyperthyroid goiter, including all three nosological entities--Graves' disease (538), toxic adenoma of the thyroid (126), and struma basedowificata nodosa (184)--operated in the clinic of endocrine surgery over a five-year period, some modern trends in the therapeutic approach are discussed, preoperative preparation of the patients and resection scope, in particular. It is recommended to discard preparation with the classical Lugol's solution in mild and medium severe forms of Graves' disease, routinely used in the clinic over the past few years, and operate after administration of 1-2 tablets Metizole which shortens preoperative hospitalization, and secures postoperative period free of hyperthyroid complications.

Adolescent↗
PubMed1994

L-thyroxine effects on thyreocytes and Hürthle cells in nodular hyperplastic goiter on fine needle aspiration samples. Morphometric evaluation.

A morphometric study was performed on the thyreocytes and Hürthle cells in 20 cases of nodular hyperplastic goiter (NHG) and in 8 cases of Hürthle cell-rich NHG. The study was carried out on cytologic samples obtained by fine needle aspiration twice from the same nodules in a selected series of patients before and after L-thyroxine therapy with the aim of evaluating the morphometric nuclear variations induced by that therapy. Thyreocytes and Hürthle cells were evaluated for nuclear Area, Perimeter, Maximum Diameter, Form Elliptic and Form Perimeter using a planimetric instrument. A statistically significant reduction in nuclear size was observed in 18 of 20 cases of NHG after L-thyroxine therapy, but the nuclear shape factors were modified only slightly or not at all. A slight reduction in the nuclear size of Hürthle cells was observed in five and an increase in the remaining three cases, but these differences were not statistically significant. Virtually no changes in shape factors were observed in this group of lesions before or after the therapy. These data are discussed and compared to the results of other series. Our results suggest that morphometry may be useful in the follow-up of NHG to evaluate the effects of L-thyroxine and that this therapy reduces the size of thyreocytes; the therapy, however, seems to have little or no effect on Hürthle cells.

Biopsy, Needle↗
PubMed1994

[DNA diagnosis: its induction, problem and future--with special reference to congenital goiter].

PCR technique is a powerful tool for genetic analysis of various diseases including infectious diseases, inherited diseases and malignant tumors. Some of our experiences and problems in gene level diagnosis using mainly the PCR technique newly introduced to our clinical laboratory were discussed. A case of congenital goiter in which the analysis at the gene level was the first demonstration of a mutation associated with the abnormal expression of the thyroglobulin gene in man, is also presented. The direct demonstration from the sputum of the presence of M. tuberculosis DNA by PCR will be a great benefit to the clinician in the diagnosis and treatment of tuberculous infection. At present, it is possible to report the results within 2 days from the submission of samples, but further considerations on the sensitivity and specificity are required. The clinical laboratory will be required to accumulate sufficient knowledge of gene level analysis of various disease conditions and master the techniques.

Adult↗
PubMed1994

[Nodular goiter from the oncologic viewpoint].

Experience in the diagnosis and treatment of nodular forms of thyroid carcinoma is generalized. Among 4,601 patients who underwent operation for nodular goiter 338 (7.3%) were found to have carcinoma. Aspiration biopsy was widely used in establishing the diagnosis and chromothyrolymphography during the operation. The method of operative treatment consists in extrafascial resection of the thyroid gland and subsequent substitution therapy with thyroidine or thyrotoxine.

Adolescent↗
PubMedDate not supplied

[Echography of the thyroid gland in the diagnosis of endemic goiter].

Screening of 1520 children living in the Khvalynsk district of the Saratov region, including assessment of urinary excretion of iodine and ultrasonic examinations of the thyroid in children and adults, revealed endemic goiter in the region. Special attention was paid to echographic examination of the thyroid; this method was used in examinations of 161 children aged 2 to 14 with thyroid enlargement of the I-III degree. 103 (64.0%) of there children had enlarged thyroid, in some children with diffusely enlarged thyroid of the I-II degree ultrasonic examination showed no enlargement, and in some children the gland was found even reduced in size. The greatest discrepancy between the data of palpation and ultrasonography was observed in first-degree thyroid enlargement, the least so in second-degree enlargement; in third-degree enlargement there was no such a discrepancy. Assessment of thyroid structure revealed various disorders of the organ in 29 of the 161 examined children, these disorders present both in enlarged glands and in those of normal or reduced size. Nodes that could not be palpated were detected in 2 children. Ultrasonic examinations of 56 adults aged 20 to 60 revealed changed structure of the thyroid in 35, with nodes of various sizes and localization detected in 15 of these.

Adolescent↗
PubMedDate not supplied

[Functional activity of human thyrocytes in diffuse toxic goiter, autoimmune thyroiditis and thyroid nodules using nucleolar silver staining].

A comparative study of the thyrocyte nucleolar organizer region (NOR) activity was performed on silver - stained thyroid gland aspiration biopsies from controls, 39 patients with Graves' disease (GD), 15 other patients with Hashimoto thyroiditis (HT), and 71 patients with nodules which underwent surgery. Thyrocyte nucleoli from unchanged thyroid gland were round and small-sized. Their number ranged from 1.34 up to 1.96 per nucleus (mean 1.61 +/- 0.07). The average number of silver (Ag) grains ranged from 3.0 to 6.9 per nucleus (mean - 5.36 +/- 0.36). Compared to the controls the patients with GD revealed thyrocyte nucleoli with increased mean number of AG - grains per nucleus (9.84 +/- 0.24). There was a close correlation between thyrocyte NOR activity, on the one hand, and the level of T3 or T4 hormones and thyroid gland size, on the other. In patients with AT the argentophilla of thyrocyte nucleoli was intermediate between that of controls and patients with GD. This group of patients revealed an increased NOR activity of thyroid gland lymphocytes. Nucleoli of malignant thyroid cells were larger and more irregular than those of benign cells. The mean number of malignant cell nucleoli (2.55 +/- 0.22) was greater than that of the control group (1.61 +/- 0.07; p < 0.05) being identical with those of follicular adenomas (2.47 +/- 0.11) and nodular goiter (2.46 +/- 0.11). The mean number of Ag-grains in the malignant cells (14.9 +/- 0.79) was higher than that in FA (7.95 +/- 0.2; p < 0.0001) and NG (8.0 +/- 0.12; p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Surgical methods in the treatment of nodular goiter].

The experience with surgical treatment of 4476 patients with a nodular form of goiter has been summarized. Of them, in 2684 the solitary nodes were revealed, in 1359--the multiple ones, in 433--the mixed ones. Operative intervention was performed with regard for spreading of the thyroid gland lesion: from sparing resection to total thyroidectomy with transplantation of a graft under superficial fascia of chest.

Adolescent↗
PubMed1993

[Cytochemical definition of oxidation-reduction enzyme activity peripheral blood lymphocytes in patients with thyrotoxic goiter].

In patients with thyrotoxic goiter (TTG), a significant decrease in the activity of alpha-glycerophosphate-dehydrogenase and adenosinetriphosphatase of the peripheric blood lymphocytes was revealed. The lowest indices were noted in patients with a severe form of TTG, who underwent strumectomy. After conservative and operative treatment of TTG, a tendency for normalization of the enzyme activity was observed. Study of changes in the activity of the oxidation-reduction lymphocytic enzymes in dynamics permits to assess the severity of the course of TTG and to control and predict the effectiveness of treatment as well.

Adenosine Triphosphatases↗
PubMed1993

Iodine deficiency in pregnant women in an area of moderate goiter endemia.

Low levels of iodine, observed in endemic goiter areas, decrease the synthesis of T3 and T4. This phenomenon is particularly dangerous during pregnancy when demand for thyroid hormones increases considerably. Iodine deficiency may cause brain tissue damage of varying degree, even cretinism in most severe cases. The aim of the study was to make an initial evaluation of TSH and thyroid hormone levels, thyroid volume, and urine iodine excretion in pregnant women. The group under study consisted of 46 women, inhabitants of Kraków region. Their mean age was 26.8 years, 18 were primiparas and 28 multiparas. All deliveries were physiologica, vaginal, within the biological norm of 281 +/- 22 days from the last menstrual period. The concentrations of T3, T4 and TSH were determined in maternal and umbilical blood. Urine iodine levels were measured in the patients. Mean body weight of the newborns was 3338 g, mean pregnancy duration 39.6 weeks, and mean Apgar score 9.9. The results for maternal blood were (mean, SD in parentheses): T3 1.5 ng/ml (0.4), T4 11.6 micrograms% (2.9), TSH 2.3 microU/ml (1.2), thyroid volume 27.8 ml (15.2), urine iodine level 34.99 micrograms/l (29.12), and for umbilical blood T3 0.59 ng/ml (0.1), T4 10.6 micrograms/dl (2.1), FT3 1.28 pm/l (1.1), FT4 15.6 pm/l (4.8), TSH 3.7 microU/ml (0.9). Urine iodine level in pregnant women was several times lower than normal. 80% of the women under study had enlarged thyroid glands. We conclude that investigations of the problem should be continued.

Adult↗
PubMedDate not supplied

[The results of comprehensive caries prophylaxis in children under endemic goiter conditions].

Caries prevention was carried out in 800 children aged under 7 living in regions endemic for goiter. The complex of preventive measures included natrium fluoratum tablets (Polfa, Poland), a combination of fluoride lacquer with 3% remodent, Azerbaijan black tea tincture with F, 10 mg/l, all of these combined with antistrumin, an iodine-containing drug. Clinical data, enamel acid solubility values, data of microbiologic examinations of dental deposit, status of natural antibacterial defense of tissues and organs of the oral cavity demonstrated a high caries-preventive efficacy of the measures taken. A high caries-preventing efficacy of tea preparations has been revealed, their antibacterial properties among other things.

Azerbaijan↗
PubMed1993

[A case of recurrent mediastinal goiter (oxyphilic cell carcinoma)].

A case of recurrent mediastinal goiter (oxyphilic cell carcinoma) in a 66-year-old female was reported. 19 years ago, the patient submitted to a right-hemithyroidectomy for the oxyphilic cell adenoma. Since two months, her dyspnea gradually aggravated. On admission, abnormal mass of right upper mediastinum was shown by chest X-ray. CT scan and MRI showed a 8 cm sized right upper mediastinal tumor with tracheal compression.

Adenoma↗
PubMed1993

Treatment of upper airway obstruction associated with goiter.

The authors examined the resolution of spirometric indices of upper airway obstruction (UAO) following surgical treatment for goiter. The results of a recent study suggest that the integrity of the upper airway remains intact but prolonged recovery is required.

Adult↗
PubMed1995

Follicular thyroid carcinoma and mediastinal goiter in a case of situs inversus viscerum.

A 55-year-old woman with total situs inversus viscerum was subjected to total thyroidectomy for a well-differentiated follicular thyroid carcinoma. After surgery the patient remained euthyroid for two months and serum TSH did not rise. A whole body scan with iodine-131 (131I) showed mediastinal uptake. A chest computed tomography visualized a sequestered substernal goiter. Upon the patient's refusal to undergo surgery, she was treated with 150 mCi of 131I. A further dose of 100 mCi of 131I was administered six months later. Ten years after treatment, the patient is still alive and disease-free.

Adenocarcinoma, Follicular↗
PubMed1996

[Removal of complete type of mediastinal goiter in thirty-six-year-old female--a case report].

A tumor 6 cm in diameter located in the anterior superior mediastinum was found in a 36-year-old female, initially detected on chest-X-ray film in mass screening. The tumor was positively shown by 201thallium chloride scintigram. It was removed, and rapid diagnosis by frozen section proved benign. Follicular adenoma, with no connection to the thyroid, was diagnosed. It was a complete type of mediastinal goiter. Considering quality of life (QOL) as a 36-year-old female, the approach is important. Right half collar incision and upper median sternotomy from the top to the 3rd intercostal space was performed. Because few difficulties were experienced in removing the tumor, this case suggested that the incision and approach has usefulness to keep QOL.

Adenoma↗
PubMed1996

[Surgical treatment of benign recurrent goiter with pre-existing unilateral recurrent laryngeal nerve paralysis--a report of experiences].

Operations for recurrent goiter are considered to range among the most difficult procedures in thyroid surgery, because the risk of a permanent recurrent nerve palsy increases to 10 or 30%. In case of pre-existing unilateral lesion of the nerve the danger of bilateral paralysis of the vocal chord will become even larger. The results from 29 patients with an intracapsular resection (nearly total removement of the thyroid tissue without the preparation of the recurrent nerve) are presented and compared with those found in 4 patients with an extracapsular approach. All four patients, where the operation was performed extracapsularly, must be tracheotomized although the palsy did recover within 21 days till 14 months. After an intracapsular resection of the recurrence at the side of an intact nerve (29 patients) a tracheotomy had not been necessary.

Adult↗
PubMedDate not supplied

[Medical treatment of multinodular goiter].

Thyroid nodules are among the most common clinical problems in endocrinology. Among several factors responsible for the development of goiter, circulating TSH plays a major role because of its direct growth-promoting effects on the thyroid cells; moreover TSH may enhance the effects of other local growth factors which act in a paracrine mode in the thyroid gland. In addition, autoimmune thyroiditis can clinically appear as thyroid nodules frequently with the functional aspect of a subclinical hypothyroidism. For these reasons a therapeutical approach based on the thyroxine suppression of TSH secretion has become largely used by 1970s and is correctly employed in 75% of the patients with thyroid nodules whose biopsies result benign.

Female↗
PubMedDate not supplied

[Recurrent goiter: analysis of 134 reinterventions].

Reoperative surgery for thyroid disease still plays a predominant role in the treatment of goiter recurrences. At the moment, neither useful biological nor clinical indicators exist to prevent such recurrences. The effectiveness of TSH-suppressive therapy is still debatable and some authors have proposed total thyroidectomy for this benign disease in order to eliminate the risk of relapse. We analyzed 134 patients who underwent reintervention for recurrence of goitre in order to: 1) study possible clinical or epidemiological characteristics that could influence recurrence, 2) to verify the indications to reoperation, and 3) to evaluate the incidence of complications. For the study of complications, we adopted as a control group a series of 361 patients operated on by the same medical staff and undergoing subtotal thyroidectomy for multinodular goitre, with a minimal follow-up of 10 years. The surgical technique is described and several peculiarities are discussed. In the group of patients who had reoperation two cases (1.5%) of laryngeal palsy and two cases (1.5%) of hypoparathyroidism were recorded and this was not significantly different from the control group. A positive correlation was found between recurrence and young age at the time of first surgery (p < 0.006), female sex (p = 0.045) and esthetic results (p = 0.013). No further clinical recurrence was found in 101 patients after a mean follow-up of 122 months, while in 16 cases the echography revealed nodules in the residual parenchyma. In our opinion total thyroidectomy is not justified as a first standard procedure for this benign disease caused by the activity of various not yet well understood, growth factors.

Adult↗