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Goiter caused by excessive exposure to an iodine-containing disinfectant was an incidental finding at necropsy of captive penguins dying from renal failure, believed due to nutritional secondary hyperparathyroidism. The disease was reproduced experimentally in ducklings.
Examinations of sera and cyst fluids in patients with cystic degenerated euthyroid goiters showed significant differences between the values of the cyst fluids and sera for almost all of the chemical substances. In the brown cyst fluids there are mostly higher values compared with the appropriate sera. Autolysis, diffusion and resorption, metabolic changes and, in the case of thyroid hormones, active incretion by wall-forming thyroid tissue, are the reasons for these differences in the concentrations.
A 70-year-old female was referred to our hospital because of swelling at her frontal neck and an abnormal shadow on a chest X-ray film. CT scan and MRI showed a 11.0 x 7.5 cm well-demarcated tumor in the upper mediastinum. Thyroidal scintigraphy revealed an slight accumulation, leading to a diagnosis of intrathoracic goiter. During operation the mass was found to be composed of two tumors. The upper tumor was attached with fibrous adhesion to the right lobe of cervical thyroid but no connection. Histological examination showed follicular but not malignant adenoma of the thyroid.
The Authors report a review of the Literature and their personal series to evaluate the role of total thyroidectomy in the surgical management of non-toxic multinodular goiter. On the basis of the data obtained, the Authors consider total thyroidectomy the therapy of choice for this pathology.
We studied the main values of ultrasonic scanning of patients with thyroid nodes depending on the dose, conditions of irradiation and sex. A total of 281 patients who had received a dose of irradiation of 0.01 to 2.0 Gr were evaluated; of these, 82 took part in the elimination of the effects of the Chernobyl accident (EEA) after evacuation, and 190 subjects were evacuees from the ChNPP 30-km zone, their age ranging between 20 to 68 years. In 43.6% of those having taken part in EEA, thyroid nodes did not exceed 1 cm across, in 44% node diameter was in the range 1 to 2 cm, in 12.4% it exceeded 2 cm. A screening examination revealed volume formations up to 1 cm in 79.5% of the evacuees, 1 to 2 cm across (9.4%), and in 13.02% node diameter exceeded 2 cm. In a major proportion of the examined patients the nodes were hypoechogenous. Distribution of echogenicity of nodes in male subjects does not depend on the dose and period of irradiation. A suggestion is made to the effect that ChNPP accident factors are not involved in the development of nodular forms of goiter in the immediate 7 years following irradiation.
Between January 1st, 1979 and December 31st 1993, 2501 operations for benign diseases of the thyroid gland were performed. The documentation was done prospectively. The operation technique remained the same during these years. The recurrent laryngeal nerve wasn't routinely identified. All together we saw 0.6% permanent vocal cord palsies. The incidence of nerve paralysis was correlated to the size (weight), to the expansion of the goiter, to the performed operative procedure and to patients' age and gender.
The different surgical options for the treatment of non toxic nodular goiter led the Authors to study the residual thyroid function following conservative surgery (subtotal thyroidectomy, lobectomy and enucleation). Follow-up showed an overall recurrence rate of 49%, with a higher rate after lobectomy and enucleation than after subtotal thyroidectomy. On the other hand, subclinical hypothyroidism was higher in patients who underwent subtotal thyroidectomy. No significative correlation was found between high plasmatic levels of TSH and recurrences.
A 66-year-old man was admitted to our hospital as a result of an abnormal shadow which was observed on his chest X-ray. A chest CT scan and chest MRI revealed an upper mediastinal tumor. The tumor was located in the retrotracheal region and resected completely following a thoracotomy. Histological examination of the tumor revealed follicular adenoma of the thyroid gland. Complete mediastinal goiter is a relatively rare lesion, with only 59 cases (including our case) in Japan prior to 1997. Only two cases were reviewed, in which the tumors were located in the retrotracheal region, out of the 59 cases in Japan.
We report the unusual case of an 87-year-old woman with cardiac myxoma and adenomatous goiter. She exhibited slight elevations of serum interleukin-6 (IL-6), but levels of thyroid hormones such as T3, free T3 and free T4 were all abnormally low. Interleukin-6 may potentiate the alteration of thyroid metabolism.
A case of retrotracheal goiter in the posterior mediastinum in a 53 year-old woman revealed by dyspnea is here described. A computed tomographic scan and magnetic resonance imaging specified the his extension from the lower flap of the thyroid, and its relationships in the mediastinum. It was removed through a cervicotomy only.
In a series of 579 consecutive first operations for bilateral benign nodular goiter, the incidence of hypocalcemia was analyzed related to the extent of the bilateral operative procedure and manipulation of the parathyroid glands (identification, mobilization, non-identification). The incidence of early hypocalcemia increased with the extent of the operation and with increasing manipulation of the parathyroid glands. However, permanent hypocalcemia was exclusively found after identification of less than three parathyroid glands (1.5% vs 0%), most evidently after bilateral conventional subtotal resection (3.5%). As a rule, the parathyroid glands should be identified routinely, especially in conventional subtotal resections, if possible without further mobilizing manipulations.
AIM: Gain-of-function mutations of the thyrotropin receptor (TSHR) gene have been invoked as one of the major causes of toxic thyroid adenomas. This study evaluates F-18-FDG-PET in these patients. METHODS: Twenty patients with focal autonomous nodules and ten with disseminated autonomy were investigated the day before radioiodine therapy. Twenty patients with cancer of the head or neck and normal thyroid function served as controls. RESULTS: F-18-FDG-Uptake was higher in patients than in controls. Focal autonomous nodules were associated with focally enhanced glucose metabolism. Disseminated autonomous goiters showed various patterns of focal or global hypermetabolism. CONCLUSION: Autonomous thyroid tissue caused by constitutive mutations of the TSH receptor is characterised by simultaneous increases in glucose and iodine metabolism which are correlated.
We discovered two well-demarcated nodules incidentally in a thyroid removed because of a nodular goiter. Histologically, the nodules showed a pattern of paraganglioma or so-called paraganglioma-like adenoma of the thyroid (PLAT), with lobules of polygonal and oval cells in a vascular stroma, but the immunohistochemical markers typical of paraganglioma, including chromogranin, synaptophysin, Leu 7 and 5-100, and thyroglobulin, characteristic of PLAT, were negative in the tumor cells. C-cell markers calcitonin and somatostatin were also negative. Stain for neuron-specific enolase (NSE), however, showed a distinctive pattern of reactivity within cells at the periphery of the lobules, whereas all tumor cells stained positively for keratins. Stain for carcinoembryonic antigen showed a focal interstitial pattern that corresponded to small intercellular spaces filled by microvilli identified ultrastructurally. This pattern of immunohistochemical staining has not been previously described in paraganglioma or in PLAT, and may have implications about the origin and nature of these controversial entities.
A 39-year-old Danish woman was treated with an oral dose of 400 MBq 131I for a non-toxic goiter with compression symptoms. Serum anti-TPO and TSH receptor antibodies were negative before radioiodine therapy. The patient developed hyperthyroidism four months after treatment and ophthalmopathy after another three months. TSH receptor stimulating and blocking antibodies, eye muscle IgA and IgG were measured and an increase in stimulating TSH receptor antibodies were found concomitant with development of hyperthyroidism. IgG class antibodies against porcine eye muscle antigens and eye muscle fibroblasts were elevated and unchanged during the follow-up. A significant increase in IgA class antibodies against porcine eye muscle antigens was seen concomitant with development of ophthalmopathy. It is speculated that 131I has led to an exacerbation of eye muscle as well as TSH receptor stimulating antibodies and possibly leading to the development of ophthalmopathy, or at least is associated with it.
Iodine balance during pregnancy and lactation was investigated by measuring iodine concentration in the urine of 11 pregnant women, born and living in a moderately iodine deficient endemic goiter area in Northeastern Sicily, collected during the last week of pregnancy, and between the 5th and 7th day after delivery, and in their milk sampled simultaneously with the urine of their newborns. The results were compared with those obtained on similar samples from 16 euthyroid age-matched nongoitrous women and their offspring from an iodine sufficient area. Urinary iodine concentration in pregnant women from the endemic area (1.28 +/- 0.13 micrograms/dl, mean +/- SE) was significantly lower than that of pregnant women from the iodine sufficient area (3.77 +/- 0.57 micrograms/dl) (t = 3.56, p less than 0.005). The longitudinal measurement of iodine concentration in each nursing woman showed a marked increase (approximately 90%) when compared with the values obtained during pregnancy in both endemic and control groups (2.32 +/- 0.36 and 7.76 +/- 2.08 micrograms/dl; t = 2.13 p less than 0.05, respectively). The slight difference in milk iodine concentration between the endemic (3.25 +/- 0.77 micrograms/dl) and the control (4.33 +/- 0.57 micrograms/dl) group was not statistically significant (t = 1.14; p less than 0.5, NS). Similarly no difference was found in urinary iodine excretion between the endemic and the control newborn groups (3.41 +/- 0.76 and 4.30 +/- 0.65 micrograms/dl, respectively, t = 0.88 p less than 0.1, NS).(ABSTRACT TRUNCATED AT 250 WORDS)
Since 1946 104 children and adolescents with toxic diffuse goiter have been treated. Sixty-seven were treated with a thioamide for more than 12 months. Remission occurred in 61%. Twenty-five patients had a 12-hour perchlorate discharge test to determine the least frequent dose schedule required for disease control: 68% could be controlled on a single daily dose and an additional 25% on an every 12-hour schedule. A one-hour radioiodine uptake on combined therapy and change in thyroid gland size during treatment were found to be highly correlated with the presence of a spontaneous remission. Thirty-six patients have been treated by subtotal thyroidectomy. To date 65% have developed permanent hypothyroidism. In the author's opinion, thoamides are the treatment of choice for the majority of children and adolescents.
During a period of 9 years, 71,500 patients underwent thyroid investigations at our department. Sixteen patients with thyroid hemiagenesis, 13 women and 3 men, were seen during this period. Fifteen had no left lobe and only 1 had no right lobe, the isthmus was present in 5 patients. Associated thyroid diseases of the lobe that was present could be observed in 11 patients (9 diffuse or nodular goiters, 2 thyroid autoimmune diseases). One patient was hyperthyroid and 7 were hypothyroid. Hypothyroidism associated with hemiagenesis has rarely been reported in the literature. In our survey, the high percentage of hypothyroidism may be explained by coexisting iodine deficiency, which could be verified in 4 hypothyroid patients. Ultrasonography is the key investigation to diagnose thyroid hemiagenesis. Fine-needle aspiration biopsies, laboratory tests, and scintigraphies are useful to diagnose other diseases within the remaining lobe or to visualize ectopic thyroid tissue. Review of the literature, including our cases, presented a total of 256 patients with thyroid hemiagenesis. Its prevalence can be estimated between 1:1900 and 1:2675. Left to right ratio of thyroid hemiagenesis is 3.6:1 with an isthmus present in 44%. The female-to-male ratio is 3:1; however, the larger number of females is probably based on a bias due to a female predominance of the populations investigated. On the basis of an equal distribution of both sexes, the female-to-male ratio of thyroid hemiagenesis would be only 1.3:1 in our survey.
Thyroid imaging using TI-201 was useful to visualize the normal thyroid tissue, which was not visualized by conventional imaging using I-123 or Tc-99m, in three patients with toxic nodular goiter.