Sample records for goiter substernal

  1. Harmonic focus in thyroidectomy for substernal goiter

    Hahn, Christoffer Holst; Trolle, Waldemar; Sørensen, Christian Hjort


    , hospital stay and complications. MATERIALS AND METHODS: Prospective non-randomised study of 242 consecutive patients with substernal goiter out of 2258 patients (11%) who underwent thyroidectomy. A total of 121 patients had thyroidectomy performed with bipolar electrocoagulation and knot-tying techniques...

  2. Incidental Detection of Internal Jugular Vein Thrombosis Secondary to Undiagnosed Benign Substernal Goiter

    Mai Tone Lønnebakken


    This case illustrates that benign substernal goiter may be associated with asymptomatic internal jugular vein thrombosis. Carotid Doppler ultrasound should involve evaluation of the internal jugular vein concerning thrombosis as its presence may reveal space-occupying lesions in the thorax.

  3. Goiter

    ... if the goiter is due to an underactive thyroid Small doses of Lugol's iodine or potassium iodine solution if the goiter is due to a lack of iodine Radioactive iodine to shrink the gland, especially if the thyroid is producing too much thyroid hormone Surgery ( thyroidectomy ) ...

  4. Operation Skill for Removal of Giant Substernal Goiters Through Cervical Approach%巨大胸骨后甲状腺肿经颈入路手术切除的技巧

    连金山; 王龙龙; 刘婕; 高珊; 芦语昕


    Objective To investigate the operation skill for removal of giant substernal goiters through cervical approach.Methods A retrospective analysis of 5 cases clinical materials of giant substernal goiters.Results All cases were performed through low-collar cervical approach, no deaths in the intraoperative or postoperative were no deaths, with less bleeding, shorter operative time and showing no any adverse physical postoperative symptoms, such as hemothorax, pneumothorax, tracheomalacia, esophageal injury and impairment of recurrent laryngeal nerve. No postoperative recurrence cases in follow-up for 6-12 months.Conclusion Giant substernal goiters can be removed through cervical approach without sternotomy, with advertages such as little trauma, short operation time, quick recovery, less complications, short hospitalization time, low cost and so on, worthy of clinical application.%目的:探讨经颈部低领切口手术切除巨大胸骨后甲状腺肿的技巧。方法回顾性分析5例巨大胸骨后甲状腺肿的临床资料。结果全组病例均经低领颈部切口手术切除,术中及术后均无死亡病例,术中出血量少,手术时间短,术后无血胸、气胸、气管软化、食道损伤及喉返神经损伤,术后随访6~12个月无复发病例。结论巨大胸骨后甲状腺肿可经颈部低领切口切除,无需胸骨劈开,具有创伤小、手术时间短、恢复快、并发症少、住院天数短、费用少等优点,值得临床推广应用。

  5. 胸骨后结节性甲状腺肿的外科治疗及并发症防治%Surgical treatment and complications prevention of substernal thyroid goiter

    罗东林; 高博; 姜燕; 张姝; 郭翎佶; 田武国; 张晓华; 赵健洁; 严洁


    Objective:To investigate the surgical treatment and complications prevention of substernal thyroid goiter.Methods: Clinical features of 28 patients with substernal thyroid goiter underwent surgery in our hospital from January 2004 to December 2014 were summa-rized and analyzed.Results:All patients were received surgery, 24 patients underwent cervical collar incision while 4 patients underwent combined cervical-thoracic incision.Postoperative hypocalcemia occurred in 3 patients, hoarseness occurred in 1 patient, tracheomalacia occurred in 5 patients, intraoperative trachea suspension in 4 persons, tracheotomy in 1 person, extubation and discharge after seven days, hypothyroidism occurred in 8 patients.There was no bleeding, thyroid storm and other serious complications.All patients were clinically cured, who were followed up for 6 months to 10 years, no recurrence happened.Conclusion:Cervical collar incision was nearly always adequate for most cases of substernal goiter, if intraoperative operate difficultly, thoracotomy should be chosen immediately.Furthermore, trachea suspension can effectively prevent breathing difficult caused by tracheal collapse.%目的:探讨胸骨后结节性甲状腺肿的外科治疗方法及其并发症防治。方法:总结分析2004年1月~2014年12月在我院行手术治疗的28例胸骨后结节性甲状腺肿患者的临床资料。结果:全部病例均行手术治疗,颈部切口入路24例,颈胸联合切口入路4例。术后发生低钙血症3例,声音嘶哑1例,气管塌陷软化5例,术中行气管悬吊4例,行气管切开1例,术后7天拔管出院,发生甲状腺功能减退8例,无大出血及甲状腺危象等严重并发症,均临床治愈出院。随访6个月~10年,无复发。结论:大部分胸骨后结节性甲状腺肿可经颈部低领状切口完成手术,如术中操作困难,应果断开胸手术,气管悬吊可有效预防气管塌陷致呼吸困难的发生。

  6. Substernal Thyroid Masses

    Mohamed A.H. Regal


    Full Text Available A thyroid mass, most often a non toxic colloid goiter or occasionally an adenoma, is not an unusual finding below the level of the thoracic inlet.1 In 1992 Creswell and Wells estimated that these tumors comprise 5.8% of all mediastinal lesions.1 There is no standard definition for thyroid glands extending below the thoracic inlet, but such masses descend from their original cervical location for more than 2 or 3 cm below the thoracic inlet, and are not truly primary tumors of the mediastinum. They preserve the connection between the thoracic and cervical portion and receive their blood supply from the neck.2,3 In 1940, the seminal report of Wakeley and Mulvany divided intrathoracic thyroid masses into 3 types; (1”Small substernal extension” of a mainly cervical mass, (2 “Partial” intrathoracic, in which the major portion of the mass is situated within the thorax, and (3”Complete” in which all of the mass lies within the thoracic cavity.

  7. Percutaneous microwave ablation of type I substernal goiter under ultrasonic guidance%超声引导下经皮微波消融治疗Ⅰ型胸骨后甲状腺肿

    徐庆玲; 陈云乾; 隋亚平; 王军; 王淑荣


    Objective To investigate the feasibility and clinical effect for percutaneous microwave ablation of type I substernal goiter under the guidance of ultrasound . Methods Thirteen patients with type I substernal goiter were selected . All patients underwent percutaneous microwave ablation treatment under the guidance of ultrasound . Thirteen patients with 47 medals nodules were performed ultrasound guided percutaneous microwave ablation . Intraoperative heat blocking blood flow" was used to prevent severe hemorrhage .Liquid isolation belt" and leverage from" methods were used to effectively prevent surrounding important structures against heat damage .Small amount of residual method" was used to avoid tracheal collapse . All patients were followed up post‐operative 1 ,3 ,6 ,12 months by monitoring of thyroid nodule volume change , adverse reactions , and postoperative complications . Results Thirteen patients with 47 medals nodules were successfully performed percutaneous microwave ablation guided by ultrasound . Among them ,2 patients performed the second treatment for too large volume of goiter ,tracheal displacement and poor physical tolerance of older . The postoperative ultrasound contrast and color Doppler showed that the lesions were completely inactivated . No obvious complications occurred in all 13 patients , and no permanent hoarseness occured . The symptoms of cervical oppression and discomfort disappeared for all patients within 1-4 months after surgery . Thirteen patients were followed up for 12 months after the operation . The thyroid function was normal and the volume reduction rate of thyroid nodules was (85 ± 31)% . Conclusions Percutaneous microwave ablation of type I substernal goiter under ultrasonic guidance is a safe and effective method to reduce the thyroid nodules with no serious complications . It is worth to be popularized in clinical practice .%目的:探讨超声引导下Ⅰ型胸骨后甲状腺肿微波消融治疗的可行性及

  8. Forgotten goiter. Our experience and a review of the literature.

    Calò, Pietro Giorgio; Tatti, Alberto; Medas, Fabio; Petruzzo, Palmina; Pisano, Giuseppe; Nicolosi, Angelo


    "Forgotten" goiter is an extremely rare disease which is defined as a mediastinal thyroid mass found after total thyroidectomy. The authors report their experience of 7 cases of residual mediastinal goiter after total thyroidectomy for substernal goiter. Six patients were female and one male with a median age of 56 years (range: 25-70 years). Four patients were asymptomatic, 2 patients showed signs of mediastinal compression, and one patient had persistent hyperthyroidism. A sternal splitting incision associated with a cervical incision was required in 3 patients while an exclusively cervical incision was sufficient in 4 patients. Histology did not show neoplasia. Postoperative outcome was uncomplicated in 6 patients and in one patient a transient recurrent laryngeal nerve paralysis occurred. In the majority of cases forgotten goiter is the consequence of the incomplete removal of a plunging goiter, although sometimes it may be attributed to a concomitant, unrecognized mediastinal goiter which is not connected to the thyroid. The residual goiter has the same clinical presentation as an ordinary intrathoracic goiter. Our experience confirms that surgical treatment of forgotten goiter is associated with only minimal morbidity although a sternal split is sometimes required. Forgotten goiter is a rare pathology which can be prevented if particular attention is paid to preoperative imaging and intraoperative management during the first operation. However surgical treatment for forgotten goiter, when performed in specialized centers, is associated with low morbidity.

  9. The "forgotten" goiter after total thyroidectomy.

    Sahbaz, Alper; Aksakal, Nihat; Ozcinar, Beyza; Onuray, Feyyaz; Caglayan, Kasim; Erbil, Yesim


    "Forgotten" goiter is an extremely rare disease which is defined as a mediastinal thyroid mass found after total thyroidectomy. We report two cases with forgotten goiter. One underwent total thyroidectomy due to thyroid papillary cancer and TSH level was in normal range one month after surgery. The thyroid scintigraphy scan revealed mediastinal thyroid mass. The second case underwent total thyroidectomy due to Graves' disease and TSH level was low after surgery. At postoperative seventh year, patients were admitted to our Endocrinology Division due to persistent hyperthyroidism and CT scan revealed forgotten thyroid at mediastinum. Both patients underwent median sternotomy and mass excision, there was no morbidity detected after second surgical procedures. In the majority of cases forgotten goiter is the consequence of the incomplete removal of a plunging goiter. Although in some cases, it may be attributed to a concomitant, unrecognized mediastinal goiter which is not connected to the thyroid with a thin fibrous band or vessels. Absence of signs like mediastinal mass or tracheal deviation in preoperative chest X-ray do not excluded the substernal goiter. Retrosternal goiter should be suspected if the lower poles could not be palpated on physical examination and when postoperative TSH levels remained unchanged. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  10. The “forgotten” goiter after total thyroidectomy

    Sahbaz, Alper; Aksakal, Nihat; Ozcinar, Beyza; Onuray, Feyyaz; Caglayan, Kasim; Erbil, Yesim


    INTRODUCTION “Forgotten” goiter is an extremely rare disease which is defined as a mediastinal thyroid mass found after total thyroidectomy. PRESENTATION OF CASE We report two cases with forgotten goiter. One underwent total thyroidectomy due to thyroid papillary cancer and TSH level was in normal range one month after surgery. The thyroid scintigraphy scan revealed mediastinal thyroid mass. The second case underwent total thyroidectomy due to Graves’ disease and TSH level was low after surgery. At postoperative seventh year, patients were admitted to our Endocrinology Division due to persistent hyperthyroidism and CT scan revealed forgotten thyroid at mediastinum. Both patients underwent median sternotomy and mass excision, there was no morbidity detected after second surgical procedures. DISCUSSION In the majority of cases forgotten goiter is the consequence of the incomplete removal of a plunging goiter. Although in some cases, it may be attributed to a concomitant, unrecognized mediastinal goiter which is not connected to the thyroid with a thin fibrous band or vessels. Absence of signs like mediastinal mass or tracheal deviation in preoperative chest X-ray do not excluded the substernal goiter. CONCLUSION Retrosternal goiter should be suspected if the lower poles could not be palpated on physical examination and when postoperative TSH levels remained unchanged. PMID:23336990

  11. Bocio Goiter

    Judith Parlá Sardiñas


    Full Text Available Bocio es todo aumento de volumen de la glándula tiroidea. Su patogenia está dada fundamentalmente por una disminución en los niveles circulantes de hormonas tiroideas, con el consiguiente aumento de los niveles de hormona tirotropa que provocan hipertrofia e hiperplasia de las células foliculares y dan lugar al aumento de volumen de la glándula. Se clasifica en bocio simple, nodular y puberal. Según la OMS se clasifica por grados desde el 0 al III, y de acuerdo con la etiología en endémico y esporádico. El diagnóstico se realiza por el interrogatorio, el examen físico y se apoya en estudios complementarios: los niveles de TSH y el ultrasonido. El tratamiento depende de la etiología, la edad y el momento fisiológico de aparición. Consta de 5 pilares: preventivo, conservador o expectante, medicamentoso, quirúrgico y el uso de radioyodo. El seguimiento es clínico, apoyado en la ecografía y estudios de la función tiroidea, durante el primer año cada 6 meses, y que, si no hay modificación, se repiten anualmente.Goiter is any increase of volume of the thyroid gland. The pathogenesis is mainly due to a reduction of the circulating levels of thyroid hormones, with the resulting rise of thyrotropin hormone levels that cause hypertrophy and hyperplasia of the follicular cells and give rise to the increased volume of the gland. It is classified as simple, nodular and pubertal goiter. According to the WHO, the degree-based classification goes from 0 to III, and according to etiology, it may be endemic and sporadic. The diagnosis of goiter is based on the questioning of the patient, the physical exam and supplementary studies as TSH levels and ultrasonography. The treatment depends on the etiology, the age of the patient, and the time of onset and has five pillars: preventive, preservative or expectant, pharmacological, surgical and the use of radioiodine. The clinical follow-up supports on echography and thyroid function studies every

  12. Surgical treatment of 27 patients with retrosternal goiter%27例胸骨后甲状腺肿手术治疗分析

    张志国; 段志军


    目的总结胸骨后甲状腺肿手术治疗经验及疗效.方法回顾性分析27例胸骨后甲状腺肿行颈低领式切口手术切除的临床资料.结果27例均获治愈,术后声嘶2例,发生一过性手足抽搐3例;均在1个月内恢复.27例均获随访12~26个月,无复发病例.结论经颈部切口切除胸骨后甲状腺肿适合绝大多数患者,术前CT扫描对手术方式的选择具有指导意义.%Objective: To sum up experience and curative effect from the surgical therapy of substernal goiter. Methods: The clinical data of 27 cases of substernal goiter subject to cervical collar incision were reviewed. Results: All of the patients achieved good results. In the 2 patients occurred hoarseness, three cases were with transient tetany, postoperative recovery was in in one months. no one’s goiter recurrence. Conclusions:Low neck collar incision removed substernal goiter is feasible for most patients. The choice of operation methods were established mainly on the basis of the preoperative CT scan.

  13. [Plunging and mediastinal goiters].

    Barrault, S; Gandon, J; Le Guillou, C


    Of 185 cases of substernal goitre operated upon between 1976 and 1985, four were patients with autonomous mediastinal goitre. Diagnosis was established from results of clinical examination, a scan of mediastinum and radiologie imaging with a cervical and mediastinal CT scan as the investigation of choice. Treatment is exclusively surgical because of the risk of mediastinal compression. Most cases in this series were operated upon through a purely cervical approach, but 22 patients required partial upper sternotomy combined with cervicotomy, this minimal approach route allowing very good exposure of upper mediastinum.

  14. Diagnosis and treatment of 22 cases with substernal goite%胸骨后甲状腺肿22例的诊断与治疗

    邓淼; 陈登庭


    Objective To study the diagnosis, surgical approaches and prevention of complications for substernal goiter. Methods A retrospective study of 22 cases of substernal thyroid nodules was made. Results Among the 22 cases, 10 cases were nodular goite, 7 cases were adenomas,3 cases were nodular goiter canceration,1 case was papillary thyroid car-cinoma with lymph node metastases adjacent to the trachea. Resection via cervical collar incision was adequate in 20 cases.Thyroid cancers with paratracheal node,2 cases were resected by combined thoracotomy and cervical collar incision. The rate of complication after operation was 22.7%. There was no relapse among all patients through 1-5 years followed-up. Con-clusions CT and MRI can help to make correct operational program. Resection viacervical collar incision for all retrosternal thyroid nodules are advised for its safe and reliable.%目的 探讨胸骨后甲状腺肿的诊断、手术及并发症的预防和处理.方法 回顾性分析经外科手术病理证实的22例胸骨后甲状腺肿患者的临床资料.结果 22例中结节性甲状腺肿10例,甲状腺腺瘤7例,结节性甲状腺肿癌变3例,甲状腺乳头状癌伴气管旁淋巴结转移1例,甲状腺滤泡状腺癌伴气管旁淋巴结和纵隔淋巴结转移1例.20例颈部低位领式切口入路切除,2例颈部低位领式切口并胸骨正中劈开入路.术后并发症发生率为22.7%.22例胸骨后甲状腺肿物患者术后1~5年随访无复发.结论 胸骨后甲状腺肿术前行CT和MRI有助手术入路的选择;颈部低位领状切口手术对大多数胸骨后甲状腺肿是一种安全可靠并可行的选择.

  15. [Multinodular diving goiters: 100 cases in Morocco].

    Tajdine, Med Tariq; Lamrani, Mohamed; Serhane, Khalid; Achour, Abdessamad; Benariba, Farid; Daali, Mustapha


    To assess 100 cases of multinodular diving goiters, the authors review the literature to compare the epidemiology, clinical pictures, additional required work-up, treatments, complications, and sequelae. Records of 100 cases of multinodular diving goiters were collected in the surgical department of the Military Hospital of Marrakesh in Morocco from 1991 through 2004. They accounted for 6% of all goiters. The sex ratio was clearly female, and the mean age 50 years. The clinical symptoms of diving goiters involves mainly signs of compression, with dyspnea seen in 50% of cases. Thyroid dysfunction was found in only 25% of our patients. A diagnosis of diving goiter must be suspected when there are signs of mediastinal compression and a palpable cervical goiter, as seen in all our patients. The diagnosis can often be confirmed with thoracic radiography and thyroid scintigraphy. Treatment is mainly surgical and depends on disease course. Cervicotomy was performed in 97% of our patients and was sufficient to extract even most voluminous goiters and those deepest in the mediastinum. Immediate operative results were satisfactory. More long-term results were also generally satisfactory, except for 4 cases of recurrent paralysis and 5 cases of hypoparathyroidism. Both have been reported by several authors. Surgical management of multinodular diving goiters is necessary. In general, cervicotomy is sufficient, and the results generally satisfactory, except some complications and neoplasms.

  16. Two cases of fetal goiter

    Ashish Saini


    Full Text Available Introduction: Anterior fetal neck masses are rarely encountered. Careful routine ultrasound screening can reveal intrauterine fetal goiters (FGs. The incidence of goitrous hypothyroidism is 1 in 30,000-50,000 live births. The consequences of both FG and impaired thyroid function are serious. Aims and Objectives: To emphasize role of ultrasound in both invasive and non-invasive management of FG. Materials and Methods: Two pregnant patients, during second trimester, underwent routine antenatal ultrasound revealing FG, were investigated and managed. Results: Case 1: Revealed FG with fetal hypothyroidism. Intra-amniotic injection l-thyroxine given. Follow-up ultrasound confirmed the reduction of the goiter size. At birth, thyroid dyshormogenesis was suspected and neonate discharged on 50 mcg levothyroxine/day with normal growth and development so far. Case 2: Hypothyroid mother with twin pregnancy revealed FG, in twin 1, confirmed on magnetic resonance imaging (1.5 × 1.63 cm. The other twin had no thyroid swelling. Cordocentesis confirmed hypothyroidism in twin 1. Maternal thyroxine dose increased as per biochemical parameters leading to reduction in FG size. Mother delivered preterm and none of the twins had thyroid swelling. Fetal euthyroidism was confirmed on biochemical screening. Conclusion: FG during pregnancy should be thoroughly evaluated, diagnosed and immediately treated; although in utero options for fetal hypothyroidism management are available, emphasis should be laid on non-invasive procedures. Newer and better resolution techniques in ultrasonography are more specific and at the same time are less harmful.

  17. Surgical considerations about amyloid goiter.

    García Villanueva, Augusto; García Villanueva, María Jesús; García Villanueva, Mercedes; Rojo Blanco, Roberto; Collado Guirao, María Vicenta; Cabañas Montero, Jacobo; Beni Pérez, Rafael; Moreno Montes, Irene


    Amyloidosis is an uncommon syndrome consisting of a number of disorders having in common an extracellular deposit of fibrillary proteins. This results in functional and structural changes in the affected organs, depending on deposit location and severity. Amyloid infiltration of the thyroid gland may occur in 50% and up to 80% of patients with primary and secondary amyloidosis respectively. Amyloid goiter (AG) is a true rarity, usually found associated to secondary amyloidosis. AG may require surgical excision, usually because of compressive symptoms. We report the case of a patient with a big AG occurring in the course of a secondary amyloidosis associated to polyarticular onset juvenile idiopathic arthritis who underwent total thyroidectomy. Current literature is reviewed, an attempt is made to provide action guidelines, and some surgical considerations on this rare condition are given.

  18. Ultrasound diagnosis on the goiter

    Igl, W.; Fink, V.; Leisner, B.; Gebauer, A.


    Sonography of the thyroid means facilitation to the differential diagnosis of the goiter, and if combined with the nuclear-medical methods, its accuracy is even increased. Cysts, thyreoditis de Quervain, morbus Basedow, and autonomous adenoma can be assumed due to the areals with low echo in the sonogram and they can be differentiated by the scintigram. In the case of iodine-free areals which can be manifested by fluorescence scintiscanning and normal echo pattern of the thyroid below a malignoma has to be suspected. The volume can be determined with an accuracy of +-10% by ultrasound, without needing long time. Knowing the thickness of the thyroid at places of increased storage in the scintigram, an impulse-thickness-quotient can be calculated which permits, in most cases, to diagnose an autonomous adenoma at a regional increased storage without suppression test.

  19. Amyloid Goiter Secondary to Ulcerative Colitis

    Bunyamin Aydin


    Full Text Available Diffuse amyloid goiter (AG is an entity characterized by the deposition of amyloid in the thyroid gland. AG may be associated with either primary or secondary amyloidosis. Secondary amyloidosis is rarely caused by inflammatory bowel diseases. Secondary amyloidosis is relatively more common in the patients with Crohn’s disease, whereas it is highly rare in patients with ulcerative colitis. Diffuse amyloid goiter caused by ulcerative colitis is also a rare condition. In the presence of amyloid in the thyroid gland, medullary thyroid cancer should be kept in mind in the differential diagnosis. Imaging techniques and biochemical tests are not very helpful in the diagnosis of secondary amyloid goiter and the definitive diagnosis is established based on the histopathologic analysis and histochemical staining techniques. In this report, we present a 35-year-old male patient with diffuse amyloid goiter caused by secondary amyloidosis associated with ulcerative colitis.


    O. S. Rogova


    Full Text Available For today the question of early diagnosis of nosological variants, the method of treatment and prevention of nodular goiter in children is still not fully resolved. There is a few available literature data about study of this problem in children. Objective: to study morphofunctional structure of thyroid nodules in children.The article provides information consisting of the results of a retrospective analysis of case histories of 73 patients, operated with nodular goiter in Z.A. Bashlyaeva Children’sCityClinicalHospital(Moscow from 2003 to May 2015. The examination included an evaluation of the functional status of the pituitary-thyroid system: there were investigated serum thyroxine, triiodothyronine and thyroid stimulating hor-mone, also was performed thyroid scintigraphy 99mТc. In the postoperative period, there was carried out a final verification of the diagnosis according to the results of the histological conclusion. The histologi-cal type of nodal disease was defined by the WHO classification of 2004. It was established that in the structure of a single-node goiter in children prevail nodular colloid goiter with equal frequency in boys and girls, with the same frequency occurs thyroid adenoma, but more often in girls than in boys. The multinodular goiter equally often detected in girls and boys both nodular goiter colloidal with varying degree of proliferation and colloid in combination with follicular thyroid adenoma. "Hot" nodes in the multinodular goiter are more common than in the single-node goiter and more fre-quently in girls than in boys. The half of children with nodular pathology have "hot" nodes and one out of every three – decompensated form of functional autonomy. Decompensated form of functional autonomy of the thyroid gland in children with "hot" nodes detects regardless of the number of nodes. Papillary thyroid cancer occurs not only in patients with a single-node, but with a multinodular goiter. The results allow to

  1. Surgical management for substernal goiter with cervical collar incision%胸骨后甲状腺肿的诊断与手术治疗

    哈力木拉提·木尔提扎; 哈尔满·阿吉汗; 赛力克·马高维亚; 吾甫尔·依马尔


    目的 探讨胸骨后甲状腺肿的诊断方法及手术治疗.方法 回顾性分析2002-2011年52例经手术治疗的胸骨后甲状腺肿患者的临床资料.结果 本组中胸片、B超、CT及核素显像对胸骨后甲状腺肿诊断阳性率分别为64%,20%,89%和73%.52例患者(Ⅰ型36例、Ⅱ型14例、Ⅲ型2例)全部行颈部低领状切除术.术后病理:良性病变47例,恶性肿瘤5例.结论 CT、胸片是胸骨后甲状腺肿的较敏感诊断方法.绝大多数病例可采用低领状切口均能成功地完成手术,不需开胸.一般颈部低领状切口为胸骨后甲状腺肿的首选手术方式,不需开胸.

  2. Simple goiter in children and juveniles

    Wiebel, J.


    Non-toxic, simple goiter is the most common cause of thyroid enlargement in adolescents and children. Although initially there are hardly any complaints it should be treated with l-thyroxine to prevent further enlargement, degenerative alterations, development of nodules, possible hyper- or hypothyroidism occurring with increasing age. Anamnesis and clinical features are as important for establishing the diagnosis as laboratory parameters, which are not always necessary. Thyroid nodules in children or adolescents are more likely to be malignant than in later life; their nature has to be clarified by sonography, scintigraphy, fine needle biopsy or even operation. After l-thyroxine therapy has normalized thyroid size (60-90%), goiter prophylaxis with iodine supplementation can be tried, since iodine deficiency exists throughout Germany. If the goiter reappears continuous l-thyroxine treatment is recommended. Following the general introduction of iodine prophylaxis using iodinized salt there has been a significant reduction in goiter incidence in Switzerland, Austria and other areas with iodine deficiency. New legislation in the FRG now allows for the general use of e.g., Bad Reichenhaller Jodsalz, Duera Vollsalz or Bayerisches Vollsalz to prevent the development of the majority of goiters in children and adolescents.

  3. Postoperative recurrent nontoxic nodular (multinodular goiter

    Tolstokorov A.S.


    Full Text Available The extensive use of modern methods of examination (ultrasound investigation with Doppler mapping, aspiration (needle biopsy, radiodiagnostics cannot resolve the problem of verification of nodular mass in case of multinodular goiter before operation. Operative intervention is the method of choice in this case, which gives rise to the problem of surgery extent. The present study is useful in improvement of remote results of surgical treatment of multinodular goiter through statistical estimation of recurrent goiter development. The study was retrospective and included 102 consecutively admitted and operated patients with recurrent goiter and 102 patients of control group with first diagnosed and operated goiter. Patients of both groups were in euthyroid state. Patients were admitted to the Clinic of Surgery and Oncology of Raising Skills Faculty of Saratov State Medical University n.a. V. I. Razumovsky from 2000 till 2004. Statistical analyses included calculation of average mean, standard deviation and mean error. Student's ratio was used as the test of validity of average mean. Chi-square test was used for assessment of qualitative characteristics.

  4. Musculoskeletal System Symptoms in Goiter

    Sevim Akin


    Full Text Available Aim: The aim of this study was to investigate the prevalence of musculoskeletal manifestations in patients with thyroid dysfunction. Methods: One hundred and twenty-three patients (100 female, 23 male who visited the nuclear medicine department for thyroid gland scintigraphy were included in our study. According to thyroid hormone levels, patients were allocated into five categories: hyperthyroidism, subclinical hyperthyroidism, euthyroid, subclinical hypothyroidism, and hypothyroidism. Before neurological and musculoskeletal examinations, a standardized symptom questionnaire was completed including questions about sensory symptoms, muscle weakness, restricted joint mobility, musculoskeletal pain. Neurological examination, range of motion of joints, effusion or swelling of joints was assessed. Diagnosis of osteoarthritis was done by the clinical and radiological characteristics. The diagnosis of FMS was made according to criteria of American College of Rheumatology. According to the World Health Organization (WHO, a T-score ≤ -2.5 was classified as osteoporosis, whereas a T-score between -2.5 and -1.0 was classified as osteopenia. Thyroid status was determined by serum TSH levels. Results: Eighty-one percent of the patients were female (100 and 19% were male (23. Mean age of female patients was 49.99±15.27 years (range 20-87 and mean age of male patients was 61.8±12.33 years (range 34-88. When divided according to thyroid status, 21.1% (n=26 had hyperthyroidism, 21.1% (n=26 had subclinical hyperthyroidism, 49.6% (n=61 were euthyroid, 4.9% (n=6 had subclinical hypothyroidism and 3.3% (n=4 were hypothyroid. None of 59% of patients had any musculoskeletal diagnosis. Osteoporosis was the most common problem, affecting 23.7% of patients Conclusion: The presence of musculoskeletal symptoms in patients with goiter should be considered and investigated. [Cukurova Med J 2013; 38(2.000: 261-269

  5. Risk factors for goiter and thyroid nodules

    Knudsen, N.; Laurberg, P.; Perrild, H.


    is probably dependent on iodine status, because it seems that the zenith of goiter prevalence appears earlier in life the more severe iodine deficiency the population is exposed to. The association with individual risk factors has been investigated in some studies, especially the association with tobacco......The occurrence of thyroid diseases is determined by interplay between genetic and environmental factors. The major environmental factor that determines goiter prevalence is iodine status, but other environmental factors influencing entire populations have been identified such as goitrogens in food...... smoking. In iodine-deficient areas, a strong association between tobacco smoking and goiter prevalence is found, whereas the association is less pronounced in iodine-replete areas. This was predictable from experimental studies showing thiocyanate to be the mediator of the goitrogenic effect of tobacco...

  6. Endothoracic goiter. Presentation of two cases

    José Alberto Puerto Lorenzo


    Full Text Available A goiter is considered thoracic when more than 50% of the thyroid gland is in the mediastinum, under the level of the upper thoracic inlet. It is an infrequent disease, which represents about 10% of the mediastinal masses. Two cases are presented of patients who underwent endothoracic goiter surgery in the Hospital Dr. Gustavo Aldereguía Lima of Cienfuegos. The surgical treatment applied was right hemithyroidectomy, with isthmectomy and resection of the mediastinic tumor extension. It is an infrequent entity, reason for which it is considered a publication of interest.

  7. Substernal oxyphil parathyroid adenoma producing PTHrP with hypercalcemia and normal PTH level

    Rubini Domenico


    Full Text Available Abstract Background Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Preoperative serum calcium and intact-parathyroid hormone levels are the most useful diagnostic parameters that allow differentiating primary hyperparathyroidism from non-parathyroid-dependent hypercalcemia. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. Approximately 5% of patients who underwent parathyroidectomy present with persistent or recurrent hyperparathyroidism due to ectopic localization of the adenoma. Functioning oxyphil parathyroid adenoma is an uncommon histological form, seldom causing primary hyperparathyroidism. Parathyroid adenoma with hypercalcemia exhibiting normal parathyroid hormone level is rare. An incidence of 5% to 33% has been documented in the literature; no etiologic explanation has been given. In 1987, parathyroid-hormone-related peptide was isolated as a causative factor of humeral hypercalcemia of malignancy. The presence of parathyroid-hormone-related peptide in parathyroid tissue under normal and pathological conditions has been described in the literature; however, its role in causing hyperparathyroidism has not yet been defined. Case presentation We present a case of persistent hypercalcemia with a normal level of intact-parathyroid hormone due to a substernal parathyroid adenoma, treated with radioguided parathyroidectomy. The final histological diagnosis was oxyphil adenoma, positive for parathyroid-hormone-related peptide antigens. Conclusion In clinical practice, this atypical biochemical presentation of primary hyperparathyroidism should be considered in the differential diagnosis of hypercalcemia. The parathyroid-hormone-related peptide should be considered not only in the presence of malignancy.

  8. Fetal goiter and bilateral ovarian cysts

    Lassen, Pernille; Sundberg, Karin; Juul, Anders


    by each injection and followed by a gradual reduction of fetal goiter as well as the left ovarian cyst. The right cyst ruptured spontaneously. At 36 weeks + 4 days, the patient underwent elective caesarean section and gave birth to a female, weighing 2,880 g with 1- and 5-min Apgar scores of 10...

  9. C-cells in colloid goiter

    Lima Marcus A.


    Full Text Available PURPOSE: The aim of this investigation was to quantitatively evaluate C-cells in colloid goiters, analyzing 36 thyroids that were obtained through thyroidectomy from 24 patients with goiter and 12 normal glands from adult patients without thyroid disease, which were used as the control group. MATERIAL AND METHODS: On average, 6 different thyroid areas were sampled and labeled by immunohistochemistry with a monoclonal anticalcitonin antibody, utilizing the avidin-biotin-peroxidase complex. C-cells were counted in fields measuring 1 square centimeter, and the mean number of cells per field was then calculated. Data were statistically analyzed using the Mann-Whitney test. RESULTS: In the colloid goiter group, the number of C-cells ranged from 0 to 23 per field, while in normal controls they ranged from 20 to 148 per field. CONCLUSIONS: These results demonstrate a significant decrease of C-cell number in the colloid goiter group compared with control group, indicating that the hyperplastic process is restricted to follicular cells, to the detriment of C-cells, which probably cease to receive trophic stimuli.

  10. Fetal goiter and bilateral ovarian cysts

    Lassen, Pernille; Sundberg, Karin; Juul, Anders


    A unique case of fetal goiter accompanied by bilateral ovarian cysts in a mother treated with methimazole for Graves'disease is reported. The abnormal findings were detected by ultrasound at 31 weeks of gestation. Umbilical fetal blood sampling revealed elevated serum TSH, normal concentrations o...

  11. An unusual cause of hematemesis: Goiter

    Astrid AM van der Veldt; Mohammed Hadithi; Marinus A Paul; Fred G van den Berg; Chris JJ Mulder; Mikael E Craanen


    Downhill varices are located in the upper part of the esophagus and are usually related to superior vena cava obstruction. Bleeding from these varices is extremely rare. We describe a 77-year-old patient with hematemesis due to downhill varices as a result of recurrent goiter. A right lobe thyroidectomy was carried out with disappearance of the varices.

  12. Correlation between thyroid function and nodular goiter accompanied with gallstone

    Shihong Ma; Qinjiang Liu; Xiaofeng Hou



  13. Retrosternal Goiter: Analysis of 42 Cases

    Alkýn Yazýcýoðlu


    Full Text Available Aim: Cases that were operated due to diagnosis of retrosternal goiter were examined in terms of age, gender, complaints, diagnosis methods, surgical methods and postoperative complications. Material and Metod: The records of 42 cases operated due to retrosternal goiter between January 2006 and April 2012 were retrospectively evaluated. Results: Of the 42 cases, 16 (38.1% were male and 26 (61.9% were female; mean age was 56.4 years (range 31 – 79. 10 patients (23.8% were asymptomatic and the most frequent complaint was dyspnea (n = 18, 42.9%. A collar-incision was used in 22 patients (52.4%, collar + sternotomy to 5 patients (11.9%, and right thoracotomy to 8 patients (19.0%. The most frequently observed thyroid pathology was nodular hyperplasia (n = 32, 76.2% and 5 patients (11.9% were diagnosed with thyroid carcinoma. The average duration of hospital stay was 5.6 days (2 – 16 and hypoparathyroidic hypocalcemia was determined in 2 patients (4.8%; no mortality was observed. Discussion: Collar incision is adequate for excision in most cases of retrosternal goiter. Sternotomy or thoracotomy can be safely applied with low morbidity rate to cases with suspected adjacency to mediastinal structures.  

  14. Pathogenesis of nodular goiter and its implications for surgical management

    Teuscher, J.; Peter, H.J.; Gerber, H.; Berchtold, R.; Studer, H.


    Despite sufficient iodine supply, goiter continues to be of considerable surgical significance in formerly endemic countries. It now appears that iodine deficiency and increased thyrotropin stimulation are not the only causes of goiter. Xenotransplantation of human thyroid tissue onto nude mice allowed study of the regulation of growth and function in human goiter tissue. Grafts of human thyroid tissue growing in nude mice could be shown to react to endogenous mouse thyrotropic stimulation and suppression. /sup 131/I autoradiographs of xenotransplanted goiter tissue showed as marked a heterogeneity as did the original goitrous tissue prior to transplantation. There was no firm correlation between the morphologic appearance of a follicle and its iodine metabolism. Scintigraphically cold and hot goiter tissue differed from each other quantitatively but not qualitatively; i.e., both hot and cold tissue were composed of metabolically active and nonactive follicles. Iodine organification was not completely suppressible by thyroxine treatment; this indicates autonomous functional activity. The distribution of proliferating tissue labeled by /sup 3/H-thymidine did not parallel the distribution of functionally active tissue labelled by /sup 131/I. Thyroxine treatment did not completely inhibit /sup 3/H-thymidine incorporation, indicating autonomous growth. Thus, our pathogenetic concept of goiter formation is based on three mainstays: (1) goiter heterogeneity, (2) autonomy of growth and function, and (3) dissociation of growth and function in human goiter tissue. Thus, the surgeon dealing with goiter ought to remove all pathologically altered tissue, i.e., nodular tissue, irrespective of its appearance on scintiscans.

  15. Clinicopathological profile, airway management, and outcome in huge multinodular goiters: an institutional experience from an endemic goiter region.

    Agarwal, Amit; Agarwal, Sudhi; Tewari, Prabhat; Gupta, Sushil; Chand, Gyan; Mishra, Anjali; Agarwal, Gaurav; Verma, A K; Mishra, S K


    Huge goiters are common in iodine-deficient endemic regions. They are of concern to the surgeons because of the anticipated risk of difficult dissection and increased chances of surgical complications. Similarly, they are of concern to the anesthesiologists because of anticipated intubation-related difficulties and post-thyroidectomy tracheomalacia. In the present study we aimed to present our experience of managing goiters based on their gross weight, highlighting their clinicopathological profile, perioperative airway-related difficulties, and management of surgical morbidity. Retrospective analysis of patients who underwent total thyroidectomy in the primary setting at our institute from 1995 to 2009 was carried out based on the gross gland weight. The patients were thus grouped into group A: ≤200 g; group B: 201 to ≤400 g; group C: 401 to ≤600 g; group D: >600 g. Group A (660 cases); group B (108 cases); group C (36 cases); and group D (9 cases) were included. As the goiter size increased, the mean duration of goiter, compressive symptoms, retrosternal extension (RSE), airway deformity, intubation difficulty, and tracheomalacia increased. The rate of tracheostomy, sternotomy, hemorrhage, visceral injury, and hospital stay was high with huge goiters. These features were more marked in malignant goiters compared to benign goiters. However, the postoperative complications were comparable in both of those groups. Long-standing huge goiters are common in iodine-deficient endemic areas. The majority of patients have symptomatic or clinicoradiological evidence of airway involvement. The incidence of RSE, airway deformity, intubation difficulty, and tracheomalacia is high with huge goiters. The surgery is technically demanding with greater associated chances of injury to native structures. Malignancy influences the presentation and outcome in smaller goiters. In centers with experienced endocrine surgeons and dedicated anesthetists, huge goiters can be

  16. Dyshormonogenic Goiter within Ectopic Thyroid: A Case Report

    Lee, Woong Hee; Han, Jong Kyu; Kim, Young Tong; Jou, Sung Shick; Kim, Sang Won; Kim, Sung Yong; Cho, Hyun Deuk [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of)


    A dyshormonogenetic goiter is a congenital hyperplasia of the thyroid parenchyma caused by a defect in the normal hormongenetic pathway. Here, we report on a case involving the simultaneous occurrence of a thyroid and an ectopic thyroid dyshormonogenetic goiter. We describe the ultrasound and CT findings along with a brief literature review

  17. Fetal Goiter was Resolved with Decreasing Maternal Propylthiouracil Dose

    And Yavuz


    Full Text Available We report a case of fetal goiter diagnosed by detailed ultrasonography. A 33-year-old woman at twenty weeks of gestation was referred to our hospital for detailed ultrasonography. A fetal goiter was identified. She was receiving propylthiouracil (PTU 100 mg daily for Graves’ disease. Amniocentesis was performed and fetal thyroid function was evaluated as normal. Her recent thyroid function tests were normal, but anti-thyroid antibodies were positive. The dose of PTU was reduced to 50 mg. However, at twenty six weeks of gestation, maternal thyroid-related autoantibodies became undetectable. A fetal magnetic resonance imaging demonstrated a slight shrinkage of the fetal goiter at 30 weeks. The fetus was delivered vaginally. Thyroid function tests of the neonate were normal, and neonatal goiter was nonpalpable. Fetal goiter is a rare disease. It can be spontaneously resolved by decreasing the maternal dose of PTU.

  18. [Endemic goiter in the extreme North of West Siberia].

    Luzina, I G; Suplotova, L A; Osadchenko, G A


    Random examinations covering 8-60-year-old 4345 citizens of 12 settlements of the Yamal-Nenets Autonomic Territory discovered goiter endemia throughout the territory but most evident the endemy manifested in the Far North. The prevalence of endemic goiter among schoolchildren made up 52.8% (enlargement of the goiter of the 1st and 2nd degree), among adults-49.2%. By ultrasound investigation, the above percentages were 29 and 26.4%, respectively. This corresponds to moderate endemia. The median of urinary iodine excretion averaged in the territory 5.1 micrograms%, while overall iodine insufficiency (number of children with urinary iodine < 10 micrograms%) was 81.9%. In the Far North iodine excretion was less but goiter incidence was higher than normal. Thus, in the Far North goiter endemia is rather serious.

  19. [Endemic goiter in Latium: environmental and genetic factors].

    Paggi, A


    Most studies on the pathogenesis of endemic goiter focus above all on iodine deficiency. In some endemic goiter areas (i.e. Nigeria) there is no evidence of iodine deficiency; therefore, we suggest the taking into account of various factors, both environmental and non-environmental. We report the results of two studies carried out in three different areas in Latium: one of them (Cerveteri, RM) could be classified as high prevalence of goiter area, while the two others (Roccasecca dei Volsci, LT and Castel San Pietro Romano, RM) are true endemic goiter areas. The role of environmental factors, radioactivity and electromagnetism, foodstuff, the hydrogeological and chemical composition of natural water and the importance of genetics are here discussed, assuming that the endemic goiter could have a multifactorial pathogenesis.

  20. Decreased Expression of GPER1 Gene and Protein in Goiter

    Raquel Weber


    Full Text Available Goiter is more common in women, suggesting that estrogen could be involved in its physiopathology. The presence of classical estrogen receptors (ERα and ERβ has been described in thyroid tissue, suggesting a direct effect of estrogen on the gland. A nonclassic estrogen receptor, the G-protein-coupled estrogen receptor (GPER1, has been described recently in several tissues. However, in goiter, the presence of this receptor has not been studied yet. We investigated GPER1 gene and protein expressions in normal thyroid and goiter using reverse transcription quantitative polymerase chain reaction (RT-qPCR and Western blot, respectively. In normal thyroid (n=16 and goiter (n=19, GPER1 gene was expressed in all samples, while GPER1 protein was expressed in all samples of normal thyroid (n=15 but in only 72% of goiter samples (n=13. When comparing GPER1 gene and protein levels in both conditions, gene expression and protein levels were higher in normal thyroid than in goiter, suggesting a role of this receptor in this condition. Further studies are needed to elucidate the role of GPER1 in normal thyroid and goiter.

  1. Bocio endotorácico Endothoracic goiter

    Gabriel González Sosa


    Full Text Available Se informa el caso de una paciente de 71 años de edad, con antecedentes de hipertensión arterial, que acude a consulta externa pues hace unos 5 años presenta aumento de volumen de la región inferior y lateral del cuello que se acompaña de decaimientos, palpitaciones y disfagia ocasional. Se realizaron los estudios de laboratorio para la valoración preoperatoria, además de los estudios de la función tiroidea, radiografías de tórax (vista anteroposterior, tomografía de tórax, ecografía de la tiroides y biopsia de aspiración con aguja fina. Se encontró un bocio endotorácico eutiroideo y se realizó tratamiento quirúrgico que consistió en hemitiroidectomía izquierda con istmectomía. El transoperatorio y el posoperatorio transcurrieron sin complicaciones, y el informe anatomopatológico reveló la presencia de un bocio coloide nodular.This is the case of a female patient aged 71 with a history of high blood pressure seen in external consultation since five years ago she presents a volume increase of lower and lateral region of the neck accompanied of weakness, palpitations and occasional dysphagia. Laboratory studies were conducted to preoperative assessment in addition to thyroid function studies, thorax X-rays (anteroposterior view, thorax tomography, thyroid gland echography and fine needle aspiration biopsy (FNAB. A euthyroid endothoracic goiter was present; surgical treatment was done consisting of left hemithyroidectomy with isthmectomy. In transoperative and postoperative periods there were not complications and the anatomic and pathologic report revealed the presence of nodular colloid goiter.

  2. Nodular goiter after occupational accidental exposure to radiation

    Pisarev, M.A. [Radiobiology, National Atomic Energy Commission, Buenos Aires (Argentina); Human Biochemistry, Uninversity of Buenos Aires, School of Medicine, Buenos Aires (Argentina); Schnitman, M. [Center of Endocrinology and Metabolism, French Hospital C.Milstein, Buenos Aires (Argentina)


    In the present paper we present the consequences of an accidental occupational radiation exposure at a local hospital in Buenos Aires. Control at a local radiology service showed the lack of correct shielding in the X-ray equipment. The physicians and technicians (14 persons) exposed to radiation during 12 months were examined. The survey shows that: a) In 11 out of 14 radiation-exposed patients nodular goiter developed and an additional patient had diffuse goiter which means a goiter incidence of 85.7%; b) In 5 of the nodular goiter patients an increase in the size or the appearance of new nodules was observed along the follow-up period. No cancer was detected by FNA; c) Hypothyroidism was observed in 3/14 patients, and an additional patient had an abnormal TRH-TSH test, suggesting subclinical hypothyroidism; and d) Increased circulating antithyroid antibodies were found in one of the hypothyroid patients

  3. The Mystery of Michelangelo Buonarroti’s Goiter

    Davide Lazzeri


    Full Text Available Whilst painting the vault of the Sistine Chapel, Michelangelo Buonarroti left an autographical sketch that revealed a prominence at the front of his hyper-extended neck. This image was recently diagnosed as goiter. The poet Michelangelo in a sonnet dated 1509 described himself as being afflicted by goiter similarly to the cats in the northern Italian Lombardy, a region with endemic goiter. Several narratives extended this sonnet into a pathological theory. The analyses of Michelangelo’s works, however, his portraits and self-portraits, of poems and major biographies, have not indicated the likelihood of goiter. This investigation makes an attempt to assess the diagnosis on clinical as well as iconographical grounds.

  4. Thyroid hemiagenesis associated with retrosternal nodular goiter: a case report.

    Turkay Kirdak


    Full Text Available Thyroid hemiagenesis can be associated with various thyroid pathologies such as papillary thyroid cancer or nodular goiter. However, we did not encounter any publication in the literature in which hemiagenesis could be observed together with retrosternal goiter. In this report, a thyroid hemiagenesis associated with a benign nodular goiter extending retrosternally is reported. A 59-year-old male patient presented to the surgery clinic because of swelling in the neck. A mass was observed in the right thyroid lobe extending to the retrosternal region. On ultrasonography, a nodule in the right thyroid lobe measuring 63 mm was determined, which was extended retrosternally. However, the left lobe of the thyroid could not be visualized. Scintigraphy and Computerized Tomography confirmed hemiagenesis. Total thyroidectomy was performed without sternotomy. In conclusion, thyroid hemiagenesis can be associated with a retrosternally located nodular goiter.

  5. Iodine Excess is a Risk Factor for Goiter Formation

    mandatory iodine fortification of salt, goiter rates reduced to 14% ... studies have suggested that excess iodine may be the cause of ... change, which depends upon the amount of iodine present .... medicine with too much iodine causes thyroid.

  6. Iodine Status and Goiter Prevalence in Nizhegorodsky Region

    Yu I Tarasov


    Full Text Available The undertaken study was to evaluate the severity of iodine deficiency and to establish the prevalence of goiter in the city of Nizhny Novgorod and in 35 districts of Nizhegorodsky region. 1868 children aged 8—11 years were examined. The median of urinary iodine concentration was measured, and the size of the thyroid was determined by palpation and by ultrasound study. Among all the examinees, the detection rate of the goiter was 19.4% (as evidenced by palpation and the median of urinary iodine concentration was 45.05 μg/l. The findings indicate natural iodine deficiency on the whole territory studied with severity variations from mild to moderate, and the disparity in goiter rate and iodine excretion level in some districts of Nizhegorodsky region. Cluster analysis and automatic classification of the districts based on goiter prevalence and urinary iodine parameters may be useful for a comprehensive assessment of iodine status in the whole region. Analyzing the pattern of the spread of goiter has demonstrated the role of geochemical, social and medical factors existing in the region. Key words: iodine deficiency, goiter, population based stady, thyroid.

  7. Evaluation of Children with Goiter and Treatment Outcomes

    Ömer Tarım


    Full Text Available Aim: Goiter is defined as the enlargement of thyroid gland independent of the etiology. It is common in childhood, especially in adolescence. The prevalence of goiter in children aged 6 to 12 years of age was found as 24.9 to 92% in different studies performed in different regions of Turkey. The most common cause in endemic regions is iodine deficiency and it is chronic lymphocytic thyroiditis in non-endemic areas. The aim of this study was to evaluate the demographic and diagnostic characteristics; and physical, laboratory and radiological findings of the children who were presented and followed-up with goiter, and the efficacy of the treatments applied was also assessed.Materials and Methods: A total of 116 children diagnosed as having goiter by physical and ultrasonographic examination in the outpatient clinic of Pediatric Endocrinology Division of Uludag University Faculty of Medicine, between January 2000 and December 2005. Data of the patient were collected retrospectively from the files/records of the patients. Goiter grades of the patients were determined according to that recommended by WHO. Thyroid volumes were calculated from the ultrasonographic measurement of thyroid dimensions. Patients with euthyroid or hypothyroid goiter had L-thyroxine therapy and those with hyperthyroidism had propiltiourasil and/or propranolol. Results: Of all children, 80 (69% were girls and the remaining 36 were boys (31%. At the time of initial diagnosis, the mean ages of the girls and the boys were 10.1±2.9 years and 9.02± years, respectively. The mean follow-up period was 3.18±1.83 years. Most children (76.7% had grade Ib (38.8% or II (37.9% goiter at the time of diagnosis. Of all children with goiter, 62 (53.4% were euthyroid, 47 (40.5% were hypothyroid and 7 (6.0% were hyperthyroid. Seventy nine (68.1% patients had history of thyroid disease in their families. There were additional endocrinological disturbances, epilepsy and other systemic diseases

  8. Ultrasonographic determination of goiter prevalence in southern Brazilian schoolchildren

    Lisbôa H.R.K.


    Full Text Available The aim of the present study was to estimate the prevalence of goiter in schoolchildren in a formerly iodine-deficient region in southern Brazil by assessing the relationship between body surface area (m² and thyroid volume (ml measured by ultrasonography. A population-based sample of 1,094 randomly selected schoolchildren (6 to 14 years; 556 boys and 538 girls underwent clinical evaluation. A total of 119 (10.9% children were diagnosed with goiter upon clinical examination according to WHO criteria (grade Ia: 65, grade Ib: 24, grade II: 29, grade III: 1. Of these, 85 underwent ultrasonography. In order to ascertain the absence of goiter in the 975 schoolchildren with a negative result upon clinical examination, one of ten children was randomly selected for ultrasonography. Sixty-two children agreed to be submitted to the exam. Thus, 147 schoolchildren were evaluated by ultrasonography (7.5-MHz transducer. Goiter was considered to be present when the thyroid volume:body surface area index was >6.2 ml/m². The estimated prevalence of goiter if all schoolchildren had been submitted to thyroid volume measurement by ultrasound was 7.2%; it was higher in the lower socioeconomic class (8.2% than in the upper (7.8% and middle classes (6.5%. In conclusion, the prevalence of goiter in schoolchildren of this region was higher than in other iodine-sufficient areas, especially in lower socioeconomic classes. Goiter in this region may be associated with naturally occurring goitrogens that operate more intensively among less privileged individuals.

  9. Relationship between intra thyroid calcifications and thyroglobulin in endemic goiter

    Zaccheroni, V.; Iagulli, M.P.; Vescini, F.; Bianchi, G.P.; Menini, S.; Vacirca, A.; Vallese, M.; Lodi, A. [Bologna Univ., Bologna (Italy). Dipt. di medicina interna, cardioangiologia e epatologia


    The authors have been looking for the presence of parameters associated with thyroid calcifications in patients affected by simple or nodular goiter, either sporadic or endemic. A multistep discriminant analysis taking the presence-absence of calcifications as dependent variant was applied and a new variable (TG1) was created to differentiate normal from supra physiologic concentrations of hTG. In conclusion, as far as a follicular hyperstimulation can be assumed, especially if long-lasting, the presence intra thyroid calcifications should rise clinical suspect toward an old goiter rather than a neoplastic lesion.

  10. Surgical treatment of benign nodular goiter; report of 72 patients



    Full Text Available Surgical resection is usually prefered for the treatment of benign nodular goiter. But the extention of thyroidectomy in the surgical management of benign nodular goiter still remains controversial. Seventytwo patients underwent thyroid surgery between April 2002- July2007 in Kızıltepe State Hospital Otorhinolaryngology Service. Of the patients 63 were women (%87.5, 9 were man (%12.5. The range of age was between 15-62 years and mean age was 36,5. Thirtynine patients had unilateral total lobectomy+ istmusectomy (%54.2, 11 patients had unilateral lobectomy+ isthmusectomy+contralateral subtotal lobectomy (Dunhill Procedure (%15.3, 20 patients had nearly total thyroidectomy (%27.8, 2 patients had total thyroidectomy (% 2.7. Three patients had seroma (%4.1, 2 patients had hemorrhage requiring operative hemostasis (%2.7, 1 patient had suture reaction(%1.3. Patients have not had permanent or temporary nervus laryngeus recurrens injury, hypoparathyroidism and infection.As a result more extent surgical resections must be preferred by the surgeon for the treatment of benign nodular goiter. The preferable surgical treatment of solitary nodules is lobectomy+isthmusectomy. The multinodular goiter must be treated with unilateral lobectomy+ isthmusectomy+contralateral subtotal lobectomy (Dunhill procedure when the remnant thyroid tissue is normal; otherwise nearly total or total thyroidectomy is preferable.

  11. Quality of life in patients with benign nontoxic goiter

    Cramon, Per; Bonnema, Steen Joop; Bjørner, Jakob


    BACKGROUND: While health-related quality of life (HRQoL) issues often prompt treatment of benign nontoxic goiter (NTG), few clinical studies have systematically assessed HRQoL in patients with this condition. The purpose of the present study was to evaluate thyroid-related and generic HRQo...

  12. Amyloid goiter in a child - US, CT and MR evaluation

    Perez Fontan, F.J.; Mosquera Oses, J.; Pombo Felipe, F. (Hospital Juan Canalejo, La Coruna (Spain). Dept. of Radiology); Rodriguez Sanchez, I.; Arnaiz Pena, S. (Hospital Juan Canalejo, La Coruna (Spain). Dept. of Pediatric Oncology)


    There are few radiological descriptions of amyloid goiter, basically in adult patients or oriental origin. We present a ten-year-old boy with Still's disease and secondary thyroid amyloidosis, describing the US, CT and MR findings. (orig.).

  13. 颈部低领状切口治疗胸骨后甲状腺肿21例体会%Experience in thyroidectomy for substernal goiter with cervical collar incision



    目的 探讨颈部低领状切口治疗胸骨后甲状腺肿的效果.方法 回顾分析我科1998~2006年收治的21例位于胸骨后甲状腺肿的临床资料.结果 经过充分的术前检查和围手术期准备,21例患者均痊愈出院,无一例手术并发症发生.结论 颈部低领状切口治疗胸骨后甲状腺肿具有创伤小,恢复快等优点,值得临床推广应用.

  14. 经颈部低领状切口切除胸骨后甲状腺肿45例%Low Cervical Collar Incision for the Treatment of 45 Cases with Substernal Goiter

    岳喜成; 张珂


    目的:探讨颈部切口切除胸骨后甲状腺肿的临床效果.方法:回顾性分析 2005年10月~2009年10月以来我科采用颈部切口切除的45例胸骨后甲状腺肿患者临床资料.结果:手术顺利,无手术死亡病例,无术中及术后大出血,术后声音嘶哑1例,短期手足麻木1例,随访1~48个月,无复发病例.结论:经颈部低领状切口入路切除胸骨后甲状腺肿手术创伤较小、安全可靠.

  15. Behavioral responses of goitered gazelle (Gazella subgutturosa) to parasitic activity of botflies.

    Blank, David; Yang, Weikang


    We studied behavioral responses of goitered gazelles (Gazella subgutturosa) to hypodermic botfly (family Hypodermatidae) activity in the naturally arid conditions of Kazakhstan. We found that the reactions of goitered gazelles are very similar to the insect-repelling behaviors of other ruminants and that most behavioral responses of goitered gazelles, such as frantic running, tail movements, and grooming, are not specific to botflies. The seasonal and diurnal changes in the intensity of the behavioral responses of the goitered gazelles coincided with the parasitic activities of botfly maggots. Surprisingly, the group size of the goitered gazelles decreased during the breeding of these parasitic insects instead of increasing, as was expected according to our predictions. As an alternative, the goitered gazelles chose an opposite strategy of dispersion throughout the area to avoid infestation. This strategy is well-known for other species of ungulates and was quite effective, because their infestation rate was relatively low.

  16. Incidence of goiter among children in a village with nitrate contamination of drinking water.

    Gatseva, P; Vladeva, S; Pavlov, K


    An epidemiological survey was conducted on the incidence of goiter among children in the 6-14 years age group, permanently living in a village with an increased content of nitrate pollutants in drinking water. Their incidence of goiter was compared to that in a control group of children. The study comprised a total of 359 children--181 from the experimental village and 178 from the control village. A high percentage (40.9%) of goiter is observed among the children in the village with nitrate contamination of drinking water. A statistically significant difference in goiter incidence in children between the experimental and control village is present.

  17. Stressogenic aspects of diffuse toxic goiter relapse with signs of thyrotoxic myocar-dial dystrophy

    Onyushkina N.Yu.


    Full Text Available Probability of relapse development of diffuse toxic goiter during the nearest two years after treatment is determined by its results and stressogenic capacity level, which is defined by Holmes and Rage method. As long as satisfactory treatment results and level of stressogenic capacity are above 300 points, the risk of diffuse toxic goiter relapse run to 68,5%

  18. Combination therapy of temporary tracheal stenting and radiofrequency ablation for multinodular thyroid goiter with airway compression

    Shin, Ji Hoon; Beak, Jung Hwan; Oh, Yeon Mok; Ha, Eun Ju; Lee, Jeong Hyun [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)


    We report a case of multinodular thyroid goiter in an 80-year-old man who successfully underwent tracheal stent placement for respiratory distress caused by the thyroid goiter and following two radiofrequency (RF) ablation sessions performed for thyroid volume reduction. This sequential treatment allowed elective stent removals four weeks after the second RF ablation session because the thyroid volume had been progressively reduced. Combination therapy of temporary airway stenting and RF ablation for the treatment of thyroid goiter has two advantages, i.e., immediate reliefs of dyspnea with airway stenting and reductions of the thyroid volume with RF ablation, and thus, allowing symptom reliefs even after the stent removals.

  19. Goiter in portraits of Judith the Jewish heroine.

    Lazzeri, Davide; Castello, Manuel Francisco; Lippi, Donatella; Weisz, George M


    Judith was a legendary Hebrew heroine who beheaded the general Holofernes and saved the children of Israel from destruction by the Assyrian army. In the Book of Judith, which is still present in the Catholic and Orthodox Christian Bibles, Judith is presented as an illustrious woman who defeated the enemy using her virtue and fortitude. The present investigation has revealed 24 portraits in which Judith has been depicted with variable grades of thyroid gland enlargement on the scene where she decapitates Holofernes. There is no doubt that the integration of a slight thyroid enlargement in the paintings is a stylistic hallmark that portrays an idealized female beauty with a balanced neck and graceful body. The large extended goiter was probably depicted by the artists as a symbol of a powerful masculine body and her courage, and at the same time, it probably also reflects better anatomic accuracy and knowledge of artists from that period.

  20. Delayed Presentation of Forgotten Thyroid Goiter - 25 Years After Thyroidectomy.

    Khan, Fazal Wahab; Muhammad, Ayesha; Abbas, Mohsin; Bin Mahmood, Syed Usman; Fatima, Benish; Fatimi, Saulat H


    Forgotten goiter is a rare occurrence (2 - 16% of retrosternal thyroid cases) that depicts recurrence of retrosternal thyroid mass due to growth of remnant thyroid tissue overlooked during an initial thyroidectomy. The patient is a 59-year female who presented with dyspnea and stridor 25 years after total thyroidectomy. She was diagnosed as having a mediastinal mass on radiographic imaging. There were only localized pressure symptoms due to mass effect. The mass was excised employing an extra-cervical approach and using a partial sternotomy. The profuse extension of thyroid tissue, adherent to vital structures in the thorax and the extra-cervical thyroidectomy was a novel experience. The mass was completely excised and the patient's symptoms alleviated after the surgery. The patient recovered without any complications and there was no recurrence at 1 year of follow-up.

  1. Thyrotropinoma and multinodular goiter: A diagnostic challenge for hyperthyroidism

    Duygu Yazgan Aksoy


    Full Text Available Thyroid disorders are frequently encountered. The diagnosis is straightforward unless clinical or laboratory findings are inconclusive and/or perplexing. Hyperthyroidism due to a thyrotropin-secreting pituitary adenoma rarely occurs and symptoms due to thyroid hormone excess are subtle. The presentation of the disease becomes unusual when co-secretion of other hormones with thyrotropin or concomitant thyroid parenchymal pathology exist. We present the case of a 63-year-old female patient with thyrotropinoma co-secreting growth hormone and multinodular goiter. She developed hyperthyroidism first due to thyrotropinoma and later due to a toxic nodule. Herein, we discuss the diagnostic and therapeutic challenges of hyperthyroidism with atypical presentation.

  2. [The role of nitrates in the genesis of goiter morbidity].

    Gatseva, P; Vladeva, S; Pavlov, K


    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.

  3. Goiter in portraits of Judith the Jewish heroine

    Lazzeri, Davide; Castello, Manuel Francisco; Lippi, Donatella; Weisz, George M.


    Judith was a legendary Hebrew heroine who beheaded the general Holofernes and saved the children of Israel from destruction by the Assyrian army. In the Book of Judith, which is still present in the Catholic and Orthodox Christian Bibles, Judith is presented as an illustrious woman who defeated the enemy using her virtue and fortitude. The present investigation has revealed 24 portraits in which Judith has been depicted with variable grades of thyroid gland enlargement on the scene where she decapitates Holofernes. There is no doubt that the integration of a slight thyroid enlargement in the paintings is a stylistic hallmark that portrays an idealized female beauty with a balanced neck and graceful body. The large extended goiter was probably depicted by the artists as a symbol of a powerful masculine body and her courage, and at the same time, it probably also reflects better anatomic accuracy and knowledge of artists from that period. PMID:26904480

  4. Prophylaxis of postoperative hypocalcemia in patients with diffuse toxic goiter

    M. B. Gudieva


    Full Text Available In recent years, the surgical treatment of DTG includes extirpation of the thyroid gland that can lead to the development of postoperative hypocalcemia, which causes of development are under study. Up to now, there are no clear recommendations for prophylaxis of postoperative hypocalcemia. In this connection, it is actually to carry out additional research to explore the methods of prophylaxis of postoperative hypocalcemia. The study involved 57 patients with diffuse toxic goiter, who had extirpation of the thyroid gland in period from 2010 until 2015. According to results of the performed study, it has been shown that prophylactic administration of preparations of calcium and vitamin D reduces the risk of postoperative hypocalcemia for patients with vitamin D deficiency.

  5. Papillary Microcarcinoma in Multinodular Goiter with Lymphocytic Thyroiditis

    Javalgi A.P


    Full Text Available Multi nodular goitre (MNG is one of the common presentations of various thyroid diseases. Hitherto issue is whether MNG is significantly associated with malignancy. Various studies have reported a 7 to 17% incidence of malignancy in MNG; most common documented is papillary carcinoma. Here we present a case of 40 year old woman with complains of neck swelling, since 10 months. No history of hypertension and other endocrine disorders. The laboratory investigation shows subclinical hyperthyroidism. Ultrasonography (USG of anterior neck showed a hypoechoic nodule at right lobe. Cytological diagnosis of colloid goitre was made and hemithyroidectomy was performed and specimen sent for histopathology. The case on histopathology was diagnosed as papillary microcarcinoma in multinodular goiter with lymphocytic thyroiditis which was further confirmed by immunohistochemistry. Recent studies have suggested that the micro-carcinomas classically progress to a clinically evident disease if left untreated. The treatment of papillary microcarcinoma should be similar to papillary thyroid cancer.

  6. Fulminant mediastinitis after goiter recurrence surgery: a case report

    Mittag-Bonsch Martina


    Full Text Available Abstract Introduction Necrotizing soft tissue infection is a life-threatening disease characterized by rapid progressive inflammation and necrosis of the subcutaneous and deep fascia with or without involvement of the adjacent muscles. Case presentation We report the case of a 62-year-old Caucasian woman with goiter recurrence who underwent a right-sided hemithyroidectomy. Postoperatively, she developed fulminant mediastinitis caused by group A β-hemolytic streptococcus and septic shock. Our patient survived this rare life-threatening complication. Conclusions Initial atypical postoperative symptoms, such as personality changes or an unstable circulatory system, should lead a practitioner to consider the possibility of this severe complication and to begin therapy immediately.

  7. Rare Intensely Fluorine-18-fluorodeoxyglucose Avid Large Retropharyngeal Goiter in a Patient with Invasive Breast Carcinoma

    Bina Kviatkovsky


    Full Text Available Diffuse increased fluorine-18-fluorodeoxyglucose ( 18 F-FDG avidity on positron emission tomography (PET scans has been demonstrated in patients with chronic thyroiditis, likely secondary to increased inflammatory cell glucose uptake. A complex association has been demonstrated between breast cancer and thyroid disease, although the mechanism remains elusive. Development of chronic thyroiditis and/or goiter in breast cancer patients has been suggested to convey a more favorable prognosis. Goiter extension is almost exclusively into retrosternal space, with only a handful of cases reported with superior extension into retropharyngeal space. We present a rare case of a diffusely enlarged goiter extending superior and posterior into the retropharyngeal space with an associated intense 18 F-FDG avidity standardized uptake value maximum (SUV max of 16.1 in a patient with invasive ductal breast cancer. To our knowledge, this represents the first published case of diffusely 18 F-FDG avid goiter with retropharyngeal extension.

  8. A case of mediastinal goiter treated surgically using a clavicle-lifting technique

    Eisaku Ito


    Conclusion: Although further study is necessary, it appears that a transcervical approach using the clavicle-lifting technique may be an acceptable treatment for mediastinal goiters that extend to the aortic arch.

  9. Asupan Yodium, Ekskresi Yodium Urine, dan Goiter pada Wanita Usia Subur di Daerah Endemis Defisiensi Yodium

    Mutalazimah Mutalazimah


    Full Text Available Rendahnya asupan yodium berhubungan dengan ekskresi yodium urine (EYU yang tidak normal. Asupan yodium yang terlalu rendah juga menyebabkan kelenjar tiroid tidak mampu mempertahankan sekresi hormon yang adekuat sehingga timbul hipertrofi tiroid yang menimbulkan goiter. Penelitian ini bertujuan menguji hubungan asupan yodium, EYU, dan goiter pada wanita usia subur (WUS di daerah endemis defisiensi yodium. Penelitian observasional potong lintang ini dilakukan pada 115 WUS di Kecamatan Prambanan Sleman yang dipilih secara random. Asupan yodium diukur menggunakan metode food recall 24 jam, EYU diukur dengan metode acid digestion, dan goiter diukur dengan cara palpasi. Hubungan antarvariabel dianalisis dengan uji kai kuadrat. Hasil penelitian menunjukkan subjek dengan asupan yodium kurang sebanyak 83,5% dan asupan yodium cukup sebanyak 16,5%. Subjek dengan goiter sebanyak 13% dan tanpa goiter sebanyak 87%. Subjek defisiensi yodium sebanyak 15,7% (tingkat berat 2,6%; tingkat sedang 3,5%; tingkat ringan 9,6%, yang normal sebanyak 31,3%, sedangkan yang lebih sebanyak 20,8% dan ekses sebanyak 32,2%. Asupan yodium berhubungan dengan EYU, tetapi goiter tidak berhubungan dengan asupan yodium dan EYU. The low iodine intake, associated with insufficiency of urinary iodine concentration (UIC. Iodine intake is too low, also causes the thyroid gland is unable to maintain adequate hormone secretion, influence the thyroid hypertrophy that causes goitre. This study aimed to examine the relationship of iodine intake, UIC, and goiter on women of childbearing age in endemic areas of iodine deficiency. This cross-sectional observational study was performed 115 randomly selected women of childbearing age at sub-district of Prambanan, Sleman Regency. Iodine intake was measured using 24-hour food recall method, UIC measured by acid digestion method, and goiter measured by palpation method.The association between variables

  10. Medical geology of endemic goiter in Kalutara, Sri Lanka; distribution and possible causes.

    Fernando, G W A R; Liyanage, P L C L; Rajapaksha, Anushka Upamali; Vithanage, Meththika


    This study assesses the distribution of goiter in the Kalutara District, Sri Lanka in order to find causative factors for the occurrence of goiter even after the salt iodization. A questionnaire survey was conducted at the household level and at the same time iodine and selenium levels of the water sources were analyzed. Questionnaire survey results indicated the highest numbers of goiter patients in the northern part where the lowest were found in the southern sector which may be due to the presence of acid sulfate soils. Females were more susceptible and it even showed a transmittance between generations. Average iodine concentrations in subsurface water of goiter endemic regions are 28.25 ± 15.47 μg/L whereas non-goiter regions show identical values at 24.74 ± 18.29 μg/L. Surface water exhibited relatively high values at 30.87 ± 16.13 μg/L. Endemic goiter was reported in some isolated patches where iodine and selenium concentrations low, latter was <10 μg/L. The formation of acid sulfate soils in the marshy lands in Kalutara district may lead to transformation of biological available iodine oxidation into volatile iodine by humic substances, at the same time organic matter rich peaty soil may have strong held of iodine and selenium which again induced by low pH and high temperature were suggested as the instrumental factors in the endemic goiter in Kalutara district. Hence, geochemical features such as soil pH, organic matter and thick lateritic cap in the Kalutara goiter endemic area play a role in controlling the available selenium and iodine for food chain through plant uptake and in water.

  11. Risk factors for goiter in a previously iodine-deficient region.

    Völzke, H; Schwahn, C; Kohlmann, T; Kramer, A; Robinson, D M; John, U; Meng, W


    Little information exists from formerly iodine-deficient areas regarding gender-specific risk factors for goiter and their synergisms. The aim of the present study was to investigate such gender-specific risk factors and their interactions in a large population-based sample. The Study of Health in Pomerania (SHIP) comprised 4310 randomly selected participants, aged 20 - 79 years. SHIP was performed in a previously iodine-deficient region. Data from 3915 participants with no known thyroid disorders were analyzed. Goiter was determined by thyroid ultrasound. Sociodemographic characteristics, smoking and alcohol drinking habits, marital status, education level, urine thiocyanate concentrations, and specifically in women, parity and previous or current use of oral contraceptives and hormone replacement therapy, were considered as candidate risk factors for multivariable statistical tests. Only two variables, an advanced age and current smoking, were independently associated with an increased risk for goiter in both genders. Analyses further revealed specific risk factor profiles for goiter which were different among men, pre- and postmenopausal women. We conclude that besides previous iodine deficiency, other risk factors for goiter exist which differ between gender. Among the avoidable risk factors, current smoking was strongly associated with the risk of goiter in men and women. These findings should influence activities which are intended to prevent thyroid disease.

  12. Dyshormonogenetic goiter and associated non-thyroidal anomalies

    Khalid J Farooqui


    Full Text Available Background: Dyshormonogenetic goiter (DG refers to familial goitres owing to an inherited defect in the metabolism of thyroid hormones and accounts for 10-15% of all cases of congenital hypothyroidism. Aim and Objective: To identify dysmorphic features, cardiac and urogenital anomalies in patients with DG following in the pediatric endocrinology clinic. Materials and Methods: Eight adolescents following the pediatric endocrinology clinic for hypothyroidism and associated stigmata were identified with dyshormonogenesis using 99mTc radionuclide thyroid scintigraphy and confirmation by the Perchlorate discharge test during a 6-month period from January to July 2012. Screening for associated malformations was done using clinical examination, echocardiography and ultrasonography of abdomen. Results: The eight patients (two boys and six girls had a mean age of 9.87 years. The mean duration of goitre was 36.12 months. Two patients had mental retardation and delayed developmental milestones one of whom had ectopic left kidney on renal scintigraphy. Mitral regurgitation was seen in one patient whereas renal anomalies in the form of ectopic kidney and small/contracted kidney with grade III hydronephrosis was seen in two patients. Penoscrotal hypospadias was identified in one of the patients who also had small/contracted kidney with grade III hydronephrosis and underwent pyeloplasty for the same. Dysmorphic features in the form of high arched palate, depressed nasal bridge and low set ears was seen in one patient. Conclusion: DG is associated with other extra-thyroidal congenital anomaly, some of which may need to be treated.

  13. Forgotten goiter: Diagnosis and management. A case report and literature review.

    Patel, Kunal M; Parsons, Chase C


    A mediastinal thyroid mass discovered years after a total thyroidectomy represents an unusual and uncommon clinical situation. Few cases have been reported and controversy exists regarding the etiology of this ectopic thyroid tissue as well as the optimal surgical approach for resection. We herein describe a case of a mediastinal thyroid goiter discovered five years after a total thyroidectomy. A 54-year-old Hispanic female was diagnosed with a diffuse cervical goiter secondary to Hashimoto's Thyroiditis and subsequently underwent a total thyroidectomy. Five years later the patient had a chest X-ray as part of a preoperative evaluation for an unrelated and elective surgical procedure. Significant tracheal deviation was identified. A computed tomography scan was obtained and demonstrated a well encapsulated mass in the superior mediastinum resulting in tracheal deviation and compression. This "forgotten" goiter was successfully resected utilizing a standard cervical approach and the patient recovered uneventfully. A thyroid mass within the mediastinum following a total thyroidectomy is a condition often referred to as "forgotten goiter". Prior reported cases are few, and data is limited, with some uncertainty remaining as to the exact origin of this ectopic thyroid tissue. Possible etiologies include an incomplete removal of the thyroid gland during initial cervical thyroidectomy, or perhaps an autonomous intrathoracic goiter (AIG) - a thyroid gland located in the mediastinum, independent and with no parenchymatous or vascular connection with the cervical thyroid gland. A trans-thoracic or sternal splitting approach is generally not required for resection of a mediastinal goiter and our experience confirms that the case of the "forgotten goiter" can be safely approached through a cervical incision as well. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  14. Prophylaxis and treatment of endemic goiter with iodized oil in rural Ecuador and Peru.

    Kevany, J; Fierro-Benitez, R; Pretell, E A; Stanbury, J B


    Endemic goiter is a health problem in many areas of the world; in some areas the disease is so severe that cretinism and other defects are found. In many areas geographic, economic, and other factors prevent the use of iodized salt as a preventive measure. Field studies were begun in 1966 to determine the feasibility and effectiveness of parenteral administration of iodized oil in goiter prevention. Studies were carried out in Ecuador and Peru. In Ecuador 2 villages were chosen in which the prevalence of goiter was about 60%; in Peru 3 villages were chosen where incidence was about 50%. Prevalence of goiter decreased for 20 months during the study but then began to rise again with the maximum reduction seen up to age 18 and minimal reduction after 40 years of age. The control groups in the study experienced only slight decreases in rate of incidence. Cretinism has not yet appeared among the progeny of the population injected with iodized oil but several instances have appeared in control groups. The use of iodized oil as a public health procedure for the prevention of endemic goiter and its associated defects is an acceptable measure in regions where salt iodization cannot be done.

  15. Animal models of disease: feline hyperthyroidism: an animal model for toxic nodular goiter.

    Peterson, Mark E


    Since first discovered just 35 years ago, the incidence of spontaneous feline hyperthyroidism has increased dramatically to the extent that it is now one of the most common disorders seen in middle-aged to senior domestic cats. Hyperthyroid cat goiters contain single or multiple autonomously (i.e. TSH-independent) functioning and growing thyroid nodules. Thus, hyperthyroidism in cats is clinically and histologically similar to toxic nodular goiter in humans. The disease in cats is mechanistically different from Graves' disease, because neither the hyperfunction nor growth of these nodules depends on extrathyroidal circulating stimulators. The basic lesion appears to be an excessive intrinsic growth capacity of some thyroid cells, but iodine deficiency, other nutritional goitrogens, or environmental disruptors may play a role in the disease pathogenesis. Clinical features of feline toxic nodular goiter include one or more palpable thyroid nodules, together with signs of hyperthyroidism (e.g. weight loss despite an increased appetite). Diagnosis of feline hyperthyroidism is confirmed by finding the increased serum concentrations of thyroxine and triiodothyronine, undetectable serum TSH concentrations, or increased thyroid uptake of radioiodine. Thyroid scintigraphy demonstrates a heterogeneous pattern of increased radionuclide uptake, most commonly into both thyroid lobes. Treatment options for toxic nodular goiter in cats are similar to that used in humans and include surgical thyroidectomy, radioiodine, and antithyroid drugs. Most authorities agree that ablative therapy with radioiodine is the treatment of choice for most cats with toxic nodular goiter, because the animals are older, and the disease will never go into remission.

  16. Effectiveness of Radioiodine Treatment for Toxic Nodular Goiter

    Hatice Şakı


    Full Text Available Objective: The aim of this retrospective study is to evaluate the treatment outcomes in patients with toxic nodular goiter (TNG that received radioiodine treatment (RAIT and to determine the influence of age, gender, nodule size, I-131 dose, underlying etiology and antithyroid drugs on the outcomes of RAIT. Methods: Two hundred thirty three patients (mean 64±10 years old with TNG that received RAIT were included in the study. Treatment success was analyzed according to demographic (age and gender and clinical data (thyroid function tests before and after RAIT, thyroid sonography and scintigraphy, I-131 dose, antithyroid drugs. A fixed dose of 555 MBq was administered to patients with nodules smaller than 2 cm in diameter and of 740 MBq to patients with nodules larger than 2 cm. Hyperthyroidism treatment success was defined as achieving hypothyroidism or euthyroidism six months after RAIT. Results: In our study, the cure rate was 93.9% six months after RAIT. Hypothyroidism was observed in 74 (31.7% patients, and euthyroidism was achieved in 145 (62.2% patients while 14 (6% patients remained in hyperthyroid state. Age and gender did not affect treatment outcomes. No correlation was found between underlying etiology or antithyroid drugs and therapeutic effectiveness. The effectiveness of RAIT was better in patients with nodules smaller than 2 cm. Conclusion: We observed that high cure rates were obtained in patients with TNG with 555 MBq and 740 MBq doses of I-131. While nodule diameter and RAI dose are important factors for treatment efficacy; age, gender, underlying etiology and antithyroid drugs do not affect the outcome of RAIT.


    Praveen Kumar


    Full Text Available The incidence of malignancy in nodular goiter has been found to vary from 4% to 17%. Our aim is to determine the incidence of malignancy in nodular goiter by doing the histopathological examination of thyroidectomy specimens. MATERIALS AND METHODS: This retrospective, observational study was carried out on patients who are undergone thyroidectomy for clinically diagnosed nodular goiter in Fr . Muller Medical College Hospital during 2012 - 2014 (3 yrs. All the operated specimens were subjected to a histopathological examination to determine the incidence of malignancy. RESULTS: Among the 258 nodular goitre cases which were studied, 21 (8.1% cases contained malignant foci. Among them, papillary carcinoma was the most common type of malignancy observed. CONCLUSION: The risk of malignancy in nodular goitre should not to be underestimated. Total/ Near - total thyroidectomy is the preferred operation. All the operated specimens should be sent for histopathological examination

  18. Amyloid Goiter: A Diagnosis to Consider in Diffuse Fatty Infiltration of the Thyroid.

    Bakan, Selim; Kandemirli, Sedat Giray; Akbas, Serkan; Cingoz, Mehmet; Ozcan Guzelbey, Burcu; Kantarci, Fatih; Akman, Canan


    An amyloid goiter is the presence of amyloid protein in the thyroid in sufficient amounts to produce enlargement of the gland, accompanied by fat deposition of varying extents. It can be seen in long-standing inflammatory disorders such as familial Mediterranean fever. Imaging findings depend on the amount of fat and amyloid deposition; however, the main imaging finding is diffuse fatty infiltration of the thyroid. Herein, the multimodality imaging features in 3 cases of amyloid goiters secondary to familial Mediterranean fever are presented. © 2017 by the American Institute of Ultrasound in Medicine.

  19. Mother-young recognition in goitered gazelle during hiding period.

    Blank, D A; Yang, W


    The mother-young recognition process is crucial for the growth and survival of progeny. In "follower" ungulate species, vocal and visual cues have been found to play a leading role in the mother-young identification process from the first days postpartum, with olfactory cues also important in establishing the initial selective mother-young bond immediately after birth. In "hider" species, however, much less has been documented of mother-young recognition behaviors, especially in their natural habitat. In this paper, we investigated this process in goitered gazelle (Gazella subgutturosa), a typical hider species, in its native environment in Kazakhstan. Over the course of our study period, we investigated the behaviors of 257 females with twins and 158 females with singles through visual observations. We found that within the first month after birth, when females spend only a short time with their young, mothers recognized their fawns using mostly olfactory cues, while vision was used to locate their hiding offspring. Fawns vocalized very rarely, producing only distress calls that did not seem intended for individual identification. Licking of young by their mothers was observed frequently, not only during the first week after birth, when this action was very important for fawn stimulation for a number of physiological functions, but for several weeks after (until one month of age), when licking lost its physiological importance and likely became more of a recognition procedure. Fawns did not recognize their mothers at all, either through vision or vocalizations, since during their first weeks after birth, they responded to any gazelle that approached their hiding area. By a month after birth, when mothers and fawns began to stay together for longer periods of time, their recognition process became more enhanced, and in addition to olfactory cues, the mother and her young began to use more and more visual cues for longer distance identification, as well as

  20. Research on iodine deficiency and goiter in the 19th and early 20th centuries

    Zimmermann, M.B.


    In 1811, Courtois noted a violet vapor arising from burning seaweed ash and Gay-Lussac subsequently identified the vapor as iodine, a new element. The Swiss physician Coindet, in 1813, hypothesized the traditional treatment of goiter with seaweed was effective because of its iodine content and succe

  1. Case report of the use of videolaryngoscopy in thyroid goiter masses: An airway challenge

    Stacey Watt, M.D.


    Discussion/Conclusion: A literature review of PubMed and Web of Science of the use of videolaryngoscopy in goiter, difficult airway, and airway obstruction yielded information supporting the use of the video laryngoscopy as a first choice for laryngoscopy with a proven benefit over direct laryngoscopy.

  2. Improvement of goiter volume reduction after 0.3 mg recombinant human thyrotropin-stimulated radioiodine therapy in patients with a very large goiter: a double-blinded, randomized trial

    Bonnema, Steen; Nielsen, Viveque E; Boel-Jørgensen, Henrik;


    INTRODUCTION: The effect of (131)I therapy amplification by recombinant human (rh) TSH prestimulation in very large goiters has not been evaluated in a double-blinded, placebo-controlled study. METHODS: Twenty-nine patients (22 females; age range 37-87 yr) with a large multinodular goiter (median...... the reduction of very large goiters by more than 50%, compared with (131)I therapy alone, but at the expense of more adverse effects after therapy. Our data suggest that rhTSH stimulation may work through mechanisms that go beyond the increase in thyroid (131)I uptake...

  3. A community-based case-control study to investigate the role of iron deficiency in the persistence of goiter

    Pathak, Rambha; Chaudhary, Chintu; Agarwalla, Rashmi; Shaikh, Zakirhusain; Goel, R K D; Patvegar, Bilkish


    To find out the magnitude of iron deficiency anemia in the age group of 6-12 years and investigate the role of iron deficiency as a possible contributor to endemic goiter in school children in Ambala...

  4. "Prevalence of Thyrotoxicosis: Clinical presentation and results of treatment in 384 patients with Goiter under 18 years "

    "Moayeri H


    Full Text Available Goiter is common among growing children and adolescents but thyrotoxicosis is a rare thyroid disorder in this age prevalence of thyrotoxicosis and clinical presentation in prevalence of thyrotoxicosis and clinical presentation of the disease among children and adolescents of the disease among children and adolescents presenting for goiter at the clinics of pediatric presenting for goiter at the clinics of pediatric Endocrinology of Tehran and Iran University of medical sciences and private offices. In a retrospective study the medical records of 424 patients with goiter were studied of whom 384 (285F, 99M and goiter and records available for review. All patients were examined by pediatric endocrinologist and their goiters were classified according to WHO criteria. Total T4, TSH, T3 and T3RU were measured. Out of the 384 cases that were diagnosed as goiter, 320 were euthyroid (83.4%, 49 were hypothyroid (12.7% and 15 were hyperthyroid (3.9%. Ninety-three percent of the hyperthyroid patients had graves’ disease and seven percent of them had toxic adenoma. The most common presenting feature in thyrotoxic patients was goiter. Sustained remission with medical treatment alone was attained in 46% with a mean treatment duration of 2.9 years. The comparison was made between the findings of this study and those of western countries indicating that the incidence of hyperthyroidism in Iranian pediatric population is not as high as in North America but is higher than in Europe. Clinical presentation, response to treatment and etiologic causes of the disease in our study was similar to other studies.

  5. Goiter prevalence, urinary iodine, and salt iodization level in sub-Himalayan Darjeeling district of West Bengal, India

    Akhil Bandhu Biswas; Dilip Kumar Das; Indranil Chakraborty; Asit Kumar Biswas; Puran Kumar Sharma; Romy Biswas


    National iodine deficiency disorders control program needs to be continuously monitored. Hence, a cross-sectional study was conducted during the period from April-May 2011 to assess the prevalence of goiter, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level in Darjeeling district, West Bengal. Study subjects were 2400 school children, aged 8-10 years selected through "30 cluster" sampling methodology. Goiter was assessed by standard ...

  6. The onset of goiter in several species of sharks following the addition of ozone to a touch pool.

    Morris, Alexis L; Stremme, Donald W; Sheppard, Barbara J; Walsh, Michael T; Farina, Lisa L; Francis-Floyd, Ruth


    This report describes the onset of goiter in several species of shark following the addition of ozone to a touch pool. A detailed description of a female brown-banded bamboo shark (Chiloscyllium punctatum) that was presented with multinodular goiter is provided. Four other brown-banded bamboo sharks and 11 white-spotted bamboo sharks (Chiloscyllium plagiosum) housed in the same system developed clinical disease consistent with goiter, but two zebra bullhead sharks (Heterodontus zebra) did not. Plasma thyroxine (T4) concentration was 4.64 ng/ml before euthanasia, consistent with a diagnosis of hypothyroidism. The sharks had been chronically exposed to mean (+/- standard error) NO3-N concentrations of 35 +/- 5.12 mg/L before ozonation of the system. Ozonation of aquarium water causes a reduction in environmental iodide, which is required for thyroid hormone synthesis. Nitrate is goitrogenic and would further decrease I- absorption by competitive inhibition. Multinodular goiter is consistent with goiter caused by chronic iodide deficiency. Understanding the interaction between water chemistry and goiter development is critical to development of elasmobranch health management systems.

  7. Evaluation of a goiter epidemic degree among pregnant women in natural iodine deficiency region

    V Petrova


    Full Text Available Objectives: the aim of the study was to investigate clinical features of thyroid function in pregnant woman in the region of natural iodine deficiency. Methods: serum thyroid stimulating hormone (TSH, free thyroxin (fT4 concentrations, urine excretion of iodine were measured. The structure and volume of thyroid gland were defined by palpation and ultrasonography. The 150 pregnant women (50 in every trimester were included in study. Results: median of urine iodine excretion was 72.5 mkg/l, that confirm mild iodine deficiency in the region. During pregnancy median of urine excretion of iodine is significantly lower in third trimester (51.0 mkg/l, than in first (93.0 mkg/l and in second (86.1 mkg/l. The goiter was registered more often in third trimester of pregnancy. The level of fT4 was decreased in third trimester of pregnancy. Key words: iodine deficiency, goiter, hypothyroidism pregnancy.

  8. The Condition of Thyroid and Fetoplacental Systems in Pregnant Women with Clinically Euthyroid Goiter

    V N Petrova


    Full Text Available The aim is to study a condition of thyroid and fetoplacental systems at pregnant women with clinically euthyroid goiter. Materials and methods: 116 pregnant women have been included in the basic group with clinically euthyroid goiter. The control group was made by 60 pregnant women with physiologically proceeding pregnancy, not having anamnestic and the clinical data on diseases of the thyroid. Inspection included: definition of concentration thyroid-stimulating hormone (TSH and free thyroxine (fT4 by a radio-immunologic method, sets “RIA-gnost” (France and the maintenance of antibodies to thyroid peroxydase (anti-TPO by a method hard phase immune-enzyme analysis; ultrasonic assessment of a thyroid with the help of device SONOACE 8800 “GAIA MT”; ultrasonic fetometry, placentography, measurement of amniotic fluid volume, doppler ultrasound examination of the blood flow, an estimation of a functional condition of a fetus on parameters of its biophysical profile (BP and cardiotocography (CTG, carried out on device “Oxford Sonicaid Team S8000”. Results: At studying hormonal function thyroid systems at 25 pregnant (21.6% with euthyroid goiter in the third trimester of pregnancy a level fT4 norms were lower and had values from 4.5 up to 6.9 ng/ml, therefore an average level fT4 at pregnant women of the basic group was authentically lower, than in control (8.26 ± 0.30 and 10.71 ± 0.52 ng/ml, accordingly. At the retrospective analysis it is established, that only at 5 of 116 (4.3% pregnant women with a goiter were not complications pregnancy, at the others — 111 (95.7% took place a combination various obstetric complications: an anemia — at 72 (62.0%, threat noncarrying of pregnancy — at 75 (64.6 %, an early toxicosis — at 45 (38.6%, a gestosis — at 47 (40.5% which frequency authentically is higher, than in control group: 20.0%, 25.0%, 16.6%. 20.0%, accordingly, р < 0.05. Average Estimation CTG at patients of the basic group is

  9. Novel thoracoscopic approach to posterior mediastinal goiters: report of two cases

    Strother Eric


    Full Text Available Abstract Trans-cervical resection of posterior mediastinal goiters is usually very difficult, requiring a high thoracotomy. Until recently, using conventional video-assisted thoracoscopic surgery to resect such tumors has been technically difficult and unsafe. By virtue of 3 dimensional visualization, greater dexterity, and more accurate dissection, the Da Vinci robot, for the first time, enables a completely minimally invasive approach to the posterior superior mediastinum.

  10. Genotype-phenotype correlations of dyshormonogenetic goiter in children and adolescents from South India

    Bangaraiah Gari Ramesh


    Full Text Available Background: Dyshormonogenetic goiter is one of the most common causes of hypothyroidism in children and adolescents in iodine nonendemic areas. The exact genotype-phenotypic correlations (GPCs and risk categorization of hypothyroid phenotypes of dyshormonogenetic mutations are largely speculative. The genetic studies in pediatric dyshormonogenesis are very sparse from Indian sub-continent. In this context, we analyzed the implications of TPO, NIS, and DUOX2 gene mutations in hypothyroid children with dyshormonogenetic hypothyroidism (DH from South India. Materials and Methods: This is interdisciplinary prospective study, we employed eight sets of primers and screened for 142 known single nucleotide polymorphisms in TPO, NIS, and DUOX2 genes. The subjects were children and adolescents with hypothyroidism due to dyshormonogenetic goiter. Congenital hypothyroidism, iodine deficiency, and Hashimoto's thyroiditis cases were excluded. Results: We detected nine mutations in 8/22 (36% children. All the mutations were observed in the intronic regions of NIS gene and none in TPO or DUOX2 genes. Except for bi-allelic, synonymous polymorphism of TPO gene in child number 14, all other mutations were heterozygous in nature. GPCs show that our mutations significantly expressed the phenotypic traits such as overt hypothyroidism, goiter, and existence of family history. Other phenotypic characters such as sex predilection, the age of onset and transitory nature of hypothyroidism were not significantly affected by these mutations. Conclusion: NIS gene mutations alone appears to be most prevalent mutations in DH among South Indian children and these mutations significantly influenced phenotypic expressions such as severity of hypothyroidism, goiter rates, and familial clustering.

  11. Advanced Age and Mild Thyrotoxicosis are Associated with Nodular Goiter in Graves Disease

    Serkan Yener


    Full Text Available Objective: The primary goal of this study is to evaluate predictors of nodular goiter in Graves Disease (GD.Materials and Methods: A total of 202 consecutive patients (mean age: 45; 145 female, 57 male were enrolled. All patients were treated with antithyroid drugs as initial therapy. TSH, FT3, FT4, TRAb, ATPO, and ATG were measured. Radioactive iodine uptake and thyroid ultrasonography were performed, and thyroid volume and nodule diameter were assessed. Ultrasound-guided fine needle aspiration was performed on thyroid nodules ≥8mm. Results: Diffuse goiter was detected in 51% of patients. Solitary nodules were detected in 16%, and multi-nodular disease in 33%. Mean nodule diameter was 8.82 mm. Nodular disease was slightly more common in women (p=0.063. Patients with nodular GD were older (p=0.004, had lower levels of FT3 (p=0.016 and TRAB (p=0.002 when compared with subjects with diffuse GD. Age (OR:6.867 was the independent variable predicting nodular GD. Conclusion: Increased prevalence of nodules was associated with advanced age and milder thyrotoxicosis. Apoptosis of thyroid follicular cells due to excess iodine might interfere with nodule formation, and lead to diffuse goiter in severe thyrotoxicosis. Because of increased rate if malignancy in GD, comprehensive evaluation of thyroid nodules of any size is mandatory. Turk Jem 2009; 13: 1-4

  12. Total thyroidectomy for multinodular goiter - is it really an option in endemic region?

    Kalin Vidinov


    Full Text Available Bilateral multinodular goiter is the most common indications for surgery in endemic iodine-deficiency regions such as Bulgaria. Total thyroidectomy is currently the preferred treatment for thyroid cancer, for multinodular goiter. However many surgeons and endocrinologist still choose not to perform or recommend total thyroidectomy or lobectomy for bilateral or unilateral disease. We sought to assess whether the results support the hypothesis that total thyroidectomy is safe and can be considered as the optimal surgical approach for treating BMG in endemic region such as Bulgaria. A total of 500 patients were included in this study. They underwent thyroid operation between 2004 and 2009. We excluded patients with thyroid cancer or suspicion of thyroid malignancy. We evaluated indications for total thyroidectomy, complication rates, local recurrence rate and long-term outcome after total thyroidectomy. All patients had bilateral goiter diagnosed with ultrasound (n = 500. The incidence of permanent bilateral recurrent laryngeal nerve palsy was 0% and that of permanent unilateral recurrent laryngeal nerve palsy and permanent hypocalcaemia occurred was 0.8 - 1.2 %. Hemorrhage requiring repeat surgery occurred in 0.4-2 % of patients. There was no wound infection, and postoperative mortality was 0%. Total thyroidectomy is safe and is associated with a low incidence of disabilities. Ttotal thyroidectomy has the advantages of immediate and permanent cure and no recurrences.

  13. Artificial neural network analysis for evaluating cancer risk in multinodular goiter

    Baris Saylam


    Full Text Available Background: The aim of this study was to create a diagnostic model using the artificial neural networks (ANNs to predict malignancy in multinodular goiter patients with an indeterminate cytology. Materials and Methods: Out of 623 patients, 411 evaluated for multinodular goiter between July 2004 and March 2010 had a fine-needle aspiration biopsy. All patients underwent total thyroidectomy. The interpretation was consistent with an indeterminate lesion in 116 (18.6% patients. Patient′s medical records including age, sex, dominant nodule size, pre-operative serum thyroid-stimulating hormone level, thyroid hormone therapy and final pathologic diagnosis were collected retrospectively. Results: The mean age of the patients was 44.6 years (range, 17-78 years. About 104 (89.7% were female and 12 (10.3% were male patients. Final pathology revealed 24 malignant diseases (20.7% and 92 (79.3% benign diseases. After the completion of training, the ANN model was able to predict diagnosis of malignancy with a high degree of accuracy. The area under the curve of ANNs was 0.824. Conclusion: The ANNs technique is a useful aid in diagnosing malignancy and may help reduce unnecessary thyroidectomies in multinodular goiter patients with an indeterminate cytology. Further studies are needed to construct the optimal diagnostic model and to apply it in the clinical practice.

  14. Smoking as a risk factor for thyroid volume progression and incident goiter in a region with improved iodine supply.

    Ittermann, Till; Schmidt, Carsten Oliver; Kramer, Axel; Below, Harald; John, Ulrich; Thamm, Michael; Wallaschofski, Henri; Völzke, Henry


    The role of smoking in the pathogenesis of thyroid enlargement is currently under debate. It has been hypothesized that the effect of smoking on increased thyroid volume is larger in regions with than in regions without iodine deficiency. The aim of this paper was to investigate the association of smoking with thyroid volume progression and incident goiter for different age-strata in a region with improved iodine supply. The population-based Study of Health in Pomerania compromised 3300 subjects with complete 5-year examination follow-up. Data from 2484 participants without known history of thyroid disorder or thyroid medication were analyzed. Thyroid size was evaluated by ultrasound. Determinants of thyroid volume progression and incident goiter, i.e., newly occurred goiter between baseline and follow-up, were analyzed by linear and logistic regression respectively. Participants aged 20-39 years who were current smokers at baseline and at follow-up had a lower risk of incident goiter (odds ratio: 0.33; 95% confidence interval (CI): 0.15; 0.71; P=0.005). In this subpopulation, age was inversely related to thyroid volume progression. In subjects aged 60-79 years, smoking at baseline and follow-up was a risk factor for thyroid volume progression (beta: 3.37; 95% CI: 0.84; 5.89; P=0.009). After exclusion of individuals who had actual goiter in ultrasound at baseline, this association disappeared. We conclude that the inverse association between smoking and goiter in young adults and the lacking association of smoking with goiter and thyroid volume progression in adult non-goitrous subjects indicate that smoking has a declining impact on thyroid growth in the study region. Our findings mirror the improved iodine supply of Northeast Germany.

  15. Thyroid hormone synthesis: a potential target of a Chinese herbal formula Haizao Yuhu Decoction acting on iodine-deficient goiter

    Mao, Xia; Yan, Chen; Guo, Xiaodong; Guo, Qiuyan; Liu, Zhenli; Song, Zhiqian; Lin, Na


    Haizao Yuhu Decoction (HYD), a famous multi-component herbal formula, has been widely used to treat various thyroid-related diseases, including iodine-deficient goiter. Herb pair Thallus Sargassi Pallidi (HZ) and Radix Glycyrrhizae (GC), one of the so-called “eighteen antagonistic medicaments”, contains in HYD. To explore pharmacological mechanisms of HYD acting on iodine-deficient goiter and to provide evidence for potential roles of herb pair HZ and GC in HYD, our genome-wide microarray detection and network analysis identified a list of goiter-related genes, mainly involved into the alterations in hypothalamus-pituitary-thyroid/gonad/growth axes. Then, the disease genes-drug genes interaction network illustrated the links between HYD regulating genes and goiter-related genes, and identified the candidate targets of HYD acting on goiter. Functionally, these candidate targets were closely correlated with thyroid hormone synthesis. Moreover, the potential regulating genes of herb pair HZ and GC were revealed to be crucial components in the pathway of thyroid hormone synthesis. The prediction results were all verified by following experiments based on goiter rats. Collectively, this integrative study combining microarray gene expression profiling, network analysis and experimental validations offers the convincing evidence that HYD may alleviate iodine-deficient goiter via regulating thyroid hormone synthesis, and explains the necessity of herb pair HZ and GC in HYD. Our work provides a novel and powerful means to clarify the mechanisms of action for multi-component drugs such as herbal formulae in a holistic way, which may improve drug development and applications. PMID:27384475

  16. Current prevalence of goiter determined by ultrasonography and associated risk factors in a formerly iodine-deficient area of Turkey.

    Kocak, Mustafa; Erem, Cihangir; Deger, Orhan; Topbas, Murat; Ersoz, Halil Onder; Can, Emine


    The aim of this study was to determine the prevalence of goiter and related risk factors in an adult population in a formerly iodine-deficient area of Turkey. In this cross-sectional study, we enrolled 2,500 subjects (1,270 women and 1,230 men, aged over 20 years) by multistage sampling. Blood and urine specimens were collected for the assessment of thyroid function. Thyroid ultrasonography (USG) was performed to measure thyroid volume and evaluate nodules. The overall goiter prevalence was 26.5 % (28.4 % in women, 24.5 % in men, P iodine was 122.79 μg/L. USG revealed thyroid nodules in 35.2 % of the subjects (38.4 % in women, 31.8 % in men, P iodine excretion levels, prevalence of goiter in this adult population in a formerly iodine-deficient province of Turkey remained high, even about 10 years after salt iodine supplementation program introduction. In addition, the goiter prevalence was higher for female gender, advanced age, positive family history of goiter, low education level, and high BMI.

  17. Quality-of-Life Impairments Persist Six Months After Treatment of Graves' Hyperthyroidism and Toxic Nodular Goiter

    Cramon, Per; Winther, Kristian Hillert; Watt, Torquil


    PRO scales in toxic nodular goiter (Anxiety, Overall HRQoL). However, significant disease-specific and generic HRQoL deficits persisted on multiple domains across both patient groups. Conclusions: Graves' hyperthyroidism and toxic nodular goiter cause severe disease-specific and generic HRQoL impairments......Background: The treatment of hyperthyroidism is aimed at improving health-related quality of life (HRQoL) and reducing morbidity and mortality. However, few studies have used validated questionnaires to assess HRQoL prospectively in such patients. The purpose of this study was to assess the impact...... of hyperthyroidism and its treatment on HRQoL using validated disease-specific and generic questionnaires. Methods: This prospective cohort study enrolled 88 patients with Graves' hyperthyroidism and 68 with toxic nodular goiter from endocrine outpatient clinics at two Danish university hospitals. The patients were...

  18. A 30-year perspective on radioiodine therapy of benign nontoxic multinodular goiter

    Bonnema, Steen J; Hegedüs, Laszlo


    PURPOSE OF REVIEW: There is no consensus on the ideal treatment of patients with a benign nontoxic multinodular goiter. In some European countries, (131)I therapy has replaced surgery as the treatment of choice in these patients. Recombinant human thyrotropin (rhTSH) is a very potent stimulator o...... effective than (131)I therapy without rhTSH. However, no trial has yet compared (131)I therapy and surgery head-to-head, and future trials should include evaluation of quality of life and cost....

  19. The prevalence of thyroid cancers in surgically treated patients with nodular goiter in Şırnak city

    Sevda Sert Bektaş


    Full Text Available Objectives: Iodine deficiency is still considered to be the major etiological factor for endemic goiter. The pathogenesis of the goiter in iodine deficient area caries different characteristics. The aim of this study investigate the prevalence of thyroid cancers and type of thyroid cancers in surgically treated patients with nodular goiter in Şırnak city where is iodine deficiency region.Materials and methods: Thyroid surgical materials which were sent to our department were screened retrospectively from the archives between the years 2009-2010. Thyroid resection was performed on 241 patients with nodular goiter in one year. We evaluated patients who received the diagnosis of thyroid carcinoma with histhopatological examination.Results: 222 of our patients (92.1% female and 19 (7.9% were male. The youngest patient 16 and the oldest patient was 80 years old and the average age is 40.9 ± 12.8. Histopathological examination of 197 (81.7% cases of nodular goiter, 31 (12.9% cases lymphocytic thyroiditis, 13 (5.4% patients had thyroid tumors. The three tumors on the 2 cases (0.8% benign, 11 (4.6% were malignant. As a type of cancer 1 (0.4% patients, follicular carcinoma-oncocytic variant, 10 (4.2% cases were papillary carcinoma.Conclusions: Iodine deficiency area in the province of Şırnak in patients with nodular goiter who underwent surgery for thyroid cancer rate of 4.6%, and most cancers is seen as a type of thyroid papillary carcinoma.

  20. A community-based case–control study to investigate the role of iron deficiency in the persistence of goiter

    Rambha Pathak


    Full Text Available Objectives: To find out the magnitude of iron deficiency anemia in the age group of 6–12 years and investigate the role of iron deficiency as a possible contributor to endemic goiter in school children in Ambala. Materials and Methods: The present study was conducted as a subset of a cross-sectional study among 2700 children from 6 to 12 years of age to find out the prevalence of goiter. All the subjects who were found to be suffering from goiter in the cross-sectional study were enrolled in the case–control study as cases and were compared with age- and sex-matched controls (children without goiter from the same cohort. The study was conducted from February 2011 to January 2012. Results: Out of total, goiter was observed in 12.6% of the subjects. Urinary iodine excretion was found to be <100 μg/L in 57 (10.5% children. Mean hemoglobin (Hb level of the study population was 11.9 g/dL. It was noted that 71% of the goitrous children had anemia (Hb <12 g/dL as compared to 63.7% of the control group. Serum ferritin (SF was <15 ng/mL in 70% of the children. The mean ± standard deviation of SF in the goitrous and nongoitrous children was 19.65 ± 32.51 μg/L and 27.55 ± 21.07 μg/L, respectively (P = 0.012. Conclusion: The findings in the study suggest that iron deficiency anemia in children is contributing toward the persistence of goiter in the postiodization phase.

  1. Recombinant human thyrotropin-stimulated radioiodine therapy of large nodular goiters facilitates tracheal decompression and improves inspiration

    Bonnema, Steen Joop; Nielsen, Viveque E; Boel-Jørgensen, Henrik;


    INTRODUCTION: The impact on tracheal anatomy and respiratory function of recombinant human (rh)TSH-stimulated (131)I therapy in patients with goiter is not clarified. METHODS: In a double-blinded design, patients (age 37-87 yr) with a large multinodular goiter (range, 99-440 ml) were randomized...... previously. In the placebo group, no significant changes in the lung function or SCAT were found throughout the study. In the rhTSH group, a slight decrease was observed in the forced vital capacity 1 wk after therapy, whereas the mean individual change in SCAT was significantly increased by 10.5% (95...

  2. An outbreak of thyroid hyperplasia (goiter) with high mortality in budgerigars (Melopsittacus undulatus).

    Loukopoulos, Panayiotis; Bautista, Adrienne C; Puschner, Birgit; Murphy, Brian; Crossley, Beate M; Holser, Ian; Gomes, Lucy; Shivaprasad, H L; Uzal, Francisco A


    An outbreak of goiter with high morbidity and mortality in a flock of budgerigars (Melopsittacus undulatus) in California is described. Forty-five out of 400 adult birds exhibited signs of illness, weight loss, and enlargement in the crop area; 15 of the 45 birds died over a 2-3-month period. Diet consisted of a commercial mixture with the addition of broccoli, whole oats, and carrots, but no minerals or supplements. Six budgerigars were subjected to necropsy; all 6 birds had severely enlarged thyroid glands. Thyroid follicular hyperplasia was histologically observed in all birds examined, while granulomatous thyroiditis and microfollicular adenoma were observed in 2 birds, respectively. Virological, bacteriological, parasitological, and heavy metal analyses were negative or within normal limits. The total iodine in the thyroid glands of affected birds was measured by inductively coupled plasma-mass spectrometry. Following iodine supplementation and removal of broccoli from the diet, the owner reported weight gain and a reduced death rate among clinically affected birds; no additional birds became sick. The presence of broccoli with its iodine-binding ability and the complete lack of added minerals in the diet of these animals were thought to be the predisposing factors for the outbreak in the present study. Outbreaks of goiter accompanied by high mortality are rare in any species and, to the best of the authors' knowledge, have not been described previously in any avian species. Recognition of this condition may help improve medical, welfare, and trade standards concerning this species.

  3. Treatment of nodular goiter; Der Schilddruesenknoten. Medikamentoese Therapie der benignen Knotenstruma

    Quadbeck, B. [Praxis fuer Endokrinologie, Duesseldorf (Germany)


    Benign thyroid nodules are common in iodine deficient countries like Germany. Current standard treatment of iodine deficient goiter is oral iodine and or levothyroxine but solid evidence on which to base dosage and duration of treatment is still missing. Recent studies have addressed a new pathogenic concept of a true neoplasia in thyroid nodules. Based on the pathogenesis, the effectiveness of thyroid hormone suppressive therapy in reducing volume of benign thyroid nodules is a matter of controversy since many years. It is necessary to clarify this therapeutic effect, because its use needs to be carefully weight against its potential deleterious effects in the skeletal and cardiovascular system e.g. in elderly patients. Iodine deficient goiter is the best option for medical treatment. Benign thyroid nodules displayed a slow but continous growth during long-term follow up. Treatment with levothyroxine and/or iodide did not significantly influence growth of nodules. From a therapeutic point of view, prevention of thyroid nodules in iodine deficient countries needs an early and different strategy than the therapy of existing nodules. (orig.)

  4. Surgery for thyroid goiter in western India. A prospective analysis of 334 cases.

    Bapat R


    Full Text Available 334 consecutive cases of thyroid swellings operated by a single surgical unit over 9 years have been analysed prospectively. There was a female preponderence (4.39:1. The swellings were clinically differentiated into uninodular (39.52%, multinodular (47.31% and diffuse (13.17%. Hyperthyroidism was manifested in 49 cases (14.67%. Pressure symptoms were present in only 1.5% cases. FNAC detected malignancy in 14 of 162 cases (8.64%. The initial 100 cases were operated upon by standard Lahey′s technique and the latter 234 by modified technique described by Bapat et al for benign thyroid disease. Operations performed included nodulectomies (5.39%, hemithyroidectomies (41.92%, partial thyroidectomies (25.75%, subtotal (25.45% and near total thyroidectomies (1.5%. Post-operative complications were higher in the first group and included unilateral cord palsies-5 (5%. hypocalcemia-4 (4% hypoparathyroidism-1 (1% haemorrhage-1 (1% and mortality-1 (1% vis a vis cord palsies-2 (0.85%, hypocalcemia-3 (1.28%, hypoparathyroidism-1 (0.43% and there was no mortality. Histopathology revealed 83 (24.85% colloid goiters, 193 (57.78% nodular goiters, 21 (6.29% follicular adenomas, 7 (2.10% cases of thyroiditis and 30 (8.98% malignancies. This study reveals the lower incidence of RLN palsy after modified thyroidectomies, and a low incidence of malignancy.

  5. Recombinant human thyrotropin-stimulated radioiodine therapy of nodular goiter allows major reduction of the radiation burden with retained efficacy

    Fast, Søren; Hegedüs, Laszlo; Grupe, Peter;


    Context and Objective: Stimulation with recombinant human TSH (rhTSH) before radioiodine ((131)I) therapy augments goiter volume reduction (GVR). Observations indicate that rhTSH has a preconditioning effect beyond increasing thyroid (131)I uptake. We test the hypothesis that an equivalent GVR...

  6. A novel mutation in the thyroglobulin gene that causes goiter and dwarfism in Wistar Hannover GALAS rats.

    Sato, Akira; Abe, Kuniya; Yuzuriha, Misako; Fujii, Sakiko; Takahashi, Naofumi; Hojo, Hitoshi; Teramoto, Shoji; Aoyama, Hiroaki


    Outbred stocks of rats have been used extensively in biomedical, pharmaceutical and/or toxicological studies as a model of genetically heterogeneous human populations. One of such stocks is the Wistar Hannover GALAS rat. However, the colony of Wistar Hannover GALAS rat has been suspected of keeping a problematic mutation that manifests two distinct spontaneous abnormalities, goiter and dwarfism, which often confuses study results. We have successfully identified the responsible mutation, a guanine to thymine transversion at the acceptor site (3' end) of intron 6 in the thyroglobulin (Tg) gene (Tgc.749-1G>T), that induces a complete missing of exon 7 from the whole Tg transcript by mating experiments and subsequent molecular analyses. The following observations confirmed that Tgc.749-1G>T/Tgc.749-1G>T homozygotes manifested both dwarfism and goiter, while Tgc.749-1G>T/+ heterozygotes had only a goiter with normal appearance, suggesting that the mutant phenotypes inherit as an autosomal semi-dominant trait. The mutant phenotypes, goiter and dwarfism, mimicked those caused by typical endocrine disrupters attacking the thyroid. Hence a simple and reliable diagnostic methodology has been developed for genomic DNA-based genotyping of animals. The diagnostic methodology reported here would allow users of Wistar Hannover GALAS rats to evaluate their study results precisely by carefully interpreting the data obtained from Tgc.749-1G>T/+ heterozygotes having externally undetectable thyroidal lesions. Copyright © 2014 Elsevier B.V. All rights reserved.


    E.A. Troshina


    Full Text Available The article highlights the evaluation results of the IQ indices demonstrated by the school students, who reside in the regions with different degrees of the iodine deficiency severity and iodine provided regions. The authors performed the comparative analysis of the IQ indices among children with clinically euthyroid diffusive goiter and among children with normal sizes of the thyroid gland. The research included 260 children aged from 8 to 10 from 13 regions of the Russian Federation: 130 patients with the goiter diagnosed subject to the data of the ultrasound investigation and 130 children, who have normal sizes of the thyroid gland (reference group. The comparison groups were homogenous according to the education conditions (as only children from the city comprehensive schools took part in the research. For the evaluation of the intellectual development, authors used R. Kettell's intellect test free from the cultural impact (Сulture-Fair Intelligence Test, CFIT — CF 2А form. Despite the fact that the average IQ indices in the group of children with goiter were slightly lower than among children with normal sizes of the thyroid gland, the researchers failed to identify statistically significant differences between the average IQ indices among children in the compared groups (р > 0,05. Both in the group of children with goiter and in the reference group, the average IQ indices fell within «the low normal» (80–89 points.Key words: iodine, hypothyroidism, IQ intellect index, children.

  8. [Surgical treatment of multinodular goiter at the Instituto Nacional de la Nutrición Salvador Zubirán].

    López, L H; Herrera, M F; Gamino, R; González, O; Pérez-Enriquez, B; Rivera, R; Gamboa-Domínguez, A; Angeles-Angeles, A; Rull, J A


    Surgical treatment is the first option for patients with obstructive multinodular goiter. The extent of the resection and the use of postoperative hormonal therapy are, on the other hand, still under debate. To analyze the results of surgical treatment in 101 patient with multinodular goiter seen from 1980 to 1995. The clinical/pathologic charts of all patients were reviewed with emphasis to the clinical diagnosis, extent of resection, final histology, type and number of complications, and long-term follow-up. The mean follow-up was three years (range 0.5-12). Ten males and 91 females with a mean age of 46 years were included. Surgery was recommended for a nodule suspicious of malignancy in 60 patients, for airway compression in 33, and for cosmetic reasons in eight. Unilateral lobectomy was performed in 30, bilateral subtotal thyroidectomy in 55 and total thyroidectomy in 16. Postoperative hormone therapy was administrated to 83 patients. Surgical complications occurred in six patients. Four developed permanent hypoparathyroidism and two vocal cord paralysis. There was no operative mortality. A final diagnosis of multinodular goiter was established in 89 whereas 12 had cancer. There were three asymptomatic recurrences in the group with benign lesions (they had undergone unilateral lobectomy followed by hormonal therapy). Bilateral subtotal thyroidectomy was the best treatment for multinodular goiter in our series. This procedure had few complications and there was no recurrence of the disease.

  9. Goiter prevalence, urinary iodine, and salt iodization level in sub-Himalayan Darjeeling district of West Bengal, India.

    Biswas, Akhil Bandhu; Das, Dilip Kumar; Chakraborty, Indranil; Biswas, Asit Kumar; Sharma, Puran Kumar; Biswas, Romy


    National iodine deficiency disorders control program needs to be continuously monitored. Hence, a cross-sectional study was conducted during the period from April-May 2011 to assess the prevalence of goiter, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level in Darjeeling district, West Bengal. Study subjects were 2400 school children, aged 8-10 years selected through "30 cluster" sampling methodology. Goiter was assessed by standard palpation technique, UIE was estimated by wet digestion method and salt samples were tested by spot iodine testing kit. Overall goiter prevalence rate was 8.7% (95% confidence intervals = 7.6-9.8) and goiter prevalence was significantly different with respect to gender. Median UIE level was 15.6 mcg/dL (normal range: 10-20 mcg/dL). About 92.6% of the salt samples tested had adequate iodine content of ≥15 ppm. Findings of the present study indicate that the district is in a transition phase from iodine-deficiency to iodine sufficiency.

  10. Survey of thyroid diseases among inhabitants exposed to fallout radiation from the nuclear power station explosion at Chernobyl, 2; Prevalence of palpable goiter in school children

    Sugenoya, Akira; Masuda, Hiroyuki; Asanuma, Kazuhiko; Iida, Futoshi (Shinshu Univ., Matsumoto, Nagano (Japan). Faculty of Medicine); Skidanenko, G.S.


    We report the prevalence of diffuse goiter and thyroid nodules in children aged 10-15 years living at Chechelsk city, Byelorussia, which is one of the high radioactive fallout areas after the Chernobyl accident. Seven hundred thirteen children (330 males and 383 females) were enrolled in the study. The goiter staging was defined according to the WHO classification. Those who showed apparent goiter from Grade I to III were additionally examined by ultrasonography. The prevalence of palpable goiter was 41.5% in males and 56.9% in females. The incidence in females was significantly higher than that in males (p<0.01). In the ultrasonography survey, 9 (3 males and 6 females) of 196 children revealed one or several small nodules in diffuse goiter, which were less than 1 cm in size and appeared as irregular hypoechoic lesions. These school children with nodular lesions require further medical examination for defined diagnosis and proper treatment. Future investigation regarding both the endemic goiter of this district and goiter prevalence in non-affected neighboring areas is crucial for evaluating the effects of radioactive fallout correctly. (author).

  11. Relationship between metabolic syndrome and multinodular non-toxic goiter in an inpatient population from a geographic area with moderate iodine deficiency.

    Rendina, D; De Filippo, G; Mossetti, G; Zampa, G; Muscariello, R; Benvenuto, G; Vivona, C L; Ippolito, S; Galante, F; Lombardi, G; Biondi, B; Strazzullo, P


    Obesity and insulin resistance predispose individuals to the development of both metabolic syndrome and non-toxic nodular thyroid diseases. The aim of this observational, cross-sectional study is to evaluate the relationship between metabolic syndrome and multinodular nontoxic goiter in an inpatient population from a geographic area with moderate iodine deficiency. We examined 1422 Caucasian euthyroid inpatients. Thyroid volume was determined by ultrasound of the neck. A fine-needle aspiration biopsy was performed to evaluate single thyroid nodules and dominant nodules ≥15 mm in euthyroid multinodular goiter. The diagnosis of metabolic syndrome was made according to the criteria of the American Heart Association/ National Heart, Lung, and Blood Institute. Of the sample, 277 patients had clinical evidence of multinodular nontoxic goiter, 461 met the criteria for the diagnosis of metabolic syndrome, and 132 were found to have both conditions. After adjusting for age, gender, body mass index, nicotinism, parity, alcohol intake, thyroid function, and metabolic syndrome- related pharmacological treatment, metabolic syndrome was found to be an independent risk factor for the occurrence of multinodular non-toxic goiter. The relationship between metabolic syndrome and multi nodular non-toxic goiter was apparent in both men and women. In this study of euthyroid inpatients, we demonstrate that metabolic syndrome is an independent risk factor for the occurrence of multinodular non-toxic goiter in a geographic area with moderate iodine deficiency. We propose that patients meeting the criteria for metabolic syndrome should be screened for the presence of multinodular non-toxic goiter.

  12. Normal values for thyroid ultrasonography, goiter prevalence and urinary iodine concentration in schoolchildren of the Veneto Region, Italy.

    Busnardo, B; Nacamulli, D; Frigato, F; Vianello-Dri, A; De Vido, D; Mian, C; Candiani, F; Tomasella, G; Zambonin, L; Piccolo, M; Girelli, M E


    Goiter prevalence in school-age children and median urinary iodine concentration (UIC) are the main indicators of iodine deficiency in a population. In areas of mild iodine deficiency, where goiters are small, ultrasound is preferable to physical examination to estimate goiter prevalence. The World Health Organization (WHO) has adopted thyroid volume ultrasonography results from a survey of European schoolchildren as an international reference, but these values have recently been questioned. The aims of the study were: a) to determine regional normal echographic reference values of thyroid volume in children aged between 11 and 14 yr in the Veneto Region, in North-East Italy; b) to determine goiter prevalence by physical and ultrasonographic examination; c) to determine UIC in this section of the population. A cross-sectional study was carried out on 1730 schoolchildren, aged between 11 and 14, living in towns in low-lying areas, in the valleys of the pre-Alps and in the mountains between 600 and 1200 m. Thyroid volume was evaluated by inspection and palpation using the WHO criteria. In 560 children thyroid volume was determined by ultrasound. UIC was measured in 1368 children. On physical examination a grade I goiter was found in 7.5% of children. No goiter grade II or grade III was found. The regional thyroid volume reference values by ultrasonography were similar, or slightly lower (5-20%), to the corresponding WHO reference values. Mean UIC was 148 +/- 110 microg/l, with no difference between lowlands and uplands; UIC values less than 100 microg/l were found in about 30-35% of the children. UIC was higher in children using iodized salt than in non-users. No correlation was found between thyroid volume by ultrasonography and UIC. Thyroid volume was found to be bigger in upland children than in those in low-lying areas, probably because of low iodine intake in people living in the mountains in previous generations. This data show that Veneto is not a iodine

  13. Retrosternal Goiter

    Mehmet Erol


    1-      Hong CM, Ahn BC, Jeong SY, Lee SW, Lee J. Distant metastatic lesions in patients with differentiated thyroid carcinoma. Clinical implications of radioiodine and FDG uptake. Nuklearmedizin. 2013 Aug 8;52(4:121-9

  14. [Amyloid goiter].

    Hrívó, A; Péter, I; Bánkúti, B; Péley, G; Baska, F; Besznyák, I


    Amyloid goitre is at an extremely rare occurrence. Authors review the origin of disease and its symptoms, diagnostic and therapeutic tools. The disease may be due to either primary or secondary systemic or local amyloidosis. Diagnosis may be made even before surgery on anamnestic data, on very rapid growth of thyroid glands, on diffuse appearance, on other symptoms of systemic amyloidosis, on findings of iconographic procedures and on detection of amyloid in aspirates. Final diagnosis is based on histology. Surgical therapy is aiming at avoidance of the existing and the threatening consequences of expanding mass. The outcome is independent from thyroid surgery, it is related to other manifestations of amyloidosis. Concerning with the present case the chronic superior vena cava syndrome and chylous pleural effusion as first described symptoms and asymptomatic hyperthyroxinaemia is emphasised. Neither other organ involvement, nor primary amyloidogenous molecula was found during the 18 months follow up, so patient has secondary and localised amyloidosis.

  15. Nodal colloid goiter: clinical and morphological criteria of thyroid autonomy and progressive growth

    S S Antonova


    Full Text Available Goal. To work up clinical and morphological criteria of thyroid authonomy and progressive growth in nodal colloid goiter (NCG. Methods. A group of patients with nodal euthyroid goiter (NEG (40 patients and a group of patients with nodular toxic goiter (NTG (40 patients were formed to compare clinical and morphological criteria of NCG growth to/with development of functional autonomy (FA. All patients were conducted research including physical examination, thyroid palpation, ultrasound, blood level of TSH and T4, scintigraphy, aspiration (needle biopsy, immunocytological and immunohistological reactions and statistics. In the study the method of indirect immunoperoxidase reaction with monoclonal rat/mouse antigens to Ki-67, TSH, galectin-3, Apo-test (“Dako Corporation”, “Novocastra Laboratories Ltd.” was used. Results. 1. In NEG expression of cell proliferation marker Ki-67 for certain rises pro rata to increase of proliferation degree, and in NTG grows according to FA development. 2. Apoptosis expression in NEG decreases according to degree of thyrocytes in a nodule, but in NTG falls pro rata to accumulation of thyroid FA. 3. Positive reaction for TSH in NEG tissue was found in 100%, whereas negative reaction for this receptor in NTG tissue was observed in 81% of all cases. 4. Galectin-3 was expressed in focuses of severe dysplasia of thyroid nodes tissue comparable to galectin-3 expression in the tissue of high-grade differentiated adenocarcinomas. Summary/conclusion. 1. Severe and moderate expression of Ki-67 and mild or negative immunomorphological reaction for Apo-test allows to refer such kinds of nodules to fast-growing/rapid-growing ones. 2. Reliable negative expression TSH receptor in the tissue of NCG is evidence of FA development and is an indication for a treatment of radioactive iodine or for an operation. 3. Galectin-3 probably is an early marker of malignant transformation in thyroid tissue. 4. Having conducted complex

  16. [Analysis of predictors of malignancy of nodular goiters: about 500 cases].

    Bouaity, Brahim; Darouassi, Youssef; Chihani, Mehdi; Touati, Mohamed Mliha; Ammar, Haddou


    Thyroid nodules are very common and less than 10% of them are malignant. They pose a serious diagnostic and therapeutic problem with respect to their benign or malignant nature. The study of some clinical and paraclinical factors for presumed malignancy makes it possible to codify appropriate therapeutic strategy. The aim of this study was to investigate predictors of malignancy in nodular goiters and to compare our results with those reported in the literature. This retrospective study consisted of 500 cases of nodular goiter operated in the Department of Otorhinolaryngology (ear, nose and throat or ENT) and Head and Neck Surgery at Avicenne military hospital in Marrakech between 2006 and 2012. The percentage of cancers was 6,8%. The average age of our patients was 46 years, with a sex-ratio of 5 (F/H). The hard nature of the nodule was present in 94,4% of the cases of cancer by palpation; irregular boundaries were present in 64.70% of the cases of cancer. Three nodules were fixed and malignant. Cervical lymphadenopathy were observed in 8 patients, 7 of which had cancer. Ultrasound examination showed hypoechoic appearance in 61,8% of the malignant nodules, with smooth-edges in 88,24% of the cases. Intranodular vascularization was found in 35,3% of the cases of cancers, with microcalcifications in 55,9% of the cases. Perinodular hypoechoic halo was incomplete in 73,5% of the cases of cancer. Our patients were euthyroid in 84,6% of the cases. Predictors of malignancy in nodular goiters were present in our first clinical study: patients over the age of 60 years, hard consistency of nodule, fixity, irregular and poorly defined character by palpation, as well as presence of cervical adenopathy on examination; and echographic features: hypoechoic character, smooth-edges, presence of microcalcifications and visualization of intranodular vascularization with or without peri-nodular vascularization. Although some of these factors are highly predictive of malignancy, only

  17. Iodine nutritional status and goiter prevalence in primary school children aged 6-12 of Panchmahal district, Gujarat, India

    Vihang Mazumdar


    Full Text Available Introduction: Iodine deficiency disorders (IDD create major public health problems in India, including Gujarat. Panchmahal district is known for endemic iodine deficiency. The present study was conducted to (1 estimate the prevalence of goiter in primary school children, (2 determine median urinary iodine concentration, (3 assess the level of iodine in salt samples at the household and retail shop level, and (4 profile of salt sold at retail shops in Panchmahal district, Gujarat. Methods: A total of 70 students including five boys and five girls from 1st to 7th standard who were present on the day of the first visit were selected randomly for goiter examination from each village. Urine samples were collected from one boy and one girl from each standard in each cluster. From the community, at least 28 students, including two boys and two girls from each standard in the same age group, were examined, and salt samples were tested from their households. A total of 2100 students were examined in schools and 928 students were examined in the selected villages. From each village, one retail shop was visited, and salts purchased from those shops were immediately tested for iodine with spot kits.Results: Among young primary school children, goiter prevalence was 23.35% (grade 1—18.35%, grade 2—5.0%. As the ages increase, goiter prevalence also increases except for 9-year-olds. The median urinary iodine excretion level was 110 µg/L. An iodine level >15 ppm was found in 78.3% of the salt samples tested at household level. Conclusion: The present study showed considerable goiter prevalence in primary school children in Panchmahal district of Gujarat and an inadequate iodine content of salt at the household level.

  18. Serum thyroxine and age - rather than thyroid volume and serum TSH - are determinants of the thyroid radioiodine uptake in patients with nodular goiter

    Bonnema, S J; Fast, S; Nielsen, V E;


    patients (146 females; age range: 22-87 yrs.) with nodular goiter (median 64 ml, range: 20-464 ml) selected for 131I therapy. Serum TSH was sub-normal in 42.4%. None were treated with anti-thyroid drugs. The thyroid RAIU was determined at 24h and 96h. The goiter volume was measured by ultrasound (n=127......Background: 131I therapy is widely used for treatment of non-toxic goiters. A limitation for this treatment is a low thyroid radioiodine uptake (RAIU), often encountered in these patients. Aim: To estimate the impact of various factors on the thyroid RAIU. Methods: We examined prospectively 170...

  19. Unusual presentation of a cutaneous leiomyoma of the neck simulating a goiter

    Kouame Kanga


    Full Text Available We report an unusual case of a large cutaneous leiomyoma. Dermal leiomyomas are rare and benign skin tumors derived from the smooth erector muscles of the hair. The patient was a 12-year-old child who came in for a consultation on a big cervical tumor of the anterior part of the neck which simulated goiter. The lesion evolved since the patient was five years old; it was consistently firm and was associated with skin ulceration and significant deep suppurations. Computed tomography (CT scan revealed that this tumor was limited to the soft and cutaneous tissues without invading the thoracic muscles. Surgical treatment allowed the excision of the gelatinous and well vascularized skin tumor measuring about 15 cm in diameter. Final histological examination confirmed the diagnosis of dermal leiomyoma.

  20. Diffuse infiltration of Aspergillus hyphae in the thyroid gland with multinodular goiter

    Havva Erdem


    Full Text Available A 35-year-old woman presented with a thyroid mass, weakness and shortness of breath of 3 years duration. On physical examination, she had a diffusely enlarged thyroid gland with multiple nodules. There were no signs to suggest immune suppression. The patient farmed and raised livestock. Biochemical tests and hemogram were normal. She underwent surgery, and a histological examination of the surgical specimen revealed nodular hyperplasia. Microscopically, silver methenamine (PASM stain-positive hyphae that divided into branches at 45° and conidia were detected beside the thyroid capsule, with conidia in the cystic nodule. Moreover, ischemic changes of the thyroid tissue were observed closer to the capsule. We report a case of Aspergillosis of the thyroid of a patient who underwent surgery for a multinodular goiter.

  1. Evaluation of endemic goiter prevalence in Bulgarian schoolchildren: results from national strategies for prevention and control of iodine-deficiency disorders.

    Gatseva, Penka; Vladeva, Stefka; Argirova, Mariana


    Iodine deficiency is a major health problem worldwide. The environment of the Balkan countries, including Bulgaria, is distinguished for its low iodine content. In 1994, the strategies for the prevention and control of iodinedeficiency disorders were actualized in Bulgaria and universal salt iodization and supplementation for the risk population groups (schoolchildren, pregnant women) were introduced. The aim of this study was to assess the effectiveness of the iodine prophylaxis in schoolchildren, living in an endemic for goiter area after the introduction of salt iodization in Bulgaria. For this purpose, the goiter prevalence and iodine status in 483 schoolchildren (274 boys and 209 girls) aged between 8 and 15 yr, living in an endemic for goiter area in Bulgaria were evaluated. Despite the normalization of iodine supply, mild iodine deficiency on the basis of goiter prevalence (16.15%) and urinary iodine excretion was found. These data indicate the need for reevaluation of the national strategy for prevention of iodine deficiency.

  2. Prevalence of simple nodular goiter and Hashimoto's thyroiditis in current, previous, and never smokers in a geographical area with mild iodine deficiency.

    Rendina, D; De Palma, D; De Filippo, G; De Pascale, F; Muscariello, R; Ippolito, R; Fazio, V; Fiengo, A; Benvenuto, D; Strazzullo, P; Galletti, F


    Simple nodular goiter and Hashimoto's thyroiditis are 2 frequent nonmalignant thyroid diseases. Tobacco smoking has detrimental effects on the endocrine system and in particular on thyroid function and morphology. The objective of this cross-sectional study, involving 1800 Caucasian adults from a geographical area with mild iodine deficiency, was to evaluate the relationship between tobacco smoking, smoking cessation, and the prevalence of simple nodular goiter and Hashimoto's thyroiditis. Thyroid status was evaluated by ultrasonic exploration of the neck, measurement of FT3, FT4, TSH, antibodies against thyroid peroxidase and thyroglobulin, and urinary iodine excretion. The fine-needle aspiration biopsy of significant nodules was also performed. Smoking habits were evaluated by a specific questionnaire and the calculation of number of pack years. Both current and previous smokers showed an increased risk of simple nodular goiter compared to never smokers after adjustment for potential confounders and known goitrogen factors. Interestingly, the simple nodular goiter risk was similar for never smokers and for previous smokers declaring a time since cessation of smoking for more than 69 months. Smoking habit was not associated to an increased risk of Hashimoto's thyroiditis.Smoking appears to be an independent risk factor for simple nodular goiter but not for Hashimoto's thyroiditis in an area with mild iodine deficiency. A prolonged withdrawal of smoking dramatically reduces the risk of simple nodular goiter occurrence.

  3. Accuracy of ultrasound-guided fine-needle aspiration cytology for diagnosis of carcinoma in patients with multinodular goiter

    Saif Al-Yaarubi


    Full Text Available Background: Fine-needle aspiration (FNA is a useful method for evaluating multinodular goiter; however, its role is still controversial. The aim of this study was to assess the utility of ultrasound-guided thyroid FNA in detecting malignancy in patients with multinodular goiter in Oman. Materials and Methods: This was a retrospective study where all patients with multinodular goiter seen at the Sultan Qaboos University Hospital endocrinology clinic in Oman in 2005 were evaluated. The thyroid FNA results were grouped into either malignancy (positive result or others (negative result. They were compared to those of final histopathological examination in order to calculate the value of the test in diagnosing malignancy. Analyses were evaluated using descriptive statistics. Results: A total of 272 patients were included in the study. The mean age was 39΁13 years with an age range from 5 to 85 years. The majority of the patients were females (n=236; 87%. The results of thyroid FNA revealed that 6% (n=15 of the patients had malignancies while histopathological results showed that the proportion of subjects with malignancies was 18% (n=49. Out of the 15 cases identified to have malignances by thyroid FNA, only 53% (n=8 of the subjects were confirmed to have malignancy by biopsy. Overall, the results of the tests were poor, revealing a sensitivity of 16%, specificity of 97% and a diagnostic accuracy of 82%, with a positive predictive value of 53% and a negative predictive value of 84%. Conclusion: Thyroid FNA is not a useful test in differentiating multinodular goiter from malignancy, as more than 80% of the malignancies go unnoticed.

  4. Systemic oxidative stress to nucleic acids is unaltered following radioiodine therapy of patients with benign nodular goiter

    Bonnema, Steen J; Stovgaard, Elisabeth S; Fast, Søren;


    BACKGROUND: Little is known about the whole body oxidative stress burden following radioactive iodine ((131)I) therapy of thyroid diseases. METHODS: We studied 17 patients with benign nodular goiter treated with (131)I therapy. The targeted thyroid dose was 50 Gy in 11 patients pretreated with 0....... in the thyroid gland, but the study supports that (131)I therapy of benign nodular goiter carries no or only a minute risk of developing subsequent malignancies. It remains to be explored whether our findings also apply to hyperthyroid disorders.......BACKGROUND: Little is known about the whole body oxidative stress burden following radioactive iodine ((131)I) therapy of thyroid diseases. METHODS: We studied 17 patients with benign nodular goiter treated with (131)I therapy. The targeted thyroid dose was 50 Gy in 11 patients pretreated with 0.......1 mg of recombinant human TSH (rhTSH). In 6 patients, the applied thyroid dose was 100 Gy without rhTSH prestimulation. Well-established biomarkers of oxidative stress to RNA (8-oxo-7,8-dihydroguanosine; 8-oxoGuo) and DNA (8-oxo-7,8-dihydro-2'-deoxyguanosine; 8-oxodG) were measured in freshly voided...

  5. An outbreak of Salmonella enterica serotype Choleraesuis in goitered gazelle (Gazella subgutrosa subgutrosa) and a Malayan tapir (Tapirus indicus).

    Wolf, Tiffany M; Wünschmann, Arno; Morningstar-Shaw, Brenda; Pantlin, Gayle C; Rasmussen, James M; Thompson, Rachel L


    An outbreak of Salmonella enterica serotype Choleraesuis enteritis occurred in two juvenile goitered gazelles and an adult Malayan tapir over a period of 5 wk at the Minnesota Zoo. Diagnosis was made postmortem on one gazelle and one tapir, and a second gazelle was diagnosed via fecal culture. The death of the tapir was attributed to S. enterica serovar Choleraesuis septicemia, while salmonellosis was considered to be a contributing factor besides ostertagiasis for the death of one goitered gazelle and for the diarrhea of another goitered gazelle. A third gazelle became ill in the same time period, but Salmonella infection was not confirmed by culture. All exhibited the clinical signs of profuse, watery diarrhea. The gazelles developed a protein-losing enteropathy, and the tapir showed signs of sepsis and endotoxemia. Serotyping and pulsed-field gel electrophoresis revealed the Salmonella isolates to be indistinguishable from each other. One year prior to this outbreak, Salmonella sp. was cultured from a Visayan warty pig (Sus cebifrons) housed in the same building as the tapir. After further investigation into the outbreak, spread of this pathogen was speculated to be associated with human movement across animal areas.

  6. Research and cure: knowledge and prophylaxis of endemic goiter in Argentina (1916-1958

    Feld, Adriana


    Full Text Available The present paper focuses on the reconstruction of the historical circumstances of knowledge production as well as and the debates about endemic goiter disease during the period 1916-1955 in Argentina. Taking into account the social, political and material dimensions, this text explores the re-signification of scientific and medical knowledge oriented to the prevention and health treatment, through the positioning of several social actors engaged all along the period, and the diverse historical and institutional contexts.

    El presente trabajo se orienta a reconstruir el recorrido histórico de la producción de conocimiento, así como los debates acerca de la enfermedad del bocio endémico en Argentina, fundamentalmente entre 1916 y 1955. Tomando en cuenta aspectos sociales, políticos y materiales, el trabajo explora la resignificación del conocimiento científico y médico en términos de medidas de prevención y tratamiento de la salud, a través del posicionamiento de diversos actores sociales implicados y de diversos contextos históricos e institucionales.

  7. Thyrocyte-specific Gq/G11 deficiency impairs thyroid function and prevents goiter development.

    Kero, Jukka; Ahmed, Kashan; Wettschureck, Nina; Tunaru, Sorin; Wintermantel, Tim; Greiner, Erich; Schütz, Günther; Offermanns, Stefan


    The function of the adult thyroid is regulated by thyroid-stimulating hormone (TSH), which acts through a G protein-coupled receptor. Overactivation of the TSH receptor results in hyperthyroidism and goiter. The Gs-mediated stimulation of adenylyl cyclase-dependent cAMP formation has been regarded as the principal intracellular signaling mechanism mediating the action of TSH. Here we show that the Gq/G11-mediated signaling pathway plays an unexpected and essential role in the regulation of thyroid function. Mice lacking the alpha subunits of Gq and G11 specifically in thyroid epithelial cells showed severely reduced iodine organification and thyroid hormone secretion in response to TSH, and many developed hypothyroidism within months after birth. In addition, thyrocyte-specific Galphaq/Galpha11-deficient mice lacked the normal proliferative thyroid response to TSH or goitrogenic diet, indicating an essential role of this pathway in the adaptive growth of the thyroid gland. Our data suggest that Gq/G11 and their downstream effectors are promising targets to interfere with increased thyroid function and growth.

  8. Goiter prevalence in school-going children: A cross-sectional study in two border districts of sub-Himalayan Jammu and Kashmir.

    Gupta, Rajiv Kumar; Langer, Bhavna; Raina, Sunil Kumar; Kumari, Rashmi; Jan, Reyaz; Rani, Renu


    Iodine deficiency disorder remains one of the major public health problems, despite it being easily preventable. Initially thought as the disorder of Himalayan goiter belt, the disorder has been found to have a pan-India presence. The study was planned with the aim to assess the prevalence of goiter among 6-12 years school-going children and to identify levels of iodine in salt consumed at the household level in the study area. The study was conducted among 3955 school-going (2162 children from Rajouri and 1793 children from Poonch) children age 6-12 years in Rajouri and Poonch districts of Jammu Province. The children were examined clinically to detect and grade the goiter. Salt samples were collected from subsample (n = 400) to estimate iodine content in the salt. The prevalence of goiter in the study population was found to be 18.87% and 9.70% in Rajouri and Poonch districts, respectively. Goiter prevalence was higher in 9-12 years age group as compared to 6-9 years age group and the difference in goiter prevalence in males of these two age groups was statistically significant (P = 0.02). Estimation of iodine content of the salt samples revealed that all of them (100%) had adequate iodine content. Despite the implementation of Universal Iodization Program and adequate content of iodine in salt consumed by the families, the goiter prevalence in both the districts is high. The future research should focus on identifying the reasons for this high prevalence.

  9. Goiter prevalence in school-going children: A cross-sectional study in two border districts of sub-Himalayan Jammu and Kashmir

    Rajiv Kumar Gupta


    Full Text Available Introduction: Iodine deficiency disorder remains one of the major public health problems, despite it being easily preventable. Initially thought as the disorder of Himalayan goiter belt, the disorder has been found to have a pan-India presence. The study was planned with the aim to assess the prevalence of goiter among 6–12 years school-going children and to identify levels of iodine in salt consumed at the household level in the study area. Materials and Methods: The study was conducted among 3955 school-going (2162 children from Rajouri and 1793 children from Poonch children age 6–12 years in Rajouri and Poonch districts of Jammu Province. The children were examined clinically to detect and grade the goiter. Salt samples were collected from subsample (n = 400 to estimate iodine content in the salt. Results: The prevalence of goiter in the study population was found to be 18.87% and 9.70% in Rajouri and Poonch districts, respectively. Goiter prevalence was higher in 9–12 years age group as compared to 6–9 years age group and the difference in goiter prevalence in males of these two age groups was statistically significant (P = 0.02. Estimation of iodine content of the salt samples revealed that all of them (100% had adequate iodine content. Conclusion: Despite the implementation of Universal Iodization Program and adequate content of iodine in salt consumed by the families, the goiter prevalence in both the districts is high. The future research should focus on identifying the reasons for this high prevalence.


    Djoko Kartono, PhD


    Full Text Available Based on the National Mapping Survey on Iodine Deficiency Disorders (IDD 1996/1998, Sub-District of Sungai Selan at District of Bangka Tengah, Province of Kep.Bangka Belitung was in category of severe endemic goitre. The objective of this study is to know risk factors that influence on the development of thyroid gland in Sub-district of Sungai Selan. Location of study was student of grade 3, 4 and 5 of 3 Primary School in Sub-district of Sungai Selan (severe endemic dan another 3 Primary School in Sub-district of Pangkalan Baru (non-endemic. These 6 Primary Schools were the location surveyed in 199611998. Data collection included urinary iodine concentration (UIC, iodine rich food consumption, thiocyanate rich food consumption, iodine content in salt consumed by household and iodine content in drinking water. Score of iodine rich food and score of thiocyanate rich food consumptions higher in non-endemic than in endemic area. Median value of UIC in endemic area was higher in endemic ar.ea although the median in both areas was in category of excess iodine i.e. 310 µg/L in non-endemic and 488 µg/L in endemic area respectively. All subject, in endemic and non-endemic areas, consumed iodised salt. Iodine content in salt was 35.5 part per million (ppm in non-endemic and 29,8 ppm in endemic area. The conclusion was that consumption of iodine and thiocyanate rich food and iodine content in salt and in drinking water were not the risk factors of IDD in that area.   Key words: risk factor, goiter, salt, drinking water, urinary iodine

  11. Intrathoracic Goiter. A Case Report Bocio endotorácico. Presentación de un caso

    José Alberto Puerto Lorenzo


    Full Text Available Goiter is an enlargement of the thyroid gland in the anterolateral part of the neck. It is estimated that approximately 3 % of the population worldwide suffer from this condition, although the incidence of nodular goiter has decreased in some countries due to the intake of iodized salt and iodine-rich food. A case of a 59 year-old female patient who attended consultation with an enlargement of the neck, accompanied by weakness, palpitations and dysphagia is presented. After being examined, she underwent surgery which confirmed the diagnosis of intrathoracic goiter. Since this is a rare pathology, it is of scientific interest for professionals dealing with the study and treatment of thyroid conditions.Se denomina bocio al aumento de volumen de la glándula tiroides en la región antero-lateral del cuello. Se calcula que aproximadamente el 3 % de los pobladores del mundo lo tienen, aunque la incidencia del bocio nodular ha disminuido debido a la ingestión en algunos países de sal yodada y alimentos ricos en yodo. Se presenta el caso de una paciente de 59 años que acudió a consulta por presentar aumento de volumen del cuello, acompañado de decaimiento, palpitaciones y disfagia, la cual después de ser estudiada en consulta fue intervenida quirúrgicamente, en la que se corroboró el diagnóstico de un bocio endotorácico. Por ser esta patología poco frecuente, se considera de interés científico para los profesionales dedicados al estudio y tratamiento de las afecciones tiroideas.

  12. Goiter prevalence and iodine nutritional status of school children in a sub-Himalayan Tarai region of eastern Uttar Pradesh.

    Chandra, A K; Bhattacharjee, A; Malik, T; Ghosh, S


    The present work was undertaken to evaluate the prevalence of goiter, state of iodine nutrition of the population, distribution of iodine through edible salt, bioavailability of iodine, consumption of common goitrogenic food that generally interfere with iodine nutrition in Naugarh sub-division of Siddharthnagar district in Uttar Pradesh, India. Five areas were selected from 5 Community Development (CD) Blocks taking one from each by purposive sampling method. In each area, Primary and Junior high schools were selected by simple random sampling to get representative target population. Clinical goiter survey was conducted in 1663 school-aged children from both sexes (6-12 yrs), along with the biochemical analysis of iodine (I) and thiocyanate (SCN) in 200 urine samples, iodine content in 175 edible salt samples and 20 water samples collected from the selected study areas. The studied region is severely affected by Iodine deficiency disorders (IDD) as goiter prevalence is 30.2% (grade 1: 27.1% grade 2:3.1%). Median urinary iodine level was 96 microg/L indicating biochemical iodine deficiency. The mean urinary thiocyanate was 0.810+/-0.490 mg/dL and mean of I/SCN ratios in all the studied areas were above the critical level of 7. However, 22% of the individual had I/SCN ratio salt samples had adequate iodine i.e., >or=15 ppm while iodine content in drinking water varied between 7.5-10.7 microg/L. Iodine deficiency is the primary cause, however the consumption of cyanogenic food may have important role for the persistence of IDD in the studied region during post salt iodization phase.

  13. Thyroid Ultrasonography Consistently Identifies Goiter in Adults Over the Age of 30 Years Despite a Diminished Response with Aging of the Thyroid Gland to the Effects of Goitrogenesis

    Sheela R. Brahmbhatt


    Full Text Available Iodine deficiency is a national health problem in India and we have recently reported on the severity of IDD in adults and children in Gujarat province. The aim of this study was to determine the utility of thyroid ultrasonography to detect goiter in adults from an iodine-deficient population of Gujarat. We studied 472 adults selected by random household surveys. Data were collected on height, body weight, mid-upper arm circumference, thigh circumference, triceps skinfold thickness, thyroid size (palpation and ultrasonography, and diet. Casual urine samples for iodine (UI and blood spots for TSH estimation were obtained. Endemic goiter is a major public health problem in Gujarat State, India and is probably caused by multiple factors including iodine deficiency, malnutrition, and other dietary goitrogens. These results indicate that thyroid US consistently detects goiter in adults despite a diminished thyroidal response to variable goitrogenic stimuli.

  14. Non-surgical approach to the benign nodular goiter: new opportunities by recombinant human TSH-stimulated (131)I-therapy

    Bonnema, Steen Joop; Fast, Søren; Hegedüs, Laszlo


    nodule. If thyroid hyperfunction due to nodular autonomy is the dominant problem, life-long anti-thyroid drug treatment may be relevant in elderly individuals. With the advent of recombinant human TSH (rhTSH) stimulation the goiter reduction following (131)I-therapy is significantly enhanced...... and this treatment is of particular benefit, as compared with conventional (131)I-therapy, in patients with a low baseline thyroid (131)I uptake and a large goiter. If the rhTSH dose does not exceed 0.1 mg the risk of temporary hyperthyroidism and acute thyroid swelling is low. Since patient satisfaction seemingly...... is not improved by the greater goiter reduction obtained by rhTSH-stimulated (131)I-therapy, and permanent hypothyroidism is more frequent, it may be more relevant to reduce the administered radioactivity equivalent to the rhTSH-induced increase in the thyroid (131)I uptake. Future large-scale well...

  15. Growth inhibition of human thyroid carcinoma and goiter cells in vitro by the isoflavone derivative 7-(O)-carboxymethyl daidzein conjugated to N-t-boc-hexylenediamine.

    Somjen, Dalia; Grafi-Cohen, Meital; Weisinger, Gary; Izkhakov, Elena; Sharon, Orli; Kraiem, Zaki; Fliss, Dan; Zikk, Daniel; Kohen, Fortune; Stern, Naftali


    Estrogens may enhance thyroid cancer cell growth. We have recently reported that a novel isoflavone-derived anti-estrogenic compound developed in our laboratory, the N-t-boc-hexylenediamine derivative of 7-(O)-carboxymethyl daidzein (cD-tboc), can induce apoptosis and retard growth in human thyroid carcinoma cell lines through inhibitory interaction on estrogen receptor β. Here we tested the hypothesis that cD-tboc can likewise retard cell growth in cultured human thyroid papillary carcinoma cells, normal thyroid cells, and goiter cells removed during thyroidectomy. In vitro experiments in cultured human thyroid normal, goiter, and papillary thyroid carcinoma (PTC) cells were performed. Estrogen receptors α and β (ERα and ERβ), DNA synthesis and creatine kinase (a marker of estrogenic genomic response), and the effects of cD-tboc on DNA synthesis in cultured human PTC cells were assessed. First, all cell types thus harvested and grown in culture expressed both ERα and ERβ, with a variably higher abundance of ERβ over ERα seen in the goiter and PTC cells, but not in the normal thyroid cells. Second, DNA synthesis and creatine kinase were increased in response to estradiol-17β (E2), the ERα agonist propyl-pyrazole-trisphenol as well as the ERβ agonist diarylpropionitrile. Third, cD-tboc dose-dependently inhibited DNA synthesis in cultured human PTC cells (-65%) and to a lesser extent in goiter cells (∼-30%). This study provides the first evidence that cD-tboc can act to inhibit growth in primary cultures of human PTC cells and goiter cells removed during thyroidectomy. Whether this can be utilized for the treatment of human thyroid cancer and/or goiter remains to be explored.

  16. Goiter prevalence in school-going children: A cross-sectional study in two border districts of sub-Himalayan Jammu and Kashmir

    Rajiv Kumar Gupta; Bhavna Langer; Sunil Kumar Raina; Rashmi Kumari; Reyaz Jan; Renu Rani


    Introduction: Iodine deficiency disorder remains one of the major public health problems, despite it being easily preventable. Initially thought as the disorder of Himalayan goiter belt, the disorder has been found to have a pan-India presence. The study was planned with the aim to assess the prevalence of goiter among 6?12 years school-going children and to identify levels of iodine in salt consumed at the household level in the study area. Materials and Methods: The study was conducted amon...

  17. Evaluations of Factors Predicting the Need for an Extra-Cervical Approach for Intra-Thoracic Goiter

    Ali Sadrizadeh


    Full Text Available Introduction: Intra-thoracic goiter refers to the extension of enlarged thyroid tissue into the thoracic inlet. This condition can produce symptoms of compression on adjacent organs and can sometimes be accompanied by malignant transformation. Therefore surgical treatment is almost always necessary. In order to remove the pathology with the fewest post-operative complications, selection of the appropriate surgical approach is essential. In this study we aimed to detect the criteria which help us select the best therapeutic approach.   Materials and Methods: In this retrospective study, 82 patients with intra-thoracic goiter were investigated. Their data were extracted from medical records and analyzed using SPSS software.   Results: Overall 82 patients, 18 (21% males and 64 (78% females with mean age of 56.38 years were studied. The most common clinical symptoms were mass (95% and dyspnea (73%. In most patients, the surgical approach was cervical (90.2%, while 9.8% of patients required an extra-cervical approach. Post-operation complications were observed in 17.1% of patients; the most common being transient recurrent laryngeal nerve paralysis (4.9%. Malignancy was reported in the histopathology of seven patients (8.5%. The most common malignant histopathology was papillary thyroid carcinoma (7.3%. Extension of the thyroid tissue below the uppermost level of the aortic arch was significantly correlated with the need for an extra-cervical approach to surgery (P

  18. Clinical and Epidemiological Clinical and Epidemiological Characteristics of Colloid Goiter Patients Undergoing Reoperation for Recurrent Thyroid Disease

    Gladys Iglesias Díaz


    Full Text Available Background: thyroid disease is one of the most prevalent medical conditions and thyroid cancer is the most common endocrine neoplasm. Thyroid reoperations are more common than it might seem.Objective: to establish the clinical and epidemiological characteristics of patients operated on for colloid goiter undergoing reoperation for recurrent thyroid disease.Methods: a case-series study was conducted at the León Cuervo Rubio Clinical-Surgical Hospital in Pinar del Rio. The sample included all patients (n = 29 who underwent thyroid operation and were reoperated on for recurrent thyroid disease in 2010, 2011 and 2012. The information was obtained from medical records and the register of histopathological diagnoses.Results: most patients (27.6% were in the 40-49 age group and females (79.3% were most affected. Recurrence was observed 5 to 9 years after surgery. Mixed nodules (55.2% followed by cysts (17.2% were the most frequent ultrasound diagnoses. Recurrent thyroid disease was malignant in 9% of patients.Conclusions: patients reoperated on for thyroid disease were mostly females in the fourth and fifth decade of life. The disease recurred in a period of 10 years after the first surgery in a greater number of cases. Follicular-patterned lesions, colloid goiter and cancer were the most common histologic diagnosis.

  19. Stimulation with 0.3-mg recombinant human thyrotropin prior to iodine 131 therapy to improve the size reduction of benign nontoxic nodular goiter

    Nielsen, Viveque Egsgaard; Bonnema, Steen Joop; Boel-Jørgensen, Henrik;


    ) were randomized to receive either 0.3 mg of recombinant human thyrotropin (n = 28) or placebo (n = 29) 24 hours before (131)I therapy. The (131)I dose was calculated based on thyroid size (measured by ultrasound), thyroid (131)I uptake, and (131)I half-life. The follow-up period was 1 year and included......BACKGROUND: Use of recombinant human thyrotropin increases the thyroid radioiodine (iodine 131 [(131)I]) uptake and may have a role in the context of (131)I therapy of benign goiter. METHODS: In a double-blind, placebo-controlled trial, 57 patients with nodular nontoxic goiter (51 women and 6 men...... measurements of thyroid size and function and patient satisfaction. RESULTS: Baseline median goiter volume was 51 mL (range, 20-99 mL) in the placebo group and 59 mL (range, 25-92 mL) in the thyrotropin group (P = .75). At 12 months, the mean +/- SEM relative goiter reduction was 46.1% +/- 4.0% in the placebo...

  20. An evaluation of the diagnostic efficacy of fine needle aspiration biopsy in patients operated for a thyroid nodular goiter

    Janczak D


    Full Text Available Dariusz Janczak,1,2 Wiktor Pawlowski,1 Tadeusz Dorobisz,1,3 Dawid Janczak,4 Karolina Dorobisz,5 Michal Lesniak,1 Agnieszka Ziomek,1 Mariusz Chabowski1,2 1Department of Surgery, 4th Military Teaching Hospital, 2Department of Clinical Nursing, Division of Nursing in Surgical Procedures, 3Department of Clinical Basics of Physiotherapy, 4Department of Palliative Care Nursing, Faculty of Health Science, 5Department of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland Background: Thyroid cancer (TC comprises 1% of all carcinomas and is the most common malignancy of the endocrine system. The disease is more common in women, with its peak morbidity observed in 40–50-year-old patients. The main risk factors include radiation, iodine deficiency, hereditary background, and genetic mutations. Among all diagnosed thyroid nodules, 5%–30% will evolve into cancer. The gold-standard procedure in the preoperative evaluation of a nodular goiter, apart from ultrasonography, is fine needle aspiration (FNA biopsy. The FNA biopsy is favored for its simplicity, safety, and high specificity and sensitivity rates. Aim: The aim of our study was to evaluate the clinical efficacy of FNA based on the patients’ register. Materials and methods: In the Department of Surgery at the 4th Military Teaching Hospital in Wroclaw, 2,133 patients underwent thyroid surgery for thyroid goiter between 1996 and 2015. One hundred and eight cases of TC were diagnosed and of these, 66 patients had a preoperative FNA. Results: Fourteen FNA biopsies (21% revealed cancer, all of which were confirmed in the postoperative histopathology, although six cases of FNA-diagnosed cancer revealed a different histological type postoperatively. Eighteen FNA biopsies (27% were suspected of being malignant. A disturbingly high rate of “benign” FNA biopsies (32 cases; 48% revealed TC after surgery. Conclusion: It is of great importance that the quality and quantity of

  1. Prevalence of goiter and urinary iodine status in six-twelve-year-old rural primary school children of Bharuch district, Gujarat, India

    Haresh Rameshkumar Chandwani


    Full Text Available Background: Iodine deficiency disorder (IDD creates major public health problems in India, including Gujarat. The Bharuch district is a known iodine deficiency endemic area. This study was conducted to estimate the prevalence of goiter in primary school children; to determine the median urinary iodine concentration; to assess the level of iodine in salt samples at the household and retail shop levels; and to study the profile of salt sold at retail shops. Methods: This study was carried out by using the 30-cluster survey method in the primary schools of the rural areas in Bharuch district. A total of 70 students, including five boys and five girls from the first to seventh classes, who were present in class on the day of the visit were selected randomly for goiter examination from each village. Urine samples were collected from one boy and one girl from each class in each cluster. From each community, a maximum of two boys and two girls from each standard in the same age group were examined and also salt samples were tested from their households. From each village, one retail shop was visited and the salt purchased from those shops was immediately tested for iodine with spot kits. Results: We found a goiter prevalence of 23.2% (grade 1 - 17.4% and grade 2 - 5.8%. As the age increased, the goiter prevalence decreased except in nine-year-olds. The median urinary iodine excretion level was 110 μg/L. An Iodine level > 15 ppm was found in 93% of the salt samples tested at the household level. Conclusion: The present study showed moderate goiter prevalence in primary school children in the Bharuch district of Gujarat and an inadequate iodine content of salt at some household levels.

  2. Clinical Pathological Features of 1 168 Cases of Nodular Goiter%结节性甲状腺肿1168例临床病理分析

    赵时梅; 罗宇; 史琳


    目的 探讨结节性甲状腺肿的临床病理特征.方法 回顾性分析1 168例结节性甲状腺肿的临床病理资料.结果 1 168例结节性甲状腺肿中,女性患者占88.1%,中位发病年龄为48岁.结节性甲状腺肿伴发或继发病变发生率高达57.6%,其中出血、坏死、钙化、囊性变,灶性淋巴细胞增生及桥本甲状腺炎发生率分别为20.4%、28.0%和0.3%.乳头状增生发生率为5.3%,甲状腺癌继发率为3.1%.结论 结节性甲状腺肿女性多发,继发病变多,诊断时应给予重视.%Objective To explore the clinical pathological features of nodular goiter. Methods The data of 1 168 nodular goiter were studied retrospectively. Results In all the 1168 cases,female patients occupied 88. 1% ,medianage was 48. Nodular goiter with the secondary cases was 57. 6% . Hemorrhage, necrosis, calcify, cystis degeneration; focal lymphoid hyperplasia; and hashimotos thyroiditis incidence in NG was 20. 4% ,28. 0% and 0. 3% ,respectively. The papillary hyperplasia was found in 5. 3% and the thyroid carcinoma was 3.1%. Conclusion Nodular goiter is more common in female than in male. The secondary cases are often found in nodular goiter and it should be given more attention.

  3. 胸骨后甲状腺肿26例的诊断与治疗%Diagnosis and surgical treatment of retrosternal goiter

    李长江; 袁启东; 程相超


    目的 探讨胸骨后甲状腺肿的外科治疗方法.方法 回顾性分析26例胸骨后甲状腺肿患者临床资料.结果 26例患者均行手术切除胸骨后甲状腺肿物,20例经颈部低位领式切口,6例经颈部低位领式切口加胸骨劈开.病理证实为结节性甲状腺肿18例,滤泡性腺瘤6例,甲状腺乳头状癌2例.术后出现喉返神经损伤表现2例,术后出血1例,经再次手术止血治愈,无手术死亡病例.结论 颈部低位领式切口入路可以完成大部分胸骨后甲状腺肿的手术切除,经胸手术入路对可疑癌变和巨大肿瘤患者安全可靠.%Objective To observe the diagnosis and surgical treatment of substemal goiter. Methods The clinical data of 26 cases with substemal goiter underwent thyroidresection were retrospectively analyzed. Results All the 26 cases were treated by operation. 20 cases were operated by Lower collar incision. 6 cases were operated by ster-notomy. The pathological results showed nodular goiter in 18 cases,follicular adenoma in 6 cases,and papillary carcinoma in 2 cases. Conclusions Surgery via cervical collar incision was fit for most of retrostemal thyroid nodules,and sternotomy or thoracotoray were safely fit for large or carcinomatous substemal goiter. Most cases of retrostemal goiter could be removed by Lower collar incision.


    V. A. Petrukhin


    Full Text Available Background: The course of pregnancy and delivery in patients with diffuse toxic goiter (DTG is often complicated by preeclampsia, fetoplacental insufficiency, placental abruption and associated with higher maternal and perinatal mortality. Aim: To study particulars of fetoplacental complex functioning in DTG. Materials and methods: We assessed pregnant patients with DTG (n = 92 and their newborns (n = 94. By the time of delivery, 86 of patients were clinically and biochemically euthyroid. Functions of fetoplacental complex (by levels of placental lactogen, α-fetoprotein, estriol, progesterone and cortisol were assessed by radioimmune and immunoenzyme assays. Fetometrical parameters of fetuses were studied by ultrasound method. Complex assessment of placentas was done by light and electronic microscopy. Results: Eighty seven (94,6% patients with DTG had combined complications of pregnancy. The most frequent were: the threat of termination of pregnancy, in 68 (73.9% of cases, low placenta placement, in 23 (25%, anemia, in 56 (60.9%, pre-eclampsia, in 56 (60.9%. In 59 of patients (64.1%, fetoplacental insufficiency was diagnosed, with predominance of strain or exhaustion reactions. Critical status of fetoplacental complex was found in pregnant patients with uncontrolled DTG and duration of control of less than 20 weeks, as well as in pregnant patients with DTG relapses. The values of main hormones (placental lactogen, α-fetoprotein and progesterone were below 10th percentile.According to the results of the ultrasound assessments, fetuses from mothers with DTG during gestation demonstrated decrease of the majority or percentile parameters, such as biparietal cranial size, fetal femoral length, abdomen diameter, that was especially prominent in the groups with relapsing DTG.Eighty eight of 94 newborns (93.6% were born full-term. In total, every third baby (29.3% had some degree of intrauterine developmental delay at birth. Among the cases with

  5. Hubungan Paparan Pestisida Dengan Kejadian Goiter Pada Petani Hortikultura Di Kecamatan Ngablak Kabupaten Magelang

    Hendra Budi Sungkawa


    Full Text Available ABSTRACT Background: Pesticides are toxic material  or a substance or mixture of substances used to kill a pest or  intended for preventing, destroying, repelling or mitigating any pest.[2] A pesticide may be a chemical substance, biological agent (such as a virus or bacterium, antimicrobial, disinfectant or device used against any pest. Pests in agriculture  include insects, plant pathogens, weeds, molluscs, birds, mammals, fish, nematodes (roundworms.  Although there are benefits to the use of pesticides, there are also drawbacks, such as potential toxicity to humans and environment. Usage pesticide which do not well  managed  may  generate negative impact. Chronic poisoning of pesticides may produce adverse effect on health, including, cancer, genetic mutation, thyroid diasease, reproductive disorders and neurodegenerative disases. Preliminary researh showed that farmer in district of Ngablak   98 %  have experience of pesticide exposure. Result of study indicate that 16,5 % farmer of horticulture that have pesticide exposure  district of Ngablak  have a disorder of  thyroid and manifest as goiter. This research objective was to find out the relation between pesticides exposure and the incidence of goitre on farmer exposed to pesticides. Method: this research used a case control design with  68 case and 68 control. The variable of the research include age, education, work duration, time of activity per day, pesticide type, pesticide dose, spraying frequency, time of  spraying, farmer position to wind direction while spraying and using of personal protective equipment. Result: Research result indicated  that variables that related to the incidence of endemic goitre were age (OR = 3,83; CI 95%= 1,88 – 7,81, work duration (OR = 12, 79; CI 95% = 2,85 – 57,53, time of activity per day (OR = 2,47; CI 95% = 1,16 – 5,23, pesticide type (OR = 5,86; CI 95% = 2,73 – 12,56, pesticide dose (OR = 2,96; CI 95% = 1,37 – 6

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

    Wasiak, J; Pohle, T


    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.

  7. Prestimulation with Recombinant Human Thyrotropin (rhTSH) Improves the Long-Term Outcome of Radioiodine Therapy for Multinodular Nontoxic Goiter

    Fast, Søren; Nielsen, Viveque Egsgaard; Grupe, Peter;


    Objective: The objective of the study was to evaluate the long-term outcome of recombinant human TSH (rhTSH)-augmented radioiodine ((131)I) therapy for benign multinodular nontoxic goiter. Patients and Methods: Between 2002 and 2005, 86 patients with a multinodular nontoxic goiter were treated...... scale. Results: In both groups, thyroid volume was further reduced from 1 yr to final FU (71 months). The mean goiter volume reductions obtained at 1 yr and final FU [59.2 ± 2.4% (sem) and 69.7 ± 3.1%, respectively] in the rhTSH group were significantly greater than those obtained in the (131)I......-alone group (43.2 ± 3.7 and 56.2 ± 3.6%, respectively, P = 0.001 and P = 0.006), corresponding to a gain of 24% at final FU. At last FU the mean reduction in compression visual analog scale score was significantly greater in patients receiving rhTSH (P = 0.049). Additional therapy (thyroid surgery or (131)I...

  8. Long-term follow-up after iodine-131 treatment for Plummer's disease (autonomous goiter)

    Wiener, J.D.


    A follow-up study is presented in 88 patients treated with I-131 for Plummer's disease (localized autonomous thyroid function, either multifocal or as a solitary nodule) one to 17 years before the present study. Studies included clinical examination, scintigraphy, and function tests. One patient was hypothyroid, seven were marginally hyperthyroid, and five still received low dose antithyroid drugs. Of 75 euthyroid patients, the thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) was absent in 16 (generally with scintigraphic evidence of autonomous function), subnormal in 20, and normal in 39. A single autonomous nodule prior to treatment was found relatively frequently in males and in patients with a normal TRH test at follow-up. Most goiters had become smaller and one third of all solitary nodules could not be detected anymore. Autonomous function at follow-up was probably due to residual rather than recurrent disease in most, if not all, cases. It is concluded that I-131 therapy is at least as satisfactory as partial thyroidectomy in the treatment of Plummer's disease; lifelong follow-up was not found to be necessary.

  9. Free Thyroxine, Anti-Thyroid Stimulating Hormone Receptor Antibody Titers, and Absence of Goiter Were Associated with Responsiveness to Methimazole in Patients with New Onset Graves' Disease.

    Choi, Hoon Sung; Yoo, Won Sang


    Anti-thyroid drug therapy is considered a treatment of choice for Graves' disease; however, treatment response varies among individuals. Although several studies have reported risk factors for relapse after initial treatment, few have assessed responsiveness during the early treatment period. Our study aimed to identify the clinical characteristics for responsiveness to methimazole. We included 99 patients diagnosed with Graves' disease for the first time. Drug responsiveness was defined as the correlation coefficients between decreasing rates of free thyroxine level per month and methimazole exposure dose. According to their responsiveness to treatment, the patients were classified into rapid or slow responder groups, and age, sex, free thyroxine level, and thyrotropin binding inhibiting immunoglobulin (TBII) titers were compared between groups. The mean patient age was 44.0±13.5 years and 40 patients were male (40%). The mean TBII titer was 36.6±74.4 IU/L, and the mean free thyroxine concentration was 48.9±21.9 pmol/L. The rapid responder group showed higher TBII titer and free thyroxine level at diagnosis, while age, sex, smoking, and presence of goiter did not differ between the two groups. Logistic regression analyses revealed that high level of serum thyroxine, high titer of TBII, and absence of goiter were significantly associated with a rapid response, while age, sex, and smoking were not significant factors for the prediction of responsiveness. In patients with new onset Graves' disease, high level of free thyroxine, high titer of TBII, and absence of goiter were associated with rapid responsiveness to methimazole treatment.

  10. Changes of hard dental and bone tissue of alveolar process in rats on the orthodontic tooth movement on the background of an experimental goiter

    Kamila A. Kolesnik


    Full Text Available Aim of this study was to study the state of dental hard and bone tissues of alveolar process in rats with the model of orthodontic tooth movement at the experimental goiter based on the analysis of bone phosphatases and proteases activity. Material and Methods —Experimental study with the model of goiter and orthodontic tooth movement in rats. The experiment was carried out with 30 Wistar rats of gregarious breeding. During the first stage of the experiment the goitre was being simulated by giving 1% solution of potassium perchlorate with drinking water for 20 days. During the second experimental stage using thiopental the orthodontic model of tooth movement (OMtM was being reproduced for 21 days. The lower jaw in rats served to reveal carious cavities and atrophy rate of alveolar process, the upper jaw served for determining the common activity of alkaline, acid phosphatase, elastase and total proteolytic activity (OPA, the pulp of incisors served to determine the activity of bone phosphatases. Statistical analysis — One way analysis of variance (ANOVA. Сomparison between experimental groups was carried out with the help of t-Student U and Mann-Whitney test (p.asymp.sig<0.05 was considered significant. Results — in animals under experiment the orthodontic tooth movement together with thyroid disorders is accompanied by increased proteases activity of bone tissue and impaired activity of bone phosphatases. Conclusions — sudden aggravation in the resorption processes of bone tissue of alveolar process, demineralization of hard dental tissue during the orthodontic tooth movement in relation to experimental goiter show that child with the thyroid gland disorders are in need of active treatment and preventive measures during active apparatus treatment of dentoalveolar anomalies.

  11. Prevalence of goiter and thyroid nodules before and after implementation of the universal salt iodization program in mainland China from 1985 to 2014: a systematic review and meta-analysis.

    Wei Zhao

    Full Text Available OBJECTIVES: We comprehensively estimated the prevalence of goiter and thyroid nodules (TNs before and after the implementation of the Universal Salt Iodization (USI program in mainland China and provided information for creating effective health policies. METHODS: PubMed, Google Scholar, CNKI, Chinese Wanfang and Chongqing VIP databases were searched for relevant studies from Jan 1985 to Feb 2014. Data from eligible citations were extracted by two independent reviewers. All analyses were performed with Stata 11.0 and SPSS 17.0. RESULTS: Eligible articles (N = 31; 4 in English and 27 in Chinese included 52 studies (15 about goiter rates made before 1996 and 14 afterwards, and 23 about TNs. Our meta-analysis suggests a pooled prevalence for goiter before and after 1996 and for TNs of 22.8% (95% CI: 15.3%, 30.3%, 12.6% (95% CI: 9.4%, 15.8% and 22.7% (95% CI: 18.3%, 27.0%, respectively. Egger's test of three independent categories revealed no evidence of publication bias (p = 0.101, 0.148 and 0.113, respectively. CONCLUSIONS: The prevalence of goiter was reduced by almost half after 1996 in mainland China, so the USI program was considered beneficial. However, subgroup analysis suggests that both insufficient and excess iodine may be associated with goiter. The prevalence of goiter and TNs increased significantly after 2002, suggesting a risk of excessive iodine intake. Thus, salt iodization standardizations should be set according to local conditions.

  12. Multiple Myeloma Presenting as Massive Amyloid Deposition in a Parathyroid Gland Associated with Amyloid Goiter: A Medullary Thyroid Carcinoma Mimic on Intra-operative Frozen Section.

    Hill, Kirk; Diaz, Jason; Hagemann, Ian S; Chernock, Rebecca D


    Clinical examples of amyloid deposition in parathyroid glands are exceedingly rare and usually present as an incidental finding in a patient with amyloid goiter. Here, we present the first histologically documented case of parathyroid amyloid deposition that presented as a mass. The patient did not have hyperparathyroidism. The parathyroid gland was submitted for intra-operative frozen section and concern for medullary thyroid carcinoma was raised. An important histologic clue arguing against medullary thyroid carcinoma was the evenly dispersed nature of the amyloid. Histologic perinuclear clearing and parathyroid hormone immunohistochemistry confirmed parathyroid origin on permanent sections. The patient was also found to have associated amyloid goiter. Mass spectrometry of the amyloid showed it to be composed of kappa light chains. On further work-up, the patient was diagnosed with multiple myeloma. Awareness of parathyroid amyloid deposition is important as it is a histologic mimic of medullary thyroid carcinoma, especially on frozen section. Amyloid typing with evaluation for multiple myeloma in any patient with kappa or lambda light chain restriction is also important.

  13. [Effectiveness of iodine prophylaxis and frequency of thyroid enlargement (thyroid goiter) and clinical diagnosis of thyroid diseases in inhabitants of the Szczecin region after the Czernobyl accident].

    Syrenicz, A; Goździk, J; Pynka, S; Pilarska, K; Gruszczyńska, M; Gołebiowska, I; Syrenicz, M; Miazgowski, T; Listewnik, M; Krzyzanowska, B


    The study, supported by program MZ-XVII, was carried on 4567 inhabitants of the area of Szczecin (2350 females and 2217 males). The population was chosen randomly, according to a simple drawing scheme. All subjects were clinically examined using standardised questionnaires. In 3468 persons (including 1807 girls and women, 1661 boys and men) apart form clinical examination, the assessment of thyrotropin, thyroxine and triiodothyronine in serum and frequency of antithyroglobulin antibodies and antithyroid membrane antibodies were evaluated. The data indicate that 94% of children in Szczecin's region received the prophylactic dose of iodine, mostly between the 1st and the 5th of May 1986. Only 17% of the adults received iodine. The most common preparation was Lugol solution given in a single dose. Among all persons who received iodine, only in 5% of subjects the side effects were noted (mostly in children), including symptoms of gastrointestinal tract (vomiting, abdomen pain) and occasionally intrathyroid side effects (thyroid pains). In examined population the high frequency of thyroid enlargement, mainly in women (up to 43-44% at the age group 30-50 years) was found. The frequency of clinical diagnosis of thyroid disease was higher in women than in man (most often the diffuse goiter, rarely the nodular goiter). The frequency of thyroid enlargement and clinical diagnosis of thyroid disease was not dependent on prophylactic iodine intake. The iodine prophylaxis did not influence on thyroid hormones and TSH serum levels and on frequency of antithyroid antibodies.

  14. Radioiodine therapy in elderly patients with subclinical hyperthyroidism due to non-voluminous nodular goiter and its effect on bone metabolism

    Rosario, Pedro Weslley [Santa Casa de Belo Horizonte, MG (Brazil). Endocrinology Service


    Objective: To evaluate {sup 131}I therapy in elderly patients with subclinical hyperthyroidism (SCH) due to nodular disease and who did not receive antithyroid drugs (ATDs), and the effect of the treatment on bone metabolism. Subjects and methods: Thirty-six patients with TSH {<=} 0.1mIU/L and non-voluminous goiter (< 60 cm{sup 3} were studied. Bone mineral density (BMD) was assessed in 17 women with osteopenia. Results: Mean 24-h {sup 131}I uptake was 17.5%. Symptoms of thyrotoxicosis were reported by two (5.5%) patients in the first week after therapy. One year after radioiodine treatment, SCH was resolved in 30 (83.3%) patients, and hypothyroidism was detected in one (2.7%). In the patients in whom TSH returned to normal, femoral and lumbar spine BMD increased by 1.9% and 1.6%, respectively, in average. Conclusions: In elderly patients with SCH and non-voluminous goiter, radioiodine not preceded by ATDs is a safe and effective therapeutic alternative. Resolution of SCH has beneficial effects on BMD in postmenopausal women with osteopenia. (author)

  15. Effect of 30 mCi radioiodine on multinodular goiter previously treated with recombinant human thyroid-stimulating hormone

    Paz-Filho, G.J.; Mesa-Junior, C.O.; Boguszewski, C.L.; Carvalho, G.A.; Graf, H. [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil). Hospital de Clinicas. Servico de Endocrinologia e Metabologia; Olandoski, M. [Pontificia Univ. Catolica do Parana, Curitiba, PR (Brazil). Nucleo de Bioestatistica; Woellner, L.C. [Centro de Medicina Nuclear, Curitiba, PR (Brazil); Goedert, C.A. [Centro de Tomografia Computadorizada, Curitiba, PR (Brazil)


    Recombinant human thyroid-stimulating hormone (rhTSH) enhances {sup 131}I uptake, permitting a decrease in radiation for the treatment of multinodular goiter (MNG). Our objective was to evaluate the safety and efficacy of a single 0.1-mg dose of rhTSH, followed by 30 mCi {sup 131}I, in patients with MNG. Seventeen patients (15 females, 59.0 {+-} 13.1 years), who had never been submitted to {sup 131}I therapy, received a single 0.1-mg injection of rhTSH followed by 30 mCi {sup 131}I on the next day. Mean basal thyroid volume measured by computed tomography was 106.1 {+-} 64.4 mL. {sup 131}I 24-h uptake, TSH, free-T4, T3, thyroglobulin, anti-thyroid antibodies, and thyroid volume were evaluated at regular intervals of 12 months. Mean {sup 131}I 24-h uptake increased from 18.1 {+-} 9.7 to 49.6 {+-} 13.4% (P < 0.001), a median 2.6-fold increase (1.2 to 9.2). Peak hormonal levels were 10.86 {+-} 5.44 mU/L for TSH (a median 15.5-fold increase), 1.80 {+-} 0.48 ng/dL for free-T4, 204.61 {+-} 58.37 ng/dL for T3, and a median of 557.0 ng/mL for thyroglobulin. The adverse effects observed were hyperthyroidism (17.6%), painful thyroiditis (29.4%) and hypothyroidism (52.9%). Thyroid volume was reduced by 34.3 {+-} 14.3% after 6 months (P < 0.001) and by 46.0 {+-} 14.6% after 1 year (P < 0.001). Treatment of MNG with a single 0.1-mg dose of rhTSH, followed by a fixed amount of radioactivity of {sup 131}I, leads to an efficacious decrease in thyroid volume for the majority of the patients, with a moderate incidence of non-serious and readily treatable adverse effects. (author)

  16. Radioiodine plus recombinant human thyrotropin do not cause acute airway compression and are effective in reducing multinodular goiter

    Albino, C.C., E-mail: [Instituto de Diabetes e Endocrinologia de Maringa, PR (Brazil); Graf, H.; Paz-Filho, G. [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil). Hospital das Clinicas. Servico de Endocrinologia e Metabologia; Diehl, L.A. [Universidade Estadual de Londrina (UEL), PR (Brazil); Olandoski, M.; Sabbag, A. [Pontificia Univ. Catolica do Parana (PUCPR), Curitiba, PR (Brazil). Nucleo de Bioestatistica; Buchpiguel, C. [Universidade de Sao Paulo (USP), SP (Brazil). Dept. de Radiologia


    Recombinant human thyrotropin (rhTSH) reduces the activity of radioiodine required to treat multinodular goiter (MNG), but acute airway compression can be a life-threatening complication. In this prospective, randomized, double-blind, placebo-controlled study, we assessed the efficacy and safety (including airway compression) of different doses of rhTSH associated with a fixed activity of {sup 131}I for treating MNG. Euthyroid patients with MNG (69.3 +- 62.0 mL, 20 females, 2 males, 64 +- 7 years) received 0.1 mg (group I, N = 8) or 0.01 mg (group II, N = 6) rhTSH or placebo (group III, N = 8), 24 h before 1.11 GBq {sup 131}I. Radioactive iodine uptake was determined at baseline and 24 h after rhTSH and thyroid volume (TV, baseline and 6 and 12 months after treatment) and tracheal cross-sectional area (TCA, baseline and 2, 7, 180, and 360 days after rhTSH) were determined by magnetic resonance; antithyroid antibodies and thyroid hormones were determined at frequent intervals. After 6 months, TV decreased significantly in groups I (28.5 +- 17.6%) and II (21.6 +- 17.8%), but not in group III (2.7 +- 15.3%). After 12 months, TV decreased significantly in groups I (36.7 +- 18.1%) and II (37.4 +- 27.1%), but not in group III (19.0 +- 24.3%). No significant changes in TCA were observed. T3 and free T4 increased transiently during the first month. After 12 months, 7 patients were hypothyroid (N 3 in group I and N = 2 in groups II and III). rhTSH plus a 1.11-GBq fixed {sup 131}I activity did not cause acute or chronic changes in TCA. After 6 and 12 months, TV reduction was more pronounced among patients treated with rhTSH plus {sup 131}I (author)

  17. Effect of 30 mCi radioiodine on multinodular goiter previously treated with recombinant human thyroid-stimulating hormone

    G.J. Paz-Filho


    Full Text Available Recombinant human thyroid-stimulating hormone (rhTSH enhances 131I uptake, permitting a decrease in radiation for the treatment of multinodular goiter (MNG. Our objective was to evaluate the safety and efficacy of a single 0.1-mg dose of rhTSH, followed by 30 mCi 131I, in patients with MNG. Seventeen patients (15 females, 59.0 ± 13.1 years, who had never been submitted to 131I therapy, received a single 0.1-mg injection of rhTSH followed by 30 mCi 131I on the next day. Mean basal thyroid volume measured by computed tomography was 106.1 ± 64.4 mL. 131I 24-h uptake, TSH, free-T4, T3, thyroglobulin, anti-thyroid antibodies, and thyroid volume were evaluated at regular intervals of 12 months. Mean 131I 24-h uptake increased from 18.1 ± 9.7 to 49.6 ± 13.4% (P < 0.001, a median 2.6-fold increase (1.2 to 9.2. Peak hormonal levels were 10.86 ± 5.44 mU/L for TSH (a median 15.5-fold increase, 1.80 ± 0.48 ng/dL for free-T4, 204.61 ± 58.37 ng/dL for T3, and a median of 557.0 ng/mL for thyroglobulin. The adverse effects observed were hyperthyroidism (17.6%, painful thyroiditis (29.4% and hypothyroidism (52.9%. Thyroid volume was reduced by 34.3 ± 14.3% after 6 months (P < 0.001 and by 46.0 ± 14.6% after 1 year (P < 0.001. Treatment of MNG with a single 0.1-mg dose of rhTSH, followed by a fixed amount of radioactivity of 131I, leads to an efficacious decrease in thyroid volume for the majority of the patients, with a moderate incidence of non-serious and readily treatable adverse effects.

  18. Modified-Release Recombinant Human TSH (MRrhTSH) Augments the Effect of 131I Therapy in Benign Multinodular Goiter: Results from a Multicenter International, Randomized, Placebo-Controlled Study

    Graf, H; Fast, S; Pacini, F


    Background: Recombinant human TSH (rhTSH) can be used to enhance (131)I therapy for shrinkage of multinodular goiter (MG). Objective, Design, and Setting: The objective of the study was to compare the efficacy and safety of 0.01 and 0.03 mg modified-release (MR) rhTSH as an adjuvant to (131)I the...

  19. Long-term efficacy of modified-release recombinant human TSH (MRrhTSH) augmented radioiodine (131I) therapy for benign multinodular goiter. Results from a multicenter international, randomized, placebo-controlled dose-selection study

    Fast, Søren; Hegedus, Laszlo; Pacini, Furio


    Background: Enhanced reduction of multinodular goiter (MNG) can be achieved by stimulation with recombinant human thyrotropin (rhTSH) before radioiodine (131I) therapy. The objective was to compare the long-term efficacy and safety of two low doses of modified release rhTSH (MRrhTSH) in combinati...

  20. Toxic nodular goiter

    ... adult may be less able to tolerate the effect of the disease on the heart. However, the condition is often treatable with medicines. Possible Complications Heart complications: Heart failure Irregular heartbeat ( ...

  1. Mediastinal goiter resection via cervical low collar incision%颈部低位领式切口进路切除纵隔甲状腺肿的探讨

    李虹; 闫悦; 石胜利


    目的:探讨颈部低位领式切口进路切除纵隔甲状腺肿对于减少副损伤的作用。方法:回顾性分析我科2009-2012年20例纵隔甲状腺肿患者的临床资料。结果:2例患者放弃手术治疗,其余18例患者全部采用颈部低位领式切口进路行纵隔甲状腺肿切除术,均完整切除肿物,术后无1例发生喉返神经损伤、窒息或出血等并发症。结论:颈部低位领式切口进路切除纵隔甲状腺肿,在完整切除肿物的同时,能极大的减少手术副损伤。%Objective:To discuss the advantage of the mediastinal goiter resection via cervical low collar incision. Methods:Retrospectively analyze the clinical data of 20 cases of mediastinal goiter. Results:Except 2 cases giving up surgery,the other 18 cases were operated successfully whose mediastinal goiters were all resected completely and no one developed postoperative complications such as laryngeal recurrent nerve injuries,asphyxia or bleeding. Conclu-sion:Mediastinal goiter resection via cervical low collar incision can not only resect the mediastinal goiter completely but also reduce the collateral damage greatly.

  2. A rare case of asymptomatic radioiodine-avid renal and brain metastases 20 years after hemi-thyroidectomy for adenomatous goiter.

    Santhosh, Sampath; Bhattacharya, Anish; Verma, Roshan Kumar; Lal, Anupam; Mittal, Bhagwant Rai


    A 65-year-old patient, with a history of left hemi-thyroidectomy for adenomatous goiter 20 years previously, was found to have pulmonary lesions on chest X-ray, a brain lesion on computerized tomography (CT), and elevated serum thyroglobulin (Tg). While completion thyroidectomy revealed that no pathological evidence of thyroid malignancy, radioiodine-avid pulmonary, brain, and renal and bone lesions were identified on diagnostic as well as posttherapy whole body planar scintigraphy and single photon emission computed tomography-CT. Subsequent ultrasonography-guided biopsy of a renal nodule showed thyroid follicular cells. This case suggests that metastatic differentiated thyroid carcinoma should be suspected in asymptomatic patients with incidentally detected lesions, raised serum Tg, and history of thyroid lesions.

  3. A case of papillary microcarcinoma of the thyroid with abundant colloid (masquerading as colloid goiter with papillary hyperplasia: Cytological evaluation with histopathological correlation

    Elancheran Muthalagan


    Full Text Available Papillary thyroid carcinoma (PTC is the most common malignant neoplasm of the thyroid. On fine-needle aspiration (FNA cytology smears of conventional PTC, the background usually shows scanty, bubble gum-like colloid. But the macrofollicular variant and papillary microcarcinoma reveals abundant thin colloid in the background. We report a case of papillary carcinoma of thyroid in a 37-year-old female with abundant thin colloid, obscuring the nuclear morphology in many clusters, along with the presence of typical nuclear features within occasional clusters in FNA cytology and hence, masquerading as colloid goiter with papillary hyperplasia. Histopathological examination of the total thyroidectomy specimen revealed papillary microcarcinomatous focus in a background of nodular hyperplasia. The differential diagnosis of PTC should be entertained even in colloid-rich FNA smears if the typical nuclear features are present. Hence, a meticulous search for any fragment with nuclear features of PTC is mandatory before labeling the smears as benign nodular hyperplasia.

  4. 外科治疗胸内甲状腺肿的临床研究%Clinical Study of Surgical Treatment of Intrathoracic Goiter

    林凌; 冯键; 胡定中


    目的 探讨外科治疗对胸内甲状腺肿的治疗意义与手术方式的选择.方法 回顾性分析2004年1月至2010年12月在我院胸外科接受手术治疗的52例胸内甲状腺肿患者的术前检查、手术治疗情况与随访资料.结果 根治性切除51例,姑息性切除1例.低位颈部领式切口45例(86.5%),低位颈部领式切口+胸骨正中小劈开4例(7.7%),右后外侧开胸3例(5.8%).术后并发症总发生率为7.7%.52例患者中,失访者6例,1例甲状腺低分化癌患者于术后18个月死于肿瘤转移,余45例未见复发或死亡.结论 外科手术治疗是胸内甲状腺肿治疗的首选.低位颈部领式切口因暴露佳、切除率高、创伤小、符合美观要求,适合绝大多数早期患者.肿块大伴外侵应在充分检查的基础上选择右后外侧切口第四肋间进胸进行探查切除.%Objective To investigate the clinical significance of surgical treatment in treating intrathoracic goiter and the choice among different surgical procedures. Methods 52 patients with intrathoracic goiter who were admitted into our hospital from January 2004 to December 2010 were selected in this study,whose preoper-ative examinations, surgical procedures, and follow-up date were retrospectively analyzed in this paper. Results All patients received surgical treatment, and 51 were radically resected and 1 palliatively; 45 cases( 86. 5% ) were resected via cervical collar incision,4 cases( 7. 7% ) via cervical collar incision plus mini-sternotomy, 3cases( 5.8% )via right posterolateral thoractomy. All postoperative complication rate was 7.7%. Among 52 patients, 6 cases lost follow-up, 1 case died from metastasis of low-differentiation carcinoma of goiter 18 months after surgery,45 cases remained health and no sings of replacement. Conclusion Surgery is the first choice of treating intrathoracic goiter. The choice of different surgical procedures should depend on the location, size and the local invasion of the

  5. To estimate the effect of relationship of salt iodine level and prevalence of goiter among women of reproductive age group (15-49 years).

    Kousar, Junaid; Kawoosa, Zaffar; Hamid, Sajad; Munshi, Iftikhar Hussain; Hamid, Shahnawaz; Rashid, Arsalaan F


    The present study is a Cross-Sectional Study and was conducted in Post-graduate department of Community Medicine, Govt. Medical College, Srinagar between Feb. 2012 and Jan. 2013. The sample size of 1,041 was estimated. The study was conducted to estimate the effect of relationship of salt iodine level and prevalence of goiter among women of reproductive age group in two districts of Kashmir valley, district Srinagar and district Ganderbal, which were selected randomly. A frame of the blocks and villages in the two districts and their population was formed. From each district 10% of the blocks were selected using simple random sampling. From each block, 5% of the villages were selected using simple random sampling. A door to door survey was conducted in the selected villages and all the women in the reproductive age group (15-49 years) identified and examined clinically for goiter after taking informed consent. Salt samples (one teaspoonful) from every household were taken and assessed for iodine content on spot and the iodine content of salt was assessed qualitatively by spot testing kits. The results of the present study have indicated that iodine deficiency continues to be a health problem. Almost the whole population consumes powdered salt but the storage and cooking practices diminish the iodine content of salt and results in decreased intake. Thus the need of the hour is to make people aware about proper storage and cooking practices. Women in the reproductive age group especially need to be made aware about the importance of consumption of adequately iodized salt because of the wide range of ill effects of iodine deficiency on the developing fetus and the growing child. In addition monitoring of iodine content of salt at distributor level should be done.

  6. Primary ectopic intrathoracic goiter in posterior mediastinum: a case report and review of the literature; Bocio ectopico intratoracico primario no mediastino posterior: relato de caso e revisao da literatura

    Barros, Cristiano Ventorim de [Santa Casa de Misericordia de Vitoria, ES (Brazil)]. E-mail:; Tornin, Olger de Souza [Hospital Heliopolis, Sao Paulo, SP (Brazil). Ciencias da Saude; Ribeiro, Sergio Marrone; Yamashita, Seizo; Morceli, Jose [UNESP, Botucatu, SP (Brazil). Faculdade de Medicina. Dept. de Doencas Tropicais e Diagnostico por Imagem


    The ectopic primary intrathoracic goiter is an uncommon tumor that corresponds to a hyperplasia of an ectopic thyroid tissue, that develops in the thorax, distinct from the cervical thyroid gland, which usually exists on its normal aspect. We report the case of a 61-year-old female patient, with the aspects of the radiograph and computed tomography examinations, comparing them with the literature, demonstrating the image aspects, differential diagnosis, possible etiology factors and treatments of the disease. (author)

  7. Estimation of efficacy of echinacea compositum C and teraflex application in orthodontic moving of teeth on the background of experimental goiter

    Kolesnik K.A.


    Full Text Available Disturbances of the thyroid status may be negatively reflected on the biological processes underlying orthodontic tooth movement. Research object – in experiment to estimate efficacy of application of drug complex with osteotropic and immunomodulating action in orthodontic moving of teeth (ОМT on the background of euthyroid goiter. In 75 rats of Vistar line of gregarious breeding (females, 5 months, 210±28 g experimental goiter was modeled by injection of 1% perchlorate potassium solution with drinking water within 20 days. Intragastric solution of potassium Iodidum (PI in the dose of 20 mkg/kg was introduced to rats of the 3rd, 4th and 5th groups from the 22nd day. Intragastrically drug «Echinacea compositum C» was introduced to animals of the 3rd and 5th groups from the 22nd day during 5 days. OMT was reproduced on the 29th day from the beginning of experiment. On the background of PI injection, teraflex in a dose on glucosaminglican of 750 mg/kg was introduced to the rats of the 4th and 5th groups. A mandible for calculation of carious cavities and definition of atrophy degree of an alveolar process, and the maxilla – for definition of alkaline activity, acidic phosphatase, elastase and general proteolytic activity (GPA, pulp of incisors – for phosphatases definition of activity were isolated. Echinacea compositum, potassium Iodidum and teraflex in the idea of monotherapy caused some positive influence on phosphatases of an alveolar bone. To completely prevent disturbances of activity of bone phosphatases and proteinases was possibly only at application of a full complex: PІ – throughout all treatment, echinacea compositum C – before fixation of closing springs, teraflex – after fixation. Thus, stage-by-stage use of drugs – potassium Iodidum, «Echinacea compositum C» and Teraflex promoted to normalization of activity of alkaline and acidic phosphatase in pulp and bone tissue of alveolar process, and rendered protective

  8. Elevated Serum Thyroglobulin and Low Iodine Intake Are Associated with Nontoxic Nodular Goiter among Adults Living near the Eastern Mediterranean Coast

    Yaniv S. Ovadia


    Full Text Available Background. Information about iodine intake is crucial for preventing thyroid diseases. Inadequate iodine intake can lead to thyroid diseases, including nontoxic nodular goiter (NNG. Objective. To estimate iodine intake and explore its correlation with thyroid diseases among Israeli adults living near the Mediterranean coast, where iodine-depleted desalinated water has become a major source of drinking water. Methods. Cross-sectional study of patients attending Barzilai Medical Center Ashkelon. Participants, who were classified as either NNG (n=17, hypothyroidism (n=14, or control (n=31, provided serum thyroglobulin (Tg and completed a semiquantitative iodine food frequency questionnaire. Results. Elevated serum Tg values (Tg > 60 ng/mL were significantly more prevalent in the NNG group than in the other groups (29% versus 7% and 0% for hypothyroidism and controls, resp., P<0.05. Mean estimated iodine intake was significantly lower in the NNG group (65±30 μg/d than in controls (115±60 μg/d (P<0.05 with intermediate intake in the hypothyroid group (73±38 μg/d. Conclusions. Elevated serum Tg values and low dietary iodine intake are associated with NNG among adult patients in Ashkelon District, Israel. Larger studies are needed in order to expand on these important initial findings.

  9. Estrogen receptor (ER)-beta, but not ER-alpha, is present in thyroid vessels: immunohistochemical evaluations in multinodular goiter and papillary thyroid carcinoma.

    Ceresini, Graziano; Morganti, Simonetta; Graiani, Virna; Saccani, Maria; Milli, Bruna; Usberti, Elisa; Valenti, Giorgio; Ceda, Gian Paolo; Corcione, Luigi


    Estrogen receptors (ERs) have been demostrated in the vessel structures of several systems. Little is known on the presence of ERs in the thyroid vessels. We immunohistochemically evaluated both ER-alpha and ER-beta immunoreactivity (IR) in both vascular and follicular thyroid cells in tissue samples from 17 cases of multinodular goiter (MNG) and 17 cases of papillary thyroid carcinoma (PTC). ER-alpha IR was undetectable in either tissue examined. In 100% of MNG samples, nuclear ER-beta IR was detected in both endothelial and follicular cells. In PTC samples, endothelial nuclear ER-beta IR was found in 100% of cases, whereas the nuclear staining of follicular cells was found in 83% of cases. The intensity of staining of the endothelial ER-beta IR was comparable between MNG and PTC. However, when follicular cells were considered, a tendency toward a decrease in nuclear staining and a significant increase in cytoplasmic staining were found in PTC lesions as compared to MNG. This study demonstrated that ER-beta, but not ER-alpha, IR is present in the endothelium of thyroid vessels. Furthermore, although data need to be confirmed in larger observations, these results suggest the lack of differences in the pattern of vascular ER-beta IR between MNG and PTC.

  10. The incidence of lymphocytic thyroid infiltration and Hashimoto's thyroiditis increased in patients operated for benign goiter over a 31-year period.

    Ott, Johannes; Meusel, Moritz; Schultheis, Andrea; Promberger, Regina; Pallikunnel, Shannon Joan; Neuhold, Nikolaus; Hermann, Michael


    The incidence of Hashimoto's thyroiditis (HT) seems to have increased over the last several decades. Since there is a lack of recent studies in the literature that evaluate this phenomenon on a histological basis, we aimed to assess the incidence of lymphocytic thyroid infiltration (LTI) in our large surgical patient collective over a 31-year period. In our study, a total of 1,050 patients who had undergone uni- or bilateral thyroid surgery for benign goiter were included (150 patients in each group, during 1979 to 2009). The stored histological sections of the removed thyroid specimens were re-analyzed, including routine grading of LTI severity on a scale of 0-4, according to Williams and Doniach. Positive correlations were seen for the incidences of LTI grading (0-4) (r = 0.077, p = 0.013) and HT (r = 0.044, p = 0.078) over the years. Furthermore, when comparing the years 1979-1989 and 1994-2009, i.e., before and after the second iodine prophylaxis had been introduced in Austria, a higher incidence of HT was found for the later years (2 out of 450, 0.4%, vs. 6 out of 600, 1.0%, respectively; p < 0.0001). In conclusion, the data demonstrate that the incidence of LTI and HT has increased substantially over the last 31 years.

  11. Structure of a Thyroid Gland Pathologies in a Population of Children and the Teenagers Living in Conditions Endemic Goiter of Northern Territories by Results of Ultrasonic Researches

    Y Girsh


    Full Text Available For studying structure pathologies of a thyroid gland at children and the teenagers living in northern territories Khanty-Mansiysk of autonomous region, for the period 2000–2008 the retrospective analysis of results of 3002 ultrasonic researches of a thyroid gland is lead To 32.7% of cases at children and teenagers attributes endemic goiter a craw are revealed. Chronic lymphocytic thyroiditis, changes thyroid gland, are revealed in 4.2% of cases. The one-central and multinodal craw was made with 2.1 and 0.7%, accordingly. In 60.3% according to ultrasonic of inspection of pathology a thyroid gland it is not revealed. The basic ultrasonic models colloidal a craw, central cellular a craw and an adenoma of a thyroid gland are developed. The estimation of criteria the importance of the given models is lead, the estimation of results has allowed to consider, that the received ultrasonic models were adequate for ultrasound research.

  12. Radioiondine therapy for Graves hyperthyroidism with large goiter: feasibility, efficacy and safety%131I治疗巨大与非巨大甲状腺肿性Graves甲亢疗效对比

    冯会娟; 欧阳伟; 胡瑞; 刘金华; 刘伟英


    Objective To evaluate the feasibility, efficacy and safety of radioiondine therapy in the treatment of Graves' hyperthyroidism with large goiter. Methods A total of 128 patients with Graves; hyperthyroidism with large goiter (thyroid weight>70 g) as the study group were treated with radioiondine, using 318 concurrent patients with Graves disease with a smaller goiter (thyroid weight<70 g) as the control group. The cure rate following a single-session treatment, the total cure rate and the incidence of hypothyroidism were compared between the two groups. Results In the large goiter group, the total cure rate was 95.3%, and the cure rate following a single-session treatment was 46.9%, with the incidence of hypothyroidism of 4.7%, as compared with 90.9%, 65.7%, and 9.1% in the control group, respectively. A significant difference was noted in the cure rate following a single-session treatment (P=0.000), but not in the total cure rate or the incidence of early-onset hypothyroidism (P=0.115) between the two groups. No tracheal compression, laryngeal edema, or hyperthyroidism crisis occurred in the large goiter group after the treatment. Conclusion Radioiondine is safe and effective for treatment of Graves' hyperthyroidism with large goiter, and results in a total cure rate and incidence of early-onset hypothyroidism similar to those in patients with goiters of a smaller size.%目的 通过与非巨大性甲状腺肿组的对比,探讨131I治疗巨大性甲状腺肿性Graves甲亢的临床疗效.方法 选取经过131I治疗的甲状腺质量>70 g的甲亢患者128例作为研究组,同期经过131I治疗的甲状腺质量<70 g的甲亢患者318例作为对照组,对比131Ⅰ治疗后两组患者一次治愈率、总治愈率及甲状腺功能减退发生情况.结果 131I治疗巨大甲状腺肿性Graves甲亢的总治愈率95.3%,一次治愈率46.9%,早发甲减发生率4.7%;对照组总治愈率90.9%,一次治愈率65.7%,早发甲减发生率9.1%.

  13. Intra-capsular total thyroid enucleation versus total thyroidectomy in treatment of benign multinodular goiter. A prospective randomized controlled clinical trial.

    Sewefy, Alaa M; Tohamy, Tohamy A; Esmael, Tarek M; Atyia, Ahmed M


    Due to high recurrence rate after subtotal thyroidectomy, most of centers have shifted to total thyroidectomy as a surgical treatment for benign multinodular goiter (BMNG), but serious complications, as laryngeal nerve affection & hypocalcaemia, are still present. This study aimed to evaluate treatment of BMNG using intra-capsular total thyroid enucleation in comparison to standard total thyroidectomy. This is a prospective randomized controlled clinical trial conducted in a hospital in the period from December 2009 to December 2015. Of total 224 patients with clinically BMNG. 112 patients operated by intracapsular total thyroid enucleation (ITTE group) and the other 112 patients operated by standard total thyroidectomy (STT group). The minimal follow up period was 36 months. The mean operative time in ITTE group was (93.7 ± 9.6 min) compared to (86.9 ± 8.3 min) in STT group. Transient recurrent laryngeal nerve (RLN) palsy was 0% in ITTE group VS 7.1% in STT group. No cases (0%) developed permanent RLN palsy in ITTE group VS 0.9% in STT group. Symptomatic transient hypocalcaemia occurred in 1.8% in ITTE group VS 11.6% in STT group. No cases (0%) developed permanent hypocalcaemia in ITTE group VS 0.9% in STT group. No recurrence (0%) in both groups after minimal 3 years of follow up. Intracapsular Total thyroid enucleation technique is safe with the least serious complications, especially RLN injury and hypoparathyroidism, with no recurrence, but this technique still not radical so couldn't be used in suspicious cases for malignancy. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Epidemiology of palpable goiter in Greater Buenos Aires, an iodine-sufficient area Epidemiología del bocio palpable en el Gran Buenos Aires, un área suficiente en yodo

    Hugo Niepomniszcze


    Full Text Available The Hospital de Clínicas organized a free program of goiter detection by palpation. This campaign was aimed at the population of the metropolitan area of Greater Buenos Aires (11 million inhabitants, with the prerequisite that each participant should be quite unaware whether he/she was a carrier of any thyroid disease. Attendees were split into two groups, i.e., Random and Induced. The former consisted of 542 individuals who came to consultation due to mere curiosity, while the latter involved 500 subjects, comprising consanguineous family members of patients with thyroid disorders and also individuals who suffered from other ailments. Ages ranged from 2 to 85 years. In the Random Group, goiter prevalence of 8.7% was observed, while in the Induced Group it climbed to 14.4%. Since both groups were mostly made up of women (87.2%, a correction based on the masculinity index was applied to members of the Random Group. Thus, the total observed prevalence of goiter was 6%, diffuse goiters corresponding to 3.5% and nodular ones to 2.5%. The frequency of nodules increased with age, 90.5% occurring in those over 40 years. In the Induced Group, goiter prevalence among relatives of patients with thyroid disorders proved to be 13.1%, rising to 17.8% in those who suffered from other complaints. The epidemic data presented herein are the first arising from a screening survey carried out in a large iodine-sufficient population of the southernmost tip of the American continent. These results are useful to build up the world map of goiter prevalence in non-endemic areas.El Hospital de Clínicas organizó un programa gratuito para la detección de bocio por palpación. Esta campaña estuvo dirigida a la población del área metropolitana del Gran Buenos Aires, con el prerrequisito de que cada participante debía desconocer si padecía alguna enfermedad tiroidea. De acuerdo a las motivaciones que llevaron a los pacientes a la evaluación, se dividieron en 2

  15. Dose evaluation in function of the thyroid captivation percentage and mass in patients under radiotherapy for toxic goiter treatment;Avaliacao da dose em funcao do percentual de captacao e massa tireoidiana em pacientes submetidos a radioterapia para tratamento de bocio toxico com {sup 131}I

    Alves, Aline Nunes [Universidade Catolica de Pernambuco (DF/UNICAP), Recife, PE (Brazil). Dept. de Fisica; Antonio Filho, Joao [Universidade Federal de Pernambuco (DEN/UFPE), Recife, PE (Brazil). Dept. de Energia Nuclear


    Rarely the patient's metabolism is pondered when the quantity of radioactive material administrated to the patient is calculated. Nowadays, realizing till 150 mCi/g activities treatments are not indicated to toxic goiter radiotherapy. This paper objectives to establish a group of {sup 13I}-treatment options optimization for owner toxic goiter patients to maximize benefits and minimize radiological detriments. Methodology consisted of effective and absorbed whole-body and the other organs doses evaluations. And to observe the relation between these values and the thyroid mass and captivation percentage. The results, in spite of characteristic variations of each patient, showed such a homogeneity. This phenomenon happens because of explicit dependency on the real activity administrated to the patient. Used protocols for the toxic goiter treatment optimization avoiding waste of radioisotopes. (author)

  16. Comprehensive Application of 64-slice Spiral CT Scan Techniques on Diagnosis Value of Nodular Goiter%64排CT的综合运用对诊断结节性甲状腺肿价值探讨

    肖继伟; 王晓燕; 胡道予


    目的:探讨64排螺旋CT扫描技术的综合运用对结节性甲状腺肿的诊断及鉴别诊断方面的价值。方法:选择41例经过病理证实的结节性甲状腺肿,甲状腺肿瘤及其他结节性甲状腺疾病若干,全部行64排螺旋CT平扫及动态增强扫描加后续重建,观察病灶的大小、形态、密度、边缘、强化特点及有无侵犯和转移等,总结和归纳病灶的影像学表象及特征。结果:结节性甲状腺肿、甲状腺肿瘤及其他结节性甲状腺疾病在CT影像上的表现可能少部分有所重叠,但大多数趋于不同,且有一定规律可循。结论:基于64排CT扫描技术的综合运用可在很大程度上掌握结节性甲状腺肿及相似疾病的表象及特征,对结节性甲状腺肿诊断及鉴别诊断具有重要意义。%Objective:To discuss the comprehensive application of 64-slice spiral CT scan techniques on the diagnosis value of nodular goiter and its differential diagnostic value. Methods:41 cases of nodular goiter,thyroid tumors and other nodular thyroid diseases,which had been verified by pathology,were selected to conduct 64-slice spiral CT scan and dynamic contrast-enhanced scan plus follow-up reconstruction. With observing the size,shape,density,edge,enhancing char-acteristics of the lesion as well as its infringement and metastasis,imaging characteristics of the le-sion were concluded. Results:The imaging manifestations of nodular goiter,thyroid tumors and oth-er nodular thyroid diseases overlap only in small portion on CT,but mostly they are different. Con-clusion:The comprehensive application of 64-slice spiral CT scan techniques can considerably di-agnose the representations and characteristics of nodular goiter and similar diseases,which is signifi-cant to the diagnosis and differential diagnosis of nodular goiter.

  17. Graves病患者甲状腺肿大及眼征的影响因素分析%Influencing factors on goiter and thyroid eye in patients with Graves′disease

    黄莹芝; 汤步阳; 常琳; 郭法平


    Objective To investigate the factors associated with goiter and thyroid eye of Graves'disease( GD) . Methods A total of 154 patients with GD were recruited in the study from Jan. 2011 to Dec. 2013. The patients were divided into two groups according to goiter and thyroid eye. Serum levels of free triiodothyronine(FT3), free thyroxine(FT4), thyroid stimulating hormone(TSH), thyroid peroxydase antibody( TPOAb) , thyroglobulin antibody( TGAb) and TSH receptors antibody( TRAb) were measured in chemiluminescence method. Age, FT3, FT4, TSH, TPOAb, TGAb and TRAb were compared between the two groups. Results In Graves'disease, there were 112 cases of goiter(72. 7%) and 62 cases of thyroid eye (40. 3%). Patients in group goiter showed higher FT3, FT4, TPOAb and TRAb. (P<0. 05 or P<0. 01), and lower age compared to those in group with no goiter(P<0. 01). Patients in group thyroid eye showed higher TPOAb, TGAb and TRAb compared to those in group with no thyroid eye(P<0. 05 or P<0. 01). Correlation analysis showed goiter was related to age, TPOAb and TRAb (correlation coefficient=0. 149, 0. 295, 0. 198, P<0. 05, respectively). Thyroid eye was related to TGAb and TRAb (correlation coefficient=0. 280,0. 228, P<0. 05, respectively). Conclusion In Graves'disease, goiter is related to age, higher level of TPOAb and TRAb. Thyroid eye is related to higher level of TGAb and TRAb.%目的 探讨Graves病患者甲状腺肿大及眼征的影响因素.方法 选取皖北煤电集团总医院内分泌科2011年1月至2013年12月就诊的Graves病患者154例.分别按照患者有无甲状腺肿及有无甲状腺眼征,分为甲状腺肿大组(A组)和无甲状腺肿大组(B组)以及有眼征组(C组)和无眼征组(D组).应用化学发光法检测游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、甲状腺激素受体抗体(TRAb).分别比较两组

  18. Goiter and Multiple Food Allergies

    Stefanie Leniszewski


    Full Text Available Severe iodine deficiency results in impaired thyroid hormone synthesis and thyroid enlargement. In the United States, adequate iodine intake is a concern for women of childbearing age and pregnant women. Beyond this high risk group iodine deficiency is not considered to be a significant problem. This case report describes a 12-year-old male with severe iodine deficiency disorder (IDD resulting from restricted dietary intake due to multiple food allergies. We describe iodine replacement for this patient and continued monitoring for iodine sufficiency. Children with multiple food allergies, in particular those with restrictions to iodized salt and seafood, should be considered high risk for severe iodine deficiency.

  19. Nodular goiter (epidemiology and diagnostics

    R A Chernikov


    Full Text Available Thyroid nodules measuring 1cm and more revealed in 27% adult inhabitants of region. Malignant tumors were diag nosed in 2.9% of them. There was increase in the number of people with nodules in the territories exposed to radioactive fallout after Chernobyl accident in comparison to the territories without such pollution – 57.3%/42.4% as well as malignant tumors among them (5.2%/2.7% Comparison of thyroid palpation and ultrasound in detection of thyroid nodules revealed that thyroid nodules of 10 mm were detected only in every 10th patient by means of pal pation: and nodules of 11–15 mm in every 4th patient, comparing to ultrasound data of the same patients’ group. Malignant tumors were detected on cytology in 2.9% of thyroid nodules less than 2 cm (30171 patients and in 1.9% of thyroid nodules larger than 2 cm (15 656 patients. At the same time the frequency of regional lymph node metas tases was significantly higher in patients with thyroid nodules larger than 2 cm (34.8%, than in patients with nod ules less than 2 cm – 18.3%. Only one malignant tumor was detected among 358 patients with autonomously func tioning nodules. Risk groups with higher rate of malignancy were patients living in the areas with Chernobyl’s fall out, and patients in whom nodules with “suspicious” sonographic features were revealed (rough edges, capsule inva sion, microcalcifications. Patients with high risk of malignant transformation should be submitted to FNAB regard less of thyroid nodule size. Biopsy is unnecessary for the patients with autonomously functioning nodules detected by scintigraphy.

  20. 2010年浙江省弥漫性甲状腺肿患病状况与影响因素分析%Analysis of the prevalence and its influencing factors of diffuse goiter in Zhejiang

    毛光明; 丁钢强; 楼晓明; 朱文明; 王晓峰; 莫哲; 周金水


    Objective To evaluate the status of diffuse goiter of population in Zhejiang Province and to analyze the relevant influencing factors.Methods A total of 18 188 subjects were recruited in the cross sectional survey,by multistage stratified cluster random sampling method.B ultrasound measurement were carried among the subjects to detect the thyroid volume,and the basic information and life styles were interviewed by questionnaires.Then,we analyzed the distribution and its influencing factors of diffuse goiter.Results The ratio of diffuse goiter among the surveyed population was 2.2% (403/18 188),the difference showed statistical significance (x2 =267.11,P < 0.05).The ratio among the group aged 6-7 years old and 8-10 years old was comparatively high,separately 10.3% (27/262) and 9.8% (51/519).The ratio among women (2.9%,305/10 470) was higher than it among men (1.3%,97/7672) (x2 =55.55,P < 0.05).The residents from inland areas had the highest prevalence (3.2%,138/4374),followed by residents from sub-coastal areas (2.0%,131/6411),coastal areas minimum (1.8%,138/4374) (x2 =24.31,P < 0.05).The content of water iodine and salt iodine among people with symptoms of goiter had statistical difference with it among ordinary population (water iodine:x2 =4.95,P =0.026 ; salt iodine:x2 =11.03,P < 0.01).The median (quartile) of water iodine in ordinary population was 2.41 (1.96-6.15) μg/L and among people with symptoms of goiter was 1.88 (1.49-5.15) μg/L.The median (quartile) of salt iodine in ordinary population was 30.18 (24.69-32.65) mg/kg and among people with symptoms of goiter was 29.1 (24.70-31.95) mg/kg.The influential factors of goiter were as follows:the family income,the education degree,the job and profession status,the diet character,the habitual sea food consumption,the alcohol intake status (x2 were separately 8.08,37.85,98.78,68.69,10.91,12.21,26.94,P < 0.05).Multi-factor analysis showed the results as follows:female (OR =0.27 95% CI:0

  1. Histopathological characteristics of human non-tumor thyroid tissues in a long-term model of adenomatous goiter xenografts in the NOD/Shi-scid, IL-2Rγ(null) mouse.

    Fujii, Etsuko; Kato, Atsuhiko; Chen, Yu Jau; Matsubara, Koichi; Ohnishi, Yasuyuki; Suzuki, Masami


    There is a growing need for modeling the human thyroid to link data obtained from animals to humans because of its sensitivity to radiation exposure and endocrine disruption chemicals. In a scid mouse model produced by transplanting human thyroid tissues, leakiness and thymic lymphoma that occurs spontaneously in the scid mouse can complicate the interpretation of experimental results. Considering that the NOD.Cg-Prkdc(scid)Il2rg(tm1Sug)/Jic mouse (NOD/Shi-scid, IL-2Rγ(null) or NOG mouse) may be a better host because this strain has low incidence of leakiness and thymic lymphoma, we have evaluated the potential of a model that allows long-term observation of non-tumor human thyroid tissues in this mouse. We transplanted tissues of human adenomatous goiter into NOG mice and examined the tissues histopathologically. The morphology of human adenomatous goiter tissues was maintained from 24 to 44 weeks after transplantation in NOG mice with no noted differences between donor-matched tissues or the weeks after transplantation. The tissues expressed thyroglobulin protein and mRNA as well as thyroperoxidase. Endothelial cells originating from human were found in the transplanted tissues and were thought to be a characteristic of this model. The intactness of the tissues before transplantation was found to affect the rate of tissue engraftment. From the present results we have concluded that transplanted thyroid tissues in NOG mice maintain the histopathological characteristics of their origin for long terms. Therefore this model was thought feasible for toxicity evaluation. Copyright © 2014 Elsevier GmbH. All rights reserved.

  2. 结节性甲状腺肿合并甲状腺癌的临床分析%Clinical analysis of patients with nodular goiter concomitant thyroid cancer

    米泰宇; 刘开坤


    Objective To study the clinical features, diagnosis and treatment of patients with nodular goiter concomitant thyroid cancer. Methods The clinical data of 142 cases with concomitant thyroid cancer in 1 859 cases of nodular goiter admitted from January 2008 to January 2011 were retrospectively analyzed. Results All the 142 patients underwent surgical treatment, of which, there were 112 cases of primary surgery and 30 cases of secondary surgery. The ratio of men to women was 1 : 3. 1 , and the patients predominantly manifested as nodular goiter. Fifty-five cases (38. 7% ) were suspected of having concomitant thyroid cancer as suggested by preoperative ultrasound examination, of which 21 cases ( 18. 7 % ) had nodular psammomatous calcification. Twelve cases had cervical lymph node enlargement. Ninety patients underwent high-resolution color Doppler ultrasound examination, of which 68 cases (75. 6%) were suspected of having malignant lesion. Fine needle aspirations ( FNA ) were performed in 45 cases and the correct diagnostic rate was 48. 9%. The pathological examinations of intraoperative fast frozen section wereperformed in 138 patients , with accuracy rate of 96. 4% , 5 false negative cases and no false positive case. Of the patients with thyroid cancer, 83 cases were unifocal and 59 cases were multifocal, lesions less than 2. 0 cm accounted for 75. 3% , the main pathological type was papillary carcinoma (75. 4% ) , and 64 cases showed lymph node metastasis. The surgical procedures comprised ipsilateral total lobectomy combined with isthmusectomy, ipsilateral total lobectomy combined with isthmusectomy plus contralateral subtotal lobectomy or total thyroidectomy, and ipsilateral or bilateral central compartment ( level VI) lymph node dissection. The patients with enlarged cervical lymph nodes and suspected of having cervical lymph node metastasis before or during surgery underwent additional modified neck dissection. After surgery, all the 142 patients received

  3. Clinical Research on the Effect of Therapy in Huge Goiter Merge Graves131I for Hyperthyroidism%巨大甲状腺肿合并Graves甲亢131Ⅰ治疗临床疗效研究



    Objective To observe the clinical efficacy of131I treatment of huge goiter merge graves hyperthyroidism.Methods 40 cases of large goiter hyperthyroidism patients with Graves in our hospital from 2013 October to 2014 October who were treated,according to 131I per gram of thyroid tissue from 2 to 6.3 MBq/g drug treatment,patients were discharged after 4~8 months visit.ResultsAfter 4 months and131I treatment,22 cases(55%) of the thyroid function was normal,11 cases(27.5%)of the hyperthyroidism,7 cases(17.5%)of hypothyroidism,33 cases(82.5%)of the thyroidenlargement returned to normal,7 cases of thyroid weight are decreased. After 8 months and131I treatment,27 cases(67.5%)of the thyroid function was normal,8 cases(20%)of the hyperthyroidism,5 cases(12.5%)of hypothyroidism,37 cases(92.5%)of the thyroid enlargement returned to normal,the remaining 3 cases thyroid weight decreased.Conclusion The clinical curative effect of clinical application of131I treatment of huge goiter merge graves hyperthyroidism has significant.%目的:观察131I治疗巨大甲状腺肿合并Graves甲亢的临床疗效。方法选取我院自2013年10月~2014年10月期间收治的巨大甲状腺肿合并Graves甲亢患者40例,对患者进行131I按照每克甲状腺组织2~6.3 MBq/g给药治疗,患者出院后4~8个月回访。结果经过131I治疗后的4个月,22例(55%)的甲状腺功能恢复正常,11例(27.5%)的甲状腺功能亢进,7例(17.5%)的甲状腺功能减退,其中有33例(82.5%)的甲状腺肿大恢复正常,7例的甲状腺重量均有所下降。经过131I治疗后的8个月,27例(67.5%)甲状腺功能恢复正常,8例(20%)甲状腺功能亢进,5例(12.5%)甲状腺功能减退,其中有37例(92.5%)的甲状腺肿大恢复正常,剩余3例的甲状腺重量均有所下降。结论临床上应用131I治疗巨大甲状腺肿合并Graves甲亢取得的临床疗效显著。

  4. 临床路径在结节性甲状腺肿手术患者中的应用%Application of clinical pathway in nodular goiter surgery patient



    目的:探讨临床路径在结节性甲状腺肿手术患者中的应用,评价其应用效果。方法将106例结节性甲状腺肿手术患者随机分为观察组和对照组各53例,观察组由主管医生和责任护士按照临床路径表的内容进行全程规范的检查、治疗、护理、观察及健康教育,对照组采用常规治疗、护理和健康教育。结果观察组患者对健康教育知识掌握优良率和对护理工作满意度均明显高于对照组( P<0.05)。结论临床路径的实施,有利于提高健康教育的效果及患者对护理工作的满意度。%Objective To observe the application of clinical pathway in nodular goiter surgery patient and e-valuate its effect.Methods 106 patients with nodular goiter surgery were randomly divided into observation group and control group, with 53 patients of each group.53 cases of observation group were standardized examined, treated, cared, observed and healthily educated by competent doctors and responsible nurses in accordance with the contents of the clini-cal pathway table.53 cases of control group were treated, cared and healthily educated normally.Results Excellent rate of patients grasping the health education and the nursing satisfaction in observation group were higher than those of control group ( P<0.05 ) .Conclusions The implement of clinical pathway is useful to improve the effect of health ed-ucation and the nursing satisfaction of patients.

  5. 结节性甲状腺肿的弹性成像声触诊组织定量影响因素分析%Influence factors analysis for the virtual touch tissue quantification of nodular goiter

    王书隽; 徐辉雄; 张一峰; 刘畅; 王帅; 吴蓉; 郭乐杭


    目的 分析结节性甲状腺肿声脉冲辐射力(ARFI)弹性成像声触诊组织定量(VTQ)的影响因素.方法 应用ARFIVTQ技术检测结节性甲状腺肿病灶103个,记录结节的横向剪切波速度(SWV)、部位、直径、形态、边界、回声、钙化、血流,并记录其周围相同深度甲状腺组织的SWV.利用Fisher判别分析定性地分析结节SWV与患者性别、年龄、结节部位、直径、形态、边界、回声、钙化、血流、周围组织SWV间的联系.利用多元线性逐步回归定量地分析结节SWV与患者性别、年龄、结节部位、直径、形态、边界、回声、钙化、血流、周围组织SWV之间的关系.结果 结节性甲状腺肿的SWV平均值为2.11±0.71 m/s(0.61~ 4.14 m/s).定性分析利用Fisher判别分析将结节SWV值按照低于和高于均值(2.1 m/s)归为弹性较软和较硬两类,将其他属性作为自变量,得出Fisher线性判别函数,对于较软的结节为0.45×直径+0.488×年龄+13.478×周围SWV-29.826,对于较硬的结节为0.393×直径+ 0.539×年龄+14.857×周围SWV-34.203.定量分析利用多元线性逐步回归分析,将结节SWV作为因变量,将其它属性作为自变量得出线性回归函数结节SWV=-3.491×直径+3.338×周围SWV +4.026.结论 结节直径、结节周围组织的SWV和患者年龄与结节SWV的相关度较大,是影响结节SWV大小的主要因素.直径大的结节相对偏软,年龄大的患者结节相对偏硬,周围组织较硬的结节也相对偏硬.患者性别,结节部位、形态、边界、回声、钙化、血流与其硬度关系不大.%Objective To analyze the influence factors for acoustic radiation force impulse (ARFI) virtual touch tissue quantification (VTQ) of nodular goiter.Methods VTQ of ARFI elastography was used to examine 103 nodular goiter lesions.The shear wave velocity (SWV),position,diameter,shape,bound,echo,calcification,flow signal of the nodules and the SWV of the adjacent thyroid tissues

  6. 超声引导下射频消融治疗结节性甲状腺肿46例报告%Doppler Ultrasound-guided Radiofrequency Ablation for Nodular Goiter: Report of 46 Cases

    刘金涛; 郭文斌; 杨世财; 葛述科


    目的 探讨超声引导下射频消融( radiofrequency ablation,RFA)治疗结节性甲状腺肿的临床效果. 方法 2009年6月~ 2010年9月对46例甲状腺良性结节在局部麻醉下行超声引导下RFA治疗,在颈部皮肤取1 mm切口,切开皮肤及皮下组织,将射频针穿刺在结节的中心部位开启射频,应用能量为4~6W,其中心温度可达95℃. 结果 均成功行RFA,术中无明显并发症发生,1例出现穿刺部位感染.RFA术后6个月47.8% (22/46)患者结节全部吸收,26.1% (12/46)结节体积较术前缩小≥50%,26.1% (12/26)结节体积较术前缩小25% ~ 50%. 结论 超声引导下RFA治疗结节性甲状腺肿疗效好、微创优势明显,是一种值得推广的手术方法.%Objective To explore the efficacy of Doppler ultrasound-guided radiofrequency ablation ( RFA) for benign thyroid nodules. Methods From June 2009 to September 2010, we performed RFA under the guidance by Doppler ultrasonography on 46 patients with benign thyroid nodules. We made a 1-mm incision at the neck, cut the skin and subcutaneous tissues, and then inserted a radiofrequency needle into the center point of the nodules for RFA (4-6 W, center temperature 95 ℃ ). Results The procedure was completed in all the patients without causing severe complications. One patient developed infection at the puncture site. Six months after the RFA, 22 of the patients (47. 8% ) had all the nodules disappeared, 12 patients (26. 1% ) had the size of the nodules reduced by ≥50% , while in the other 12 patients the nodules were reduced by 25% -50% . Conclusions RFA is a safe, effective, and minimally invasive method for the treatment of nodular goiter. It is worth being widely used.

  7. Study on mechanism of traditional Chinese medicines reducing phlegm and resolving masses in treatment of goiter%化痰散结中药治疗甲状腺肿的作用机制

    崔鹏; 王英娜; 高天舒; 齐腾澈; 梅兰; 尹慧丝


    Objective:To discuss the mechanism of traditional Chinese medicines reducing phlegm and resolving masses in treatment of iodine deficiency-induced goiter by observing the expression of growth factors and the balance-regulating mechanism of proliferation and apoptosis. Method: 180 four-week-old Wistar rats were selected to establish the iodine deficiency model. After the modeling , the rats were randomly divided into six groups; the normal control group, the model control group, the iodine group, the phlegm compound group, the L-T4 group and the phlegm compound and L-T4 group. At the 21st day and 77th day after administration, 15 rats in each group were killed to collect specimens. Doses were calculated and adjusted according to body surface area and body weight. TT3, TT4 radioimmunoassay, TSH, immunoradiometric method were adopted. Fas, FasL and PCNA protein expressions are detected using immunohistochemical methods. Result: Compared with the normal group and the model group, the expressions of fas and FasL in the phlegm Group significantly increased, the expressions of fas and FasL in the phlegm and L-T4 group were also increased significantly. The expression of fas in the L-T4 Group was significantly lower than that of the L-T4 group and the phlegm compound and L-T4 group. Compared with the normal group, the expression of PCNA of the phlegm group and the phlegm and L-T4 group was significantly lower. Compared with the model group, the expression of PCNA of the iodine group, the phlegm groups and the phlegm and L-T4 group were significantly lower. Compared with the normal group, the expression of VEGF in the iodine group significantly decreased after treatment. Compared with the iodine group, the expression of VEGF in the phlegm group and the L-T4 group significantly reduced. Compared with the normal group, the expression of TGF-β1 in the model group and the phlegm group significantly increased. Compared with model group, the expression of TGF-β1 in the iodine

  8. [Total thyroidectomy treatment of bening multinodular goiter].

    Palas, César; Álvarez, Facundo; Ferreira, Gastón; Gramática, Luis h


    Introducción. El tratamiento del bocio multinodular beningo (BMNB) es motivo de continuo debate en las últimas décadas pese a la evidencia de que la tiroidectomía total (TT) está relacionada a una reducción significativa en la recurrencia de la enfermedad y a una mínima morbilidad en manos entrenadas. Objetivo. Determinar la recurrencia del BMNB al cabo de 10 años en 100 pacientes tratados con TT y evaluar las complicaciones relacionadas a la técnica.Diseño. Prospectivo no randomizado.Material y métodos. Desde marzo del 1999 a marzo del 2001, cien pacientes, 95 del sexo femenino, con un promedio de edad de 42,4 años (rango: 23-67), fueron sometidos a una TT por padecer un BMNB, el cual fue confirmado por la ecografía cervical, la que además sirvió de guía para realizar la punción aspiración con aguja fina (PAAF). En todos los casos se realizó un laringoscopía inderecta pre y post postquirúrgica. Resultados. El tiempo operatorio promedio fue de 49 minutos (rango: 35-58). Registramos una parálisis recurrencial (1%) y cinco hipoparatiroidismos (5%), ambos transitorios y ningún caso definitivo. Todos los pacientes fueron dados de alta antes de las 24 horas de la cirugía. No objetivamos ninguna recurrencia del BMNB en un período de seguimiento de más de 10 años.Conclusión. La TT es el tratamiento elección del BMNB, por ser un procedimiento eficaz, seguro, con mínimas tasas de complicaciones y por evitar o reducir significativamente la recurrencia de esta enfermedad.

  9. 成安县部分高碘乡镇停供碘盐前后甲状腺肿流行病学调查%Epidemiological investigation of goiter before and after discontinuation of salt iodization in some excessive iodine townships of Cheng'an County

    李雪红; 魏美丽; 高亚敏; 武书敏; 周丽霞


    [Objective] To study the effect of the discontinuation of iodized salt on the incidence of goiter among residents in excessive iodine regions. [ Methods] Children aged 8-10 years old were randomly selected from 2 excessive iodine townships, the endemi-c goiter was diagnosed by B-ultrasound, and the consumption status of iodized salt among residents was detected. [ Results] The incidence rate of goiter among children before the discontinuation of iodized salt was 10.57% , that at one year after the discontinuation was 5.36% , and the difference was statistically significant (χ2 =4.84, P<0.05). There was significant difference in coverage rate of iodized salt between before the discontinuation of iodized salt and one year after the discontinuation (χ2 = 104. 53, P<0.01). [Conclusion] Cheng an County is the aquagenic excessive iodine region, and residents should use the non-iodized salt.%目的 研究高碘地区居民停止食用碘盐对甲状腺肿的影响.方法 随机抽取2个高碘乡8 ~ 10岁儿童用B超法诊断地方性甲状腺肿,同时检测居民的食用碘盐情况.结果 停供碘盐前儿童甲状腺肿大率为10.57%,停供碘盐后1年时儿童甲状腺肿大率为5.36%,差异有统计学意义(x2=4.84,P<0.05).停供碘盐前与停供碘盐后1年时,碘盐覆盖率差异有统计学意义(x2 =104.53,P<0.01).结论 该县属水源性高碘地区,居民应食用无碘盐.

  10. 浙江省象山县结节性甲状腺肿检出率及影响因素调查研究%Investigation in Eetection Rate and Influencing Factors of Nodular Goiter in Xiangshan County of Zhejiang Province

    叶众; 陈磊; 陆昱养; 郑广勇; 陈子萌


    Objective To investigate the detection rate of nodular goiter and the influencing factors for nodular goiter in Xiangshan county. Methods Used the multi - stage cluster random sampling in 2013,5 towns were sampled from 17 towns in Xiangshan county;2 villages were sampled from those 5 towns respectively,hence 10 villages were sampled in total. The population was divided by topographical features into 4 groups:town group,mountain group,plain group and island group. Residents older than 18 years old and resided in Xiangshan county longer than 6 months were enrolled in this study. The people included were examined if they suffered from thyroid nodules by color Doppler ultrasonography. The patients diagnosed with nodular goiter were arranged into case group;the same amount of people without nodular goiter diagnosed by B-ultrasonography in the same townships and villages were arranged into control group;the two groups matched in gender,age( ± 3)and region, and the match ratio was 1: 1. The research objects included were surveyed with questionnaire about influencing factors such as occupational exposure history,personality and psychology,lifestyle,diet and medical history. The data was analyzed by univariate and multivariate Logistic regression method. Results 1 220 cases were screened and 510 patients were diagnosed with nodular goiter,with detection rate of 41. 80% . There was significant difference in the detection rate of nodular goiter for people lived in different areas( χ2 = 5. 43,P 18周岁的象山县户籍常住人口纳为调查对象。使用彩色多普勒超声诊断仪检测调查人群甲状腺。将确诊的甲状腺结节患者纳入病例组;以性别、年龄(±3)岁、地区等因素进行1:1匹配,选取相同数量同乡镇、同村甲状腺 B 超检查阴性者作为对照组。进行问卷调查,调查内容包括:职业接触史、性格及心理因素、生活方式、食物特点、医疗史

  11. Study on the quality of life and its influencing factors in patients with diffuse toxic goiter%毒性弥漫性甲状腺肿患者生存质量及其影响因素分析

    于世鹏; 贾传鲁; 伊鹏飞; 王娜


    目的 探讨影响毒性弥漫性甲状腺肿(GD)患者生存质量的社会及临床因素.方法 采用自编调查问卷和简明健康调查量表(SF-36),对确诊的66例GD患者和66例正常对照人群进行调查和测量分析.结果 测得GD患者SF-36量表8个维度的得分低于正常对照组,并且均差异有显著性(P<0.05).其中GD患者要和正常对照组得分生理功能为[(70.45±19.25)分,(92.8±6.51)分,t=8.898,P=0.001];生理角色限制为[(39.42±39.00)分,(90.97±21.67)分,t=8.582,P=0.001];躯体疼痛为[(79.36±19.18)分,(85.98±12.88)分,t=2.453,P=0.017];社会功能为[(75.95±19.46)分,(83.79±13.17)分,t=4.457,P=0.001];情感职能为[(37.88±40.04)分,(71.21±41.30)分,t=5.732,P=0.001];精神健康为[(52.91±17.31)分.(68.67±13.33)分,t=4.519,P=0.001].SF-36总分、牛理健康综合得分和心理健康综合得分均与年龄、文化程度、临床症状计数正相关(P<0.05).GD患者的生存质量与文化程度呈正相关,与临床症状计数、年龄呈负相关.结论 GD患者生存质量明显下降,影响GD患者生存质量的主要因素是临床症状计数、年龄和文化程度.%Objective To compare the quality of life of the patients with diffuse toxic goiter( GD) and normal controls using 36-item Short Form Health Survey (SF-36) in Chinese, to explore the social and clinical factors which influence the quality of GD's life. Methods 66 patients and 66 normal controls were assessed using self-composing questionnaire and 36-item Short Form Health Survey ( SF-36 ). Results Scores of eight dimensions of quality of life were lower than that of health controls, had significantly differences than that of health controls. There were statistical significant differences in terms of the score difference of eight dimensions between the GD patients and normal controls (P < 0.05 ). The scores of physical functioning dimension in GD patients, normal controls were 70.45 ± 19.25, 92.8 ± 6.51 ( P < 0.01), respectively

  12. The relationship of CCR7 and EMT in thyroid goiter and thyroid papillary carcinoma%CCR7在结节性甲状腺肿与甲状腺癌中的表达及其与EMT关系的研究

    吕顺增; 赵婧; 邹知耕; 田铧; 李菲; 房云海; 索宁; 杨春林; 刘书涛


    目的 研究并探讨趋化因子受体-7(chemokine receptor 7,CCR7)在结节性甲状腺肿与甲状腺乳头状癌中与上皮间质转化(epithelial mesenchymal transition,EMT)的关系.方法 采用免疫组化检测CCR7、N-cadherin与基质金属蛋白酶-9(matrix metalloproteinase 9,MMP9)在50例结节性甲状腺肿与50例甲状腺乳头状癌中的表达,分析其与患者病理资料的关系.结果 CCR7、N-cadherin在结节性甲状腺肿的结节期滤泡上皮均呈高表达(分别为83.7%、90.7%),且为正相关(P<0.01),而在胶质贮存期滤泡上皮(分别为2.0%,8.2%)与结节期纤维组织(分别为6.7%,31.1%)低表达.CCR7、N-cadherin与MMP9在甲状腺乳头状癌的淋巴结转移组的阳性表达率为87.1%,90.3%,96.8%,而无淋巴结转移组的阳性表达率为42.1%,57.9%,63.2%,差异有统计学意义(P <0.01);CCR7与N-cadherin、MMP9在甲状腺乳头状癌的表达呈正相关(P<0.01).结论 CCR7在结节性甲状腺肿与甲状腺乳头状癌中均与EMT的指标具有相关性,CCR7可能参与调节滤泡上皮EMT发生.%Objective To explore the relationship of chemokine receptor 7 (CCR7) and epithelial mesenchymal transition (EMT) in thyroid goiter and thyroid papillary carcinoma.Methods CCR7,N-cadherin and MMP9 were detected by immunohistochemical technique in 50 cases of thyroid goiter tissues and 50 cases of thyroid papillary carcinoma tissues.The correlation between clinical pathological data and CCR7 expression were retrospectively analyzed.Results CCR7 and N-cadherin mainly located in nodular follicular epithelium (83.7%,90.7%) in thyroid goiter and correlated with each other statistically(P <0.01),the expression of CCR7 and N-cadherin were low in the follicular epithelium of storage period (2.0%,8.2%) and the nodular fibrous tissues (6.7%,31.1%) of thyroid goiter.The expression rate of CCR7,N-cadherin and MMP9 in thyroid papillary carcinoma tissues with lymph node

  13. [Endemic goiter in Nepal. Comparisons with endemic goiter in the Piedmont].

    Mortara, M; Cenderelli, G; Reposi, G; Migiardi, M; Costa, A


    Comparison of certain features of endemic goitre in the Khumbu district of Nepal and Piedmont is reported. Cases in the younger generations were observed in both areas. In Khumbu, the incidence of goitre in schoolchildren was 75% and cases were even noted in children who had been receiving iodine prophylactic management (injections of iodised oil: 500-1000 mg/yr) for at least three years. The iodine content of drinking water and the most commonly eaten foods was determined. Values were very low and a daily intake of not more than 30 mug was calculated. The findings are in line with metabolic studies carried out by other workers in Upper Khumbu. While it is clear that ambiental iodine deficiency is much higher in Khumbu than in those areas of Piedmont where goitre is most markedly endemic, the inadequacy of preventive iodine administration measures, and environmental features common to both areas, suggest that iodine deficiency is a concomitant factor and not the prime cause of endemic goitre.

  14. Multinodular goiter treatment with radioiodine aided by recombinant human TSH in different doses: a randomized, double-blind, placebo-controlled study;Administracao previa do TSH humano recombinante, em diferentes doses, no tratamento do bocio multinodular com iodo radioativo: um estudo randomizado, duplo cego, controlado com placebo

    Albino, Claudio Cordeiro


    Background: There is not an optimal treatment for multinodular goiter (MNG). Surgery is the main therapeutic option because it decreases thyroid volume, reduces compression symptoms and provide histological diagnosis. Radioiodine ({sup 131}I) is an efficient therapeutic option for the treatment of MNG mainly when surgery is not indicated or when the patient refused it. However, high activities of {sup 131}I are frequently required for clinically significant results. This procedure increases the body radiation exposure and the hospitalization costs. Recombinant human TSH (rh TSH) allows a reduction in the administered activity of {sup 131}I with effective thyroid volume (TV) reduction. However, this combination therapeutic can increase collateral effects. Objective: To evaluate the efficacy and safety of low and intermediate doses of rh TSH compared to placebo, associated with a fixed activity of {sup 131}I in MNG treatment. Patients and Methods: Thirty patients with MNG received 0.1 mg of rh TSH (group I, n=10), 0.01 mg of rh TSH (group II, n=10), or placebo (control group, n=10). After 24 hours, 30 mCi of {sup 131}I was given to all patients. Radioactive iodine uptake (RAIU) was determined before and 24 hours after rh TSH. Before and 2, 7, 180 and 360 days after the TV was measured by magnetic resonance image (MRI). The smallest cross-sectional area of tracheal lumen (Scat) was also measured with MRI before, 2 and 7 days after treatment. Antithyroid antibodies, TSH, T3 and free T4 were assessed regularly. Results: After 6 months, the decrease in TV was more significant in groups I (30.3 +- 16.5%) and II (22.6 +- 14.5%), than in control group (5.0 +- 14.6%; p=0.01). After 12 months, TV decreased more in group I (39.2 +- 16.9%) and group II (38.8 +- 24.4%) than in group III (23.4 +- 23.59%) but it was not statistically significant (p=0.205). During the first 30 days,total T3 and free T4 increased, without reaching thyrotoxic levels and TSH decreased. After 12 months

  15. Tratamiento del bocio tóxico difuso con 131I en dosis de 80 µCi/g de tejido tiroideo Treatment of diffuse toxic goiter with 131I at doses of 80 µCi/g of thyroid tissue

    Francisco Ochoa Torres


    Full Text Available El 131I ha demostrado ser la terapéutica más eficaz en el tratamiento del bocio tóxico difuso (BTD. Sin embargo, no existe consenso sobre la dosis a administrar: fija o de acuerdo con la actividad funcional del tiroides y su tamaño. Con el fin de evaluar los resultados terapéuticos con una dosis de 80 µCi/g de tejido tiroideo, estimado por palpación y sin tener en cuenta la actividad funcional del tiroides, se estudiaron 61 pacientes diagnosticados por la clínica, así como las determinaciones de TSH y T4 total en edades entre 20 y 80 años, de uno y otro sexos, con tamaño de la glándula de más de 30 g y si habían recibido o no propiltiouracilo (PTU previamente. El seguimiento postratamiento se realizó cada 2 meses durante 3 años por el mismo especialista y con iguales procederes. La eficacia del tratamiento con la primera dosis fue de 85,2 %. La frecuencia de hipotiroidismo a los 3 años de evolución fue de 29,5. La edad del paciente, el sexo, el tamaño del bocio y el tratamiento con PTU no influyeron en la respuesta a este. Las ventajas mostradas por el método fueron: una eficacia alta, la dosis de 131I se calcula con facilidad, es fácil de aplicar, disminuye el costo al no tener que realizar valoración del estado funcional de la glándula y reduce las consultas.131I has proved to be the most efficient therapeutics in the treatment of diffuse toxic goiter (DTG. However, there is no consensus on the dose to be administered: fixed dose or according to the functional activity of the thyroid and its size. In order to evaluate the therapeutical results at a dose of 80 Ci/g of thyroid tissue, estimated by palpation and without having into account the functional activity of thyroid and wether they had received propylthiouracil (PTU previously , 61 patients diagnosed by the clinic, as well as determinations of TSH and total T4, were studied in individuals aged 20-80 of both sexes, with a thyroid size over 30 g. The posoperative

  16. Persistent cellular metabolic changes after hemithyroidectomy for benign euthyroid goiter

    Toft Kristensen, Tina; Larsen, Jacob; Pedersen, Palle Lyngsie


    persistently increased TSH and decreased fT4, sustained mitochondrial hyperpolarization and increased V˙O2. Our results demonstrate a decrease after hemithyroidectomy of the metabolic state to which the individual is adapted, with persistent cellular metabolic changes in a hemithyroidectomized patient group...

  17. Endemic goiter in School Children in Southwestern Ethiopia

    Abstract. Background: Iodine deficiency disorder (IDD) is a serious threat to the health and well being of people residing in ... come to regard their entire population as at risk of IDD. (3). ... are among the environmental and nutritional factors.

  18. Nutrition and Goiter Status of Primary School Children in Ibadan ...

    Log in or Register to get access to full text downloads. ... Abstract. Iodine Deficiency Disorders (IDD) has continued to be of significant health problem in some communities despite universal salt iodization (USI). There is therefore a need to investigate several other factors beside iodine intake that could likely contribute to the ...

  19. Solitary fibrous tumor arising in an intrathoracic goiter

    Larsen, Stine Rosenkilde; Godballe, Christian; Krogdahl, Annelise


    . CONCLUSION: The histological appearance and immunohistochemical reaction pattern of SFT is characteristic. The entity should be considered when dealing with a spindle cell lesion in the thyroid gland. All cases of this site of origin reported have had a benign clinical course. As only a small number of cases......BACKGROUND: Solitary fibrous tumor (SFT) is a rare spindle cell tumor most often found in the mediastinal pleura. Nineteen cases of SFT arising in the thyroid gland have been reported. We report a case of SFT of the thyroid gland with immunohistochemical and cytogenetic investigation. SUMMARY: A 58...

  20. Acute airway obstruction due to spontaneous intrathyroid hemorrhage precipitated by anticoagulation therapy

    Laxmi Kokatnur


    Full Text Available Acute airway compromise due to hemorrhage in of thyroid gland is a rare life-hreating condition. The increasing use of anticoagulants for various reasons is likely increased the occurrence of this this complication. We describe an elderly patient on anticoagulation for atrial fibrillation, which developed swelling on the right side of neck causing acute airway obstruction requiring emergency intubation for airway protection. Computed tomographic scan showed massive intrathyroid hemorrhage along with substernal extension. She had supratherapeutic INR which was appropriately corrected emergently. She underwent resection of the thyroid gland which showed multinodular goiter without any evidence of malignancy. Our case illustrates the rare but lethal bleeding complication of anticoagulants in critical anatomical area and we request physicians should be wary of similar conditions.

  1. 胸骨后甲状腺肿的临床诊治%Diagnosis and surgical treatment of the substernal goitre

    蒋迎九; 温剑虎; 向小勇; 吴庆琛; 杨双强; 杜铭



  2. Effects of Haizao Yuhu Decoction with different proportions of Sargassum and Radix Glycyrrhizae on hepatic functions and pathomorphology in goiter rats%基于均匀设计的海藻玉壶汤中海藻与甘草不同比例配伍对甲状腺肿大大鼠模型肝脏功能及病理形态的影响

    李怡文; 钟赣生; 柳海艳; 刘云翔; 葛东宇; 李根茂; 欧丽娜; 王茜


    Objective: To investigate the toxic reactions of Haizao Yuhu Decoction with different proportion of Sargassum and Radix Glycyrrhizae in goiter rats through hepatic functions and pathomorphology. Methods: We set up seven matched groups according to the principle uniform design (two factors seven level) compared with normal, model, positive group. At the end of experiment, we determined alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total protein, albumin, globulin by automatic analyzer. The data statistic analysis was processed by ANOVA (analysis of variance) in combination with optimized formula soft. Results: The rats' general conditions such as eating, body weight and organization form were not affected; the serum ALT of group 2, group 3 and group 6 had decreased compared with model group; the serum AST of group 3 and group 6 also decreased; compared with model group (P<0.05), the serum ALP of group 5 had significantly increased compared with model group (P<0.05). AST/ALT ratio of group 5 had decreased compared with model group (P<0.05). Conclusion: The drugs, being opposite, may be complementary to each other after compatibility, but should be analyzed synthetically according to different dose and different processed products in order to expound the conclusions of 'Eighteen Incompatible Medicaments'.%目的:通过海藻与甘草不同比例配伍的海藻玉壶汤对甲状腺肿大大鼠模型肝功能相关指标的检测及病理形态学观察,考察含“十八反”中海藻、甘草这对反药组合的复方海藻玉壶汤对肝脏系统的影响.方法:将海藻与甘草按照2因素7水平的均匀设计实验原则设置不同配伍比例,灌胃14d,观察海藻与甘草不同配比的海藻玉壶汤对甲状腺肿大大鼠模型肝脏系数、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、总蛋白(TP)、白蛋白(ALB)、球蛋白(GLB)以及肝组织病理形态的影响.

  3. [Prevalence of goiter in the Aachen area. Ultrasound volumetry of the thyroid gland of 1,336 adults in an endemic goiter region].

    Riehl, J; Kierdorf, H; Schmitt, H; Suiter, T; Sieberth, H G


    The aim of the study was to assess the prevalence of thyroid enlargement by ultrasonic volume measurements. 1336 adults living in the iodine-deficient area of Aachen, West Germany (760 females, 576 males, mean age: 54.05 +/- 16.09 years) were included in the investigation. The ultrasonic examination was carried out in patients who did not suffer from thyroid disease at the time of study. The thyroid volume was age-dependent and varied from 13.3 +/- 10.4 ml in patients 70 years. The prevalence of thyroid enlargement ranged from 14.3% in young people to 51.3% in the elderly. There was no difference in the volumes of the left and right thyroid lobe. The prevalence of thyroid enlargement was higher in females compared to males (p 70 years. There is evidence of a high prevalence of thyroid enlargement in iodine-deficient areas.

  4. Efficacy of the Therapy of Goiter with Subclinical Hypothyroidism Associated with Helicobacter pylori infection

    G M Panyushkina


    Full Text Available Article presented results of the treatment (150 mcg/day KI of goitre with subclinical hypothyroidism associated with Helicobacter pylori infection in 54 women. In conclusion total eradication of Helicobacter pylori could increase efficacy of goitre treatment up to 90%.

  5. Neutropenia Due to Very Long Time Propylthiouracil Usage in Toxic Multinodular Goiter

    Ahmet Kaya


    Full Text Available Thyrotoxicosis affects hematopoiesis in several ways and thioamides may cause myelosuppression. We report a case of febrile neutropenia in a patient with hyperthyroidism who was using propylthiouracil for nearly 20 years for the treatment of toxic multinodular goitre. After surgery, the patient was euthyroid and neutropenia resolved. Postoperative pathology was evaluated as micropapillary thyroid carcinoma.

  6. [Hirsutism and multinodular goiter in a 40-year-old female watchmaker].

    Mai, M; Tönjes, A; Trantakis, C; Wittekind, C; Stumvoll, M; Führer, D


    This article presents the case of a female patient with acromegaly caused by ectopic production of growth hormone-releasing hormone (GHRH) secretion. In the presence of typical clinical features of acromegaly but a lack of evidence for a pituitary adenoma the results of somatostatin receptor scintigraphy were indicative of a typical carcinoid of the lungs as the cause of the ectopic secretion of GHRH and the stimulation of pituitary gland growth hormone secretion resulting in acromegaly. Finally, the patient underwent curative surgical treatment.

  7. A Rare Case of Painful Goiter Secondary to Pediatric Hashimoto's Thyroiditis Requiring Thyroidectomy for Pain Control.

    Kashyap, Liladhar; Alsaheel, Abdulhameed; Walvekar, Rohan; Simon, Lawrence; Gomez, Ricardo


    Hashimoto's thyroiditis (HT) usually presents as painless thyroid swelling. Painful pediatric HT is a rare condition with limited literature on pain management. We report a 15-year-old female who presented with 4 weeks history of fatigue, malaise and progressive, painful midline thyroid swelling. There was no difficulty in swallowing, no fever or recent upper respiratory infection symptoms. Exam was remarkable for diffusely enlarged, very tender, and non-nodular thyroid. Thyroid function tests, C-reactive protein, and complete blood count were normal. Ultrasound revealed diffusely enlarged non-nodular, non-cystic gland with mild increased vascularity. Diagnosis of HT was confirmed by biopsy and thyroid antibodies. Over a 6 week period, pain management with ibuprofen, levothyroxine, corticosteroid, gabapentin and amitriptyline was unsuccessful. Ultimately, total thyroidectomy resulted in complete resolution of thyroid pain. We can conclude that thyroidectomy may be considered for the rare case of painful HT in children.

  8. Pilot outcomes of nodular goiter miniinvasive bioimpedance measurement in complex diagnostics

    A V Borsukov


    Full Text Available Presented are the data of the application of miniinvasive bio-impedanciometry of local benign thyroid nodules (n = 80. The paper includes a comparative evaluation of bio-impedance indeces in subgroups with various morphological structure of the thyriod nodules.

  9. Surgical management of retrosternal goiter: Local experience at a university hospital

    Gamal A Khairy


    Conclusions: The presence of an RSG is an indication for surgery owing to the lack of effective medical treatment, the higher incidence of symptoms related to compression, low surgical morbidity, and the risk of malignancy.

  10. Prevalence of malignancy in multinodular goiter and solitary thyroid nodule: a histopathological audit

    Seetu Palo


    Conclusions: We conclude that the prevalence of cancer was significantly higher in STN than MNG. But, since the prevalence of malignancy in MNG was also quite high, every effort should be made to pre-operatively identify any malignant focus in patients presenting with MNG. [Int J Res Med Sci 2016; 4(6.000: 2319-2323

  11. Papillary Adenocarcinoma of the Thyroid in Ectopic Intrathoracic Goiter: One Case Report

    Jie Zhang; Changli Wang


    @@ Case Report A 58-year-old male patient presented to our department for surgical management of a right neck nodule and low fever over the past 2 weeks. Preoperative evaluation, which included chest CT scan, MRI and scintigraphy (99mTc), revealed round and clear boundary intrathoracic ectopic thyroid tissue at the right side of the anterior mediastinum and an enlarged lymph node in the right neck.

  12. Cytologic and histopathologic results of euthyroid patients with multinodular goiter: Comparison with ultrasonographic features

    Ramazan Büyükkaya


    Full Text Available Objectives: Fine-needle aspiration biopsy (FNAB is thegold standard in the management of thyroid nodules andspecimen should be obtained from dominant nodule. Inour study, we aimed to compare the FNAB and histopathologyresults of dominant and non-dominant nodulesand to evaluate the association between nodule size andhistopathology results in patients with MNG.Materials and methods: Between 2009 and 2010, 197cases who had diagnosed MNG were analyzed. Thesecases were performed FNAB from both dominant noduleand non-dominant nodule. 26 patients with inadequatecytological results were excluded and 171 cases were includedin the analysis. Malignant ultrasonographic (USfeatures were defined as showing marked hypoechogenicity,microcalcifications, solid structure and not havingperipheral halo.Results: No statistically significant difference was observedbetween malign cytology and suspected cytologyratios of dominant nodules and non-dominant nodules(p=0.083. Malignancy rates were higher at dominantnodules not having peripheral halo and non-dominantnodules including microcalcification at US. Also statisticallysignificant difference was not observed (p=0.485between malign histopathology rates of dominant andnon-dominant nodules after surgery.Conclusions: According to cytological and histopathologicalresults of patients with MNG, there was no significantdifference between the malignancy ratio of dominantand non-dominant nodules. There is no obvious correlationbetween malignancy and nodule size in patients withMNG. We think that FNAB obtained not from only dominantnodules but also nodules with suspicious featuresof malignancy is necessary for most accurate diagnosis.

  13. No link between X chromosome inactivation pattern and simple goiter in females

    Brix, Thomas Heiberg; Hansen, Pia Skov; Knudsen, Gun Peggy S


    reaction of the polymorphic CAG repeat of the androgen receptor gene. A polymerase chain reaction product is obtained from the inactive X chromosome only. The XCI pattern was classified as skewed when 80% or more of the cells preferentially inactivated the same X chromosome. Twin zygosity was established......, as shown for autoimmune thyroid disease, X chromosome inactivation (XCI) and resultant tissue chimerism could offer a novel explanation for the female preponderance of SG. To examine whether skewed XCI is associated with SG, we first compared XCI in 71 twin individuals with SG with that in 142 unrelated...

  14. Metformin prevents the development of goiter in diabetes mellitus type 2

    A K Lipatenkova


    Full Text Available Реферат по материалам статьи Ittermann T, Markus MR, Schipf S, Derwahl KM, Meisinger C, Volzke H. Metformin Inhibits Goitrogenous Effects of Type 2 Diabetes. Eur J Endocrinol. 2013 May 17;169(1:9-15. doi: 10.1530/EJE-13-0101. Print 2013.

  15. Technique and outcome of autotransplanting thyroid tissue after total thyroidectomy for simple multinodular goiters

    Amr A. Mohsen


    Conclusion: Injection of thyroid tissue suspension is a simple method for thyroid autotransplantation. TSH was elevated in the majority to maintain normal or near normal thyroid hormones. Ten-gram implants showed higher isotope uptake than 5-g, although this difference was not reflected by thyroid hormone profile. The implant seemed to function better with the passage of time from 2 months to 12 months.

  16. 76 FR 41696 - Presumptive Service Connection for Diseases Associated With Service in the Southwest Asia Theater...


    ... remanded to VA on or after August 15, 2011. FOR FURTHER INFORMATION CONTACT: Nancy Copeland, Regulations... abdominal pain, substernal burning or pain, nausea, vomiting, altered bowel habits (including...

  17. Usefulness of SPECT/CT in the Diagnosis of Intrathoracic Goiter versus Metastases From Cancer of the Breast

    Dümcke, Christine Elisabeth; Madsen, Jan Lysgård


    A 77-year-old woman was referred because of local reoccurrence of cancer of the breast. Chest x-ray showed a mediastinal tumor with dislocation of the trachea to the right. A Tc-99m pertechnetate scan showed irregular tracer uptake in an enlarged left lobe of the thyroid gland. Ultrasound confirmed...

  18. Nodular goiter with amyloid deposition in an elderly patient: fine-needle cytology diagnosis and review of the literature

    Di Crescenzo, Vincenzo; Garzi, Alfredo; Petruzziello, Fara; Cinelli, Mariapia; Catalano, Lucio; Zeppa, Pio; Vitale, Mario


    Background Amyloidosis is a systemic disease characterized by the extracellular deposition of amyloid fibrils in different organs and tissues. The thyroid gland may be affected by diffuse or nodular amyloid deposits, along with multiple myeloma (MM) (Amyloid Light-Chain Amyloidosis, AL amyloidosis) or chronic inflammatory diseases (Amyloid A Amyloidosis, AA amyloidosis), but thyroid gland involvement rarely appears as the first clinical manifestation in both conditions. The present study repo...

  19. Resultado del tratamiento quirúrgico del bocio endotorácico Result of the surgical treatment of endothoracic goiter

    Ramón González Fernández


    Full Text Available Se realizó un estudio retrospectivo y prospectivo de 30 pacientes estudiados y tratados por bocio endotorácico, seleccionados de un universo de 450 pacientes operados por nosotros a causa de diversas enfermedades tiroideas en el período comprendido entre 1994 y 2004. El sexo predominante fue el femenino (83,3 % y la edad promedio, de 52 años. El aumento de volumen (86,6 % y la disfagia (16,6 % fueron los síntomas más frecuentes. Se utilizó el ultrasonido y la radiografía de tórax en todos los casos, mientras que la biopsia por aspiración con aguja fina (BAAF se empleó en el 96,6 % de los pacientes. El bocio coloide difuso, con 19 casos (63,3 %, fue el tipo histológico más observado. La hemitiroidectomía más la exéresis de la prolongación endotorácica (12 casos; 40 % fue la intervención quirúrgica más realizada. No presentó complicaciones el 93,3 % de los pacientes y se presentó un caso con granuloma de la herida y otro con hipoparatiroidismo transitorio, lo cual constituyó el 3,3 %. En nuestros casos no encontramos degeneración maligna del bocio

  20. Acute adrenal crisis mimicking familial Mediterranean fever attack in a renal transplant FMF patient with amyloid goiter.

    Emeksiz, Hamdi; Bakkaloglu, Sevcan; Camurdan, Orhun; Boyraz, Mehmet; Soylemezoglu, Oguz; Hasanoglu, Enver; Buyan, Necla


    The most devastating complication of familial Mediterranean fever (FMF) is amyloidosis which is capable of resulting in chronic renal failure. Although amyloid deposits are frequent in adrenal glands based on the autopsies of FMF patients however; to our knowledge, symptomatic adrenal insufficiency has not been reported yet. We describe a 21-year-old-FMF amyloidosis case with a well-functioning allograft who presented to the emergency clinic with the complaints of abdominal pain, vomiting and diarrhea mimicking FMF attack. adrenocorticotrophic hormone stimulation test was performed due to resistant hyponatremia and disclosed Addison disease. In countries with a high prevalence of FMF, adrenal crisis should be borne in mind in long standing FMF patients.

  1. Determination of endogenous labelling of thyroid hormones during a radioiodide test in euthyroid goiter patients and hyperthyroid patients

    Loos, U.; Konrad, F.; Ishihara, A.; Adam, W.E.; Pfeiffer, E.F.


    The administration of a diagnostic dose of radioiodide, as in the radioiodide uptake test, results in the formation and secretion of radioactive thyroid hormones (endogenous labelling). In this report a method is described by which thyroid hormones are chromatographically isolated from serum, with the simultaneous assessment of the incorporated radioactivity over a period of time. A low-level counter was used to measure the small amounts of activity present. By this method the hormone phases during a radioiodide uptake test may be better evaluated. The present results show a good diagnostic discrimination between euthyroidism and borderline or definite hyperthyroidism (by a factor of 10 and 40, respectively). The influence of factors such as a small intrathyroidal iodide pool need, of course, to be considered. Hence, by taking into account such parameters as the intrathyroidal iodide pool, the hormone clearance etc, a technique for the measurement of thyroid hormone secretion can be developed.

  2. Primary thyroid lymphoma: A case report and review of the literature

    Rita Peixoto


    Full Text Available A rapidly enlarging mass of the anterior compartment of the neck with compressive symptoms may represent, among other diagnosis, a neoplasm of the thyroid gland.We describe the case of a 59-year-old woman referred to the endocrine surgical unit because of compressive cervical symptoms for 3 months. The cervical ultrasound revealed a sub-sternal goiter with heterogeneous echo structure and the fine-needle aspirating cytology was inconclusive. Given the large impact of symptoms on life quality, she was submitted to a total thyroidectomy. Histological examination of the surgical specimen revealed the presence of a Diffuse Large B Cell Lymphoma of the thyroid.Primary thyroid lymphomas are rare and there are few randomized studies for diagnostic and therapeutic guidance. New immunohistochemical and molecular techniques have improved the diagnostic accuracy with corebiopsy limiting the role of surgery. The treatment should first include the control of local disease with radiotherapy and/or surgery combined with chemotherapy to control obscure or disseminated disease. Palliative surgery may be needed to relieve airway compression symptoms. Under these circumstances, surgery should be performed by a specialized surgeon to decrease the associated morbidity. The prognosis of patients depends on the histological classification of the tumor and the stage of the disease.Due to the rarity of the disease, each case must be evaluated and treated individually, since there is not a consensual therapeutic approach.•Primary thyroid lymphomas are very rare.•New immunohistochemical and molecular techniques have improved the diagnostic accuracy with corebiopsy limiting surgery.•Surgery has a small role in PTL and when needed it should be performed by a specialized surgeon to decrease morbidity. keywords:Thyroid,Lymphoma,Surgery,Management

  3. Vitamin A supplementation in iodine-deficient African children decreases thyrotropin stimulation of the thyroid and reduces the goiter rate 1-3

    Zimmermann, M.B.; Jooste, P.L.; Mabapa, N.S.; Schoeman, S.; Biebinger, R.; Mushaphi, L.F.; Mbhenyane, X.


    Background: Vitamin A (VA) deficiency (VAD) and iodine deficiency (ID) often coexist in children in Africa. VAD may affect thyroid function and the response to iodine prophylaxis. Objective: The aim was to investigate the effects of supplementation with iodine or VA alone, and in combination, in chi

  4. Graves' disease and toxic nodular goiter are both associated with increased mortality but differ with respect to the cause of death

    Brandt, Frans; Thvilum, Marianne; Pedersen, Dorthe Almind


    Background: Hyperthyroidism has been associated with increased all-cause mortality. Whether the underlying cause of hyperthyroidism influences this association is unclear. Our objectives were to explore whether mortality risk and cause of death differ between Graves' disease (GD) and toxic nodular...... associated with increased all-cause mortality. After stratification for the cause of death, GD was associated with increased mortality due to cardiovascular diseases (HR=1.49 [CI 1.25-1.77]) and lung diseases (HR=1.91 [CI 1.37-2.65]), whereas TNG was associated with increased cancer mortality (HR=1.36 [CI 1.......06-1.75]). When analyzing mortality in GD using TNG individuals as controls, there was no significant difference in all-cause mortality between GD and TNG. However, GD was clearly associated with a higher cardiovascular mortality (HR=1.39 [CI 1.10-1.76]) compared to TNG. Conclusion: Both GD and TNG, treated...

  5. Graves' disease in two pregnancies complicated by fetal goitrous hypothyroidism: successful in utero treatment with levothyroxine

    Bliddal, Sofie; Rasmussen, Åse Krogh; Sundberg, Karin Milner


    Treatment of Graves' disease during pregnancy with antithyroid drugs (ATDs) poses a risk of inducing hypothyroidism and, thus, development of a goiter to the fetus. PATIENT FINDINGS: We report two patients referred to our department after discovery of a fetal goiter by ultrasound examination in t...... hypothyroidism as the cause of goiter development. Reduction of maternal ATD dose and injection of levothyroxine intra-amniotically quickly reduced the goiter size, and both babies were born euthyroid and without goiters....

  6. Evidence for a more pronounced effect of genetic predisposition than environmental factors on goitrogenesis by a case control study in an area with low normal iodine supply.

    Singer, J; Eszlinger, M; Wicht, J; Paschke, R


    Family and twin studies suggest a genetic predisposition for euthyroid goiters. However, iodine deficiency and smoking are important exogenous factors for goiter development. We investigated goiter predisposition by a matched case control study in a region with recently documented low normal iodine supply. A sum of 376 patients were included in the study. We matched 188 patients with euthyroid/subclinically hyperthyroid goiter (TSH 4.20-0.05 mU/l) with 188 euthyroid controls without thyroid enlargement for age and gender. Thyroid ultrasound was performed in all patients, whereby 50.5% of patients with goiters showed a positive family history for goiter. In contrast, only 25% of control patients had a positive family history (prisk for goiter development (goiter prevalence 73.3%). Patients with a positive goiter family history had a 4.1-fold increased goiter risk (piodine supply, the significantly higher rate of positive family histories in patients with goiters as compared to the matched controls as well as the increased goiter prevalence in children of parents with goiters indicate the importance of genetic factors in goiter development. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Iodine deficiency and iodine excess in Jiangsu Province, China

    Zhao, J.


    Keywords:iodine deficiency, iodine excess, endemic goiter, drinking water, iodine intake, thyroid function, thyroid size, iodized salt, iodized oil, IQ, physical development, hearing capacity, epidemiology, meta-analysis, IDD, randomized trial, intervention, USA, Bangladesh, ChinaEndemic goiter can

  8. Outcome of surgery for toxic goitres in maiduguri: A single teaching ...


    Aug 28, 2011 ... There were 53 patients with toxic diffuse goiters (Grave's disease) with their mean age ... complications and majority of patients being euthyroid after long follow-up. Key words: .... standing toxic multinodular goiters. Discussion.

  9. the linkage between geological setting and human health in ethiopia

    preferred customer

    of evolved volcanic materials such as ignimbrites and rhyolites .... mental retardation and brain damage and goiter ... (Numbers near black circles indicate goiter prevalence rate, note that the size of the circle corresponds to prevalence rate.

  10. Thyroidectomy

    ... enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism). How much of your thyroid gland is removed ... in some cases, if the goiter is causing hyperthyroidism. Overactive thyroid (hyperthyroidism). Hyperthyroidism is a condition in ...

  11. Chronic thyroiditis (Hashimoto disease)

    Hashimoto thyroiditis; Chronic lymphocytic thyroiditis; Autoimmune thyroiditis; Chronic autoimmune thyroiditis; Lymphadenoid goiter - Hashimoto; Hypothyroidism - Hashimoto; Type 2 polyglandular autoimmune ...

  12. Thyroid gland removal

    Total thyroidectomy; Partial thyroidectomy; Thyroidectomy; Subtotal thyroidectomy; Thyroid cancer - thyroidectomy; Papillary cancer - thyroidectomy; Goiter - thyroidectomy; Thyroid nodules - thyroidectomy

  13. Atrioventricular Dissociation following Blunt Chest Trauma

    Salim Surani


    Full Text Available Blunt chest trauma (BCT is a common clinical presentation seen in emergency departments. Few cases of cardiac conduction abnormalities due to BCT have been reported in the medical literature. This dysrhythmias may present as permanent conduction defects requiring permanent pacemaker or may have temporary conduction abnormalities requiring temporary pacemaker or supportive care. We present the case of a young woman who suffered from BCT after being kicked by a horse with the development of a significant substernal hematoma. She developed temporary atrioventricular block, which was completely resolved with the decrease in the size of the substernal hematoma suffered.




    [目的]比较甲状腺片与左甲状腺素钠片治疗良性甲状腺肿的临床疗效.[方法]将符合病例入选标准的120例甲状腺结节性疾病患者按就诊的先后顺序随机分为观察组、对照组,每组60例.对照组给予甲状腺粉(片),每次80 mg,每日2次,口服.观察组给予左甲状腺素钠片,每次75 μg,每天2次,口服.2组均以7d为1个疗程,治疗2个疗程后观察疗效.观察2组甲状腺肿块的发生部位、大小、形态、数目、包膜及内部回声、后方回声,此外观察肿块周围及肿块内部血管分布情况,并记示收缩期峰值流速( Vmax)\\舒张期最小血流速度(Vmin)和阻力指数( resistence index,RI)等指标.[结果]观察组治愈率为36.67%,总有效率为76.67%;对照组治愈率为20.00%,总有效率66.67%.2组治愈率、总有率率相比较差异有统计学意义(P<0.05).Vmax、Vmin、RI等血流参数2组治疗前后相比差异有统计学意义(P< 0.05);Vmax、Vmin、RI等指标治疗后2组组间相比差异有统计学意义(P< 0.05).[结论]采用左甲状腺素钠片治疗良性甲状腺肿的临床疗效较甲状腺片显著,可较好地改善Vmax、Vmin、RI等血流参数.%[Objective] To compare the clinical efficacy of thyroid lablets with levothyroxine sodium tablets in the treat-ment of benign goitre. [Methods] 120 patients with thyroid nodular disease met the inclusion criteria randomly divided into two groups according to the order, 60 cases in each group. Control group was given thyroid powder (tablets), each 80 nig, 2 times a day, orally. Observation group received levothyroxine sodium tablets, each 75|Ag, 2 times a day, orally. 7 days as a course of treatment in the two groups, the effects were observed afler 2 courses. Observed the occurrence location, size, shape, num-ber, amicuk and internal echo, posterior echo of thyroid, and the blood vessels distribution around and in mass, and recorded peak systolic velocity (Vmax) \

  15. Políticas sanitarias y situación actual del Bocio Endémico: El caso de Colombia Sanitary policy and current situation of Goiter Syndrome: Colombia Case

    María Victoria ValeroBernal


    Full Text Available La deficiencia de yodo tiene muchos efectos adversos, sobre la Salud Humana. Se Considera la deficiencia de yodo, como la principal causa de discapacidad humana prevenible, se estima que más de 800'000.000 de personas están en riesgo; 190'000.000 afectados con bocio y más de 3'000.000 pueden presentar cretinismo. El bocio endémico es considerado uno de los desórdenes producidos por la deficiencia de yodo. Su alta prevalencia en distintas regiones a nivel mundial, llevó a que la OMS declarara durante muchas décadas problema de salud pública, debido a las consecuencias directas en la salud de grupos vulnerables como las mujeres embarazadas y los niños en edad escolar sino por su impacto negativo en el desarrollo de las comunidades afectadas. En Colombia, se adoptó la yodización universal de la sal como principal estrategia para el control de estos desórdenes declarándose su eliminación a finales del siglo pasado. Sin embargo, algunos reportes posteriores han mostrado que la prevalencia de bocio endémico y el estado nutricional del yodo medido por la determinación de la yoduria en algunas regiones del país requieren atención por parte de las autoridades sanitarias no solo por la persistencia de los desórdenes por deficiencia de yodo sino por el riesgo de enfermedades tiroideas por la ingesta excesiva de yodo en algunas regiones del país.Iodine deficiency leads to many adverse effects concerning human health. Iodine deficiency has been considered the leading cause of preventable human disability; it has been estimated that more than 800 million of the world's population are at risk, 190 million are affected by goitre and more than 3 million may be suffering from cretinism. Endemic goitre is considered to be one of the disorders caused by iodine deficiency. Its continued high prevalence around the world has led to the WHO declaring it to be a public health problem for many decades now due to its direct impact on the health of vulnerable groups, such as pregnant women and schoolaged children, and its negative impact on the affected communities' development. Universal salt iodisation (USI was adopted in Colombia as the main strategy for controlling such disorders; it was declared that they had been eliminated at the end of the last century. However, subsequent reports have shown that the prevalence of endemic goitre and iodine nutritional status (measured by determining urinary iodine in some areas of Colombia requires the pertinent health authorities' attention due to the persistence of iodine deficiency disorders and the risk of thyroid disease caused by excessive iodine intake in some regions of Colombia.

  16. Programa nacional de bocio nodular (PRONBONO: Estudio multicéntrico de bocio nodular único palpable National Program for Nodular Goiter (PRONBONO: Multicenter study of single palpable thyroid nodules

    M. Corino


    Full Text Available Introducción: La presencia de nódulos tiroideos palpables en la población general, es uno de los signos clínicos tiroideos más frecuentes en la práctica diaria. Objetivos: 1 establecer la prevalencia de las distintas patologías en bocio nodular único palpable y analizar sus características y su relación con los resultados citológicos. 2 analizar la existencia de diferencias regionales en Argentina. Pacientes y Métodos: Estudio prospectivo de 739 pacientes con bocio nodular único palpable evaluados entre el 1/1/2000 y el 31/12/2001 en Centros de Buenos Aires, Bahía Blanca, Mendoza y La Pampa. Se recabaron datos de examen clínico, ecografía tiroidea, TSH, ATPO y citología por punción con aguja fina. (PAAF. Fue utilizado para el análisis estadístico Correlación de Pearson, X2 y Test de Fisher. Resultados: la edad (X ± DS fue 46,3 ± 14 años, 93,1 % eran de sexo femenino. El 1,6 % tenía historia de radiación en cuello y el 29,9 % antecedentes familiares de patología tiroidea. Hallazgos clínicos: disfagia en el 7,9 %, disfonía 3,5 %, crecimiento nodular en los últimos 6 meses 19,2 %, consistencia dura el 24,7 %, fijeza a estructuras adyacentes 1,5 % y adenopatías en el 3 %. Hallazgos bioquímicos: TSH normal en el 81,2 % y ATPO positivos en el 30,3 % de los casos. Características Ecográficas: nódulos sólidos: 53,1 %, hipoecoicos: 63,8 %, microcalcificaciones 10,3 %, halo incompleto: 15 %, multinodular: 30,5 %, tiroides heterogénea: 60,2 % y adenopatías: 3,8 %. Hallazgos citológicos: En el 86,8 % de los casos fue necesario solo una punción para llegar al diagnóstico. Insatisfactorio (excluyendo quiste: 3,2 %: benignos: 77,3 %; sospechosos: 12,6 % y cáncer: 7 % (42 papilar, 2 medular y 3 sin especificar. Una correlación significativa (pIntroduction: the presence of palpable thyroid nodules in the general population is one of the most common clinical signs of thyroid disease in daily practice. Objectives: 1 To assess the prevalence of pathologies, clinical and cytological findings of single palpable thyroid nodules (SPTN in Argentina. 2 Analyze the regional differences in Argentina. Methods: Prospective study of 739 patients with STPN were evaluated at centres in Buenos Aires, Bahía Blanca, Mendoza, and La Pampa between 1/1/00 and 12/31/01. Clinical examination, thyroid ultrasound scan (US, TSH, TPOAb and fine needle aspirations (FNA were performed. Statistics: Pearson Correlation, X2 & Fisher Tests. Results: Age (X ± SD 46 ± 14ys: 93.1 % were women. Previous history of neck radiation & familial thyroid disease were found in 1.6 and 29.9 % respectively. Clinical findings: dysphagia: 7.9 %; dysphonia: 3.5%; nodule growth: 19.2 %; hard consistence: 24.7 %; fixation to adjacent structure: 1.5 % and lymphadenopathies (ADP: 3 %. Biochemical findings: TSH was normal in 81.2 % & TPOAb+ in 30.3 %. US features: solid: 53.1 %; hypoechoic: 63.8 %; microcalcifications: 10.3 %; incomplete halo: 15 %; more than 1 nodule: 30.5 %; thyroid heterogeneity: 60.2 % and ADP: 3.8 %. Cytology: Only 1 FNA was needed in 86.8%. Unsatisfactory (excluding cysts: 3.2 %; benign: 77.2%; suspicious: 12.6 % and cancer: 7 % (42 papillary, 2 medullary and 3 non specified. A significant correlation (p<0.02 was established between malignant nodules and rapid growth, hard, fixed, solid nodule, incomplete halo and ADP, though these parameters were more frequent (in absolute number in benign nodules. Surgery was mainly indicated based on FNA results. Histological diagnosis of 96 patients who underwent surgery showed 51 carcinomas, of which only 2 were cytologically benign and 31 adenomas. Conclusion: Palpable single nodules were more frequent in middle aged euthyroid women. One third had familial thyroid pathology, similar to the presence of TPOAb. On US, nodules were predominantly solid, hypoechoic, single with heterogeneous thyroid gland. FNA was predominantly benign. Rapid growth, hard, fixed, solid nodule, incomplete halo and ADP were associated with malignancy, but benignity was more common. In most of the patients surgery was recommended based on cytological findings. Our results are similar to those reported in other geographic areas.

  17. 甲状腺多发良性结节术后并发症风险的比较—Meta分析%Compare the postoperative complications incidence of benign multi-nodular goiter: A meta-analysis

    Pilei Si; Yulin Xu; Yi Tu; Yi Guo; Shengrong Sun


    Objective: The aim of our study was to compare the risk of main postoperative complications of patients underwent total thyroidectomy (TT), near total thyroidectomy (NTT) and subtotal thyroidectomy (ST) for treating BMNG. Methods:Electronic databases including Cochrane Controlled Trials Register, EMbase, Medline, SCI Expanded-ISI, NTIS, SIGLE and CNKI were searched. Eligible studies were randomized controlled trials which compared the incidence of postoperative complications of TT with ST/NTT for treating BMNG. Data extraction was using predefined data fields and assessment of methodological quality with the GRADE approach. A Mantel-Haenszel random-effects model was used and the effect sizes were expressed by using relative risks and 95% confidence intervals. Results: Four studies including 881 participants that met inclusion criteria were analyzed. Compared with ST/NTT, TT was associated with increased risk of transient RLNI (recurrent laryngeal nerve injuries) (relative risk 2.18, 95% confidence interval 1.08 to 4.42; P 0.05) and permanent hypocalcemia (2.37, 0.35 to 15.97; P > 0.05). The quality of evidence for each individual outcome was ultimately rated as moderate (permanent RLNI and permanent hypocalcemia), low (transient RLNI and transient hypocalcemia).Conclusion: For treating BMNG with thyroidectomy, there were no statistically significant differences in postoperative complications between TT and ST/NTT on a long view.

  18. Desordenes por deficiencia de yodo: bocio endémico correlación entre la presencia de bocio y factores de crecimiento / Iodine deficit disorders: correlation betwen endemic goiter and growth factors

    Cuéllar Cuéllar, Andrés Arturo


    Contexto: Los trastornos por deficiencia de yodo se consideran de importancia en salud pública. Constituyen la principal causa prevenible de daño cerebral y retraso mental. Materiales y métodos: en el presente estudio piloto se tomo una muestra de 128 sujetos de dos localidades; se realizó yodo en orina, niveles de hormona estimulante del tiroides (TSH), Tiroxina libre (T4L), anticuerpos antiperoxidasa; ecografía tiroidea. En aquellos sujetos en quienes se identificó disfunción tiroidea y/...

  19. 颈前低位弧形切口手术治疗良性甲状腺肿物26例%Low Cervical Collar Curved Incision in the Treatment of Benign Thyroid Goiter (Report of 26 Cases)



    目的 探讨颈前低位弧形切口手术治疗良性甲状腺肿物的疗效.方法 26例良性甲状腺肿物患者均行气管插管全麻下颈前低位弧形切口手术,术中均留置烟卷引流管.结果 所有手术均取得成功,术中无输血.术后2例出现声音嘶哑,治疗后1月内恢复,随访3~16个月,无并发症.结论 颈前低位弧形切口治疗良性甲状腺肿物安全、有效,且具有一定的美容效果.

  20. 颈部低领状切口治疗胸骨后甲状腺肿21例体会%Experience of low cervical collar incision for the treatment of substemal goiter in 21 cases



    目的 探讨颈部低领状切口治疗胸骨后甲状腺肿的疗效.方法 回顾分析我科1998年1月至2006年12月收治的21例位于胸骨后甲状腺肿的临床表现、诊断及治疗.结果 手术过程顺利.术中出血少.手术后除1例发生暂时性声嘶外,无其他严重并发症发生.结论 颈部低颈状切口较易暴露甲状腺下极,有利于进行甲状腺手术,同时有美容效果.

  1. The mice goiter induced by different iodine ion water%不同浓度碘离子诱发小鼠甲状腺肿的实验研究

    李英华; 朱惠民; 刘福英; 董少霞; 张建军; 王彦娜; 郭影



  2. Should an infected Nuss bar be removed?

    Van Renterghem, KM; von Bismarck, S; Bax, NMA; Fleer, A; Hollwarth, ME


    Background: The Nuss procedure is a minimally invasive procedure for correction of pectus excavatum. It involves insertion of a substernal metal bar. A feared complication of any implanted device is infection, which often necessitates removal. The purpose of this report is to describe the authors' e

  3. 新疆鹅喉羚



    The goitered gazelle,a common site in China’s consid-ered a second-class Wild animal under State protection,It is alsoreterred to as a yellow goat due to its body Shape. Goitered gazellesin Xinjiang live mostly in the plains and deserts.It acquired the name "goiteredgazelle”because of the goose-throat-like goiter on its long,thin neck.

  4. Endocrine glands

    ... Diabetes Gigantism Diabetes insipidus Cushing Disease Watch this video about: Pituitary gland Testes and ovaries: Lack of sex development (unclear genitalia) Thyroid: Congenital hypothyroidism Myxedema Goiter ...

  5. TSH test

    Thyrotropin; Thyroid stimulating hormone; Hypothyroidism - TSH; Hyperthyroidism - TSH; Goiter - TSH ... thyroid gland. It is also used to monitor treatment of these conditions. Your provider may also check ...

  6. Emergency thyroidectomy: Due to acute respiratory failure

    Zulfu Bayhan


    CONCLUSION: Respiratory failure due to giant nodular goiter is a life-threatening situation and should be treated immediately by performing awake endotracheal intubation following emergency total thyroidectomy.

  7. Exploring Prevalence Of Goitre In Rural Areas Of Ahamedabad And Gandhinagar Districts Of Gujrat (1987-88.

    Talsania N J


    Full Text Available The present study was undertaken to identify and map out the prevalence of goiter in the rural areas of Ahamadabad and Gandhinagar districts. 60 villages from Ahamadabad and 8 from Gandhinagar district were surveyed. The overall prevalence rate of goiter was 11.5% in Ahamedbad district and 8.4% in Gandhinaagar district. The prevalence of goiter grade I was 6.3% in the preadolescent population in Ahamadabad while it was below 5% in the same age group in Gandhinagar district. These observations Clearly revealed that endemic goiter is prevalent to a mid degree in Ahmedabad district.

  8. [Pericardial Fenestration in a Patient with Myocardial Metastasis and Cardiac Tamponade after Surgery for Esophageal Cancer;Report of a Case].

    Kobayashi, Kensuke; Suto, Yukio; Akashi, Okihiko; Sakata, Yoshihito; Hayama, Yasufumi; Kon, Junichi; Chino, Osamu


    We report a case of pericardial fenestration in a patient with myocardial metastasis and cardiac tamponade after surgery for esophageal cancer. A 66-year-old man had been suffering from orthopnea, hypotension and general malaise due to cardiac tamponade and heart failure. Esophagectomy was performed with substernal gastric tube reconstruction for advanced esophageal carcinoma. Nine months after the operation, heart failure developed, and myocardial and pericardial metastasis was subsequently detected. Subxiphoidal pericardiocentesis was abandoned due to the substernal gastric tube, and pericardial fenestration was performed through a small left anterior thoracotomy at the 5th intercostal space. His symptoms were ameliorated immediately and the procedure contributed greatly to maintain his quality of life. Preoperative computed tomography was useful for revealing the anatomical positions of the gastric tube and important vessels.

  9. Treatment Following Intoxication With Lethal Dose of Paraquat: A Case Report and Review of Literature

    Davarpanah, Mohammad Ali; Hosseinzadeh, Farideh; Mohammadi, S. Saeed


    Introduction: Paraquat is a widely used nitrogen-based herbicide which is lethal and causes multi-organ failure by accumulation in cells, which subsequently leads to death. Case Presentation: The present case report introduced a 25-year-old male with nausea, vomiting, and severe substernal burning sensation after incidentally ingestion of a large amount of paraquat. The treatment of the patient with antioxidants (N-acetylcysteine and vitamin E) and hemodialysis started immediately after arriv...

  10. Thymic abscess with bacteremia and manubriosternal pyarthrosis in a geriatric patient.

    Rubinstien, E; Slavin, J


    We describe a geriatric patient with acute substernal chest pain thought to be due to coronary heart disease, who was subsequently found to have Staphylococcus aureus bacteremia associated with infection of the thymus and manubriosternal joint. To our knowledge, this is the first report of (1) a thymic abscess in a geriatric patient, (2) a thymic abscess associated with bacteremia, (3) extra-articular extension of manubriosternal pyarthrosis, and (4) manubriosternal pyarthrosis in the geriatric age group.

  11. Sources of circulating 3,5,3'-triiodothyronine in hyperthyroidism estimated after blocking of type 1 and type 2 iodothyronine deiodinases

    Laurberg, Peter Marvin; Vestergaard, Henrik; Nielsen, Soren


    Graves' hyperthyroidism and multinodular toxic goiter lead to high serum T(3) compared with serum T(4). The source of this high T(3) has not been clarified.......Graves' hyperthyroidism and multinodular toxic goiter lead to high serum T(3) compared with serum T(4). The source of this high T(3) has not been clarified....

  12. Thyroid Surgery

    ... etc.). Surgery is also an option for the treatment of hyperthyroidism (Grave’s disease or a “toxic nodule” (see Hyperthyroidism brochure ), for large and multinodular goiters and for any goiter that may be causing ... MEANS OF TREATMENT? Surgery is definitely indicated to remove nodules suspicious ...

  13. Cytomorphologic significance of marginal vacuoles in diffuse thyroid enlargements

    Anshu Gupta


    Conclusions: A significant association was found between abundant MVs and a hyperthyroid state. Moderate/absent MVs in diffuse goiters were not found to correlate with thyroid function. Thus, all diffuse goiters with prominent MVs require hormonal evaluation to rule out hyperfunction of the thyroid.

  14. Clinical, biochemical & cytomorphologic study on Hashimoto′s thyroiditis

    Tina Thomas


    Interpretation & conclusions: Our study showed predominance of females in the study population in 21-40 yr age group with diffuse goiter. We suggest that in an endemic zone for goiter, all women of the child bearing age should be screened for HT.

  15. The twenty-second screening for thyroid disorders in radiation-contaminated areas of the Ukraine

    Harada, Tanekazu [Kawasaki Coll. of Allied Health Professions, Kurashiki, Okayama (Japan); Monobe, Manami


    One hundred and ninety-one people who reside in radiation-contaminated areas of the Ukraine near the site of the Chernobyl nuclear plant accident were screened in 1999. The ages of people screened ranged from 1 to 74 years. Diffuse goiter was palpable in 67.5%, and nodular goiter in 3.1%. Thyroid cancer was detected in only one suspicious case. Among the people with diffuse goiter, however, there were positive anti-thyroglobulin hemagglutination tests (TGHA) in 6.7% and positive anti-microsome hemagglutination tests (MCHA) in 16.7% of cases. In addition, urinary iodine concentrations and daily urinary excretion were low. Thus, it is thought that the majority of diffuse goiters in this area are not due to autoimmune thyroiditis but to iodine deficiency. At present, no definite conclusion can be drawn on the relationship between the large number of diffuse goiters and radioactive contamination. Further studies are required. (author)

  16. Clinical, biochemical & cytomorphologic study on Hashimoto's thyroiditis

    Thomas, Tina; Sreedharan, Suja; Khadilkar, Urmila N.; Deviprasad, D; Kamath, M. Panduranga; Bhojwani, Kiran M.; Alva, Arathi


    Background & objectives: Despite, the extensive salt iodization programmes implemented in India, the prevalence of goiter has not reduced much in our country. The most frequent cause of hypothyroidism and goiter in iodine sufficient areas is Hashimoto's thyroiditis (HT). This study records the clinical presentation, biochemical status, ultrasonographic picture and cytological appearance of this disease in a coastal endemic zone for goiter. Methods: Case records of patients with cytological diagnosis of HT were studied in detail, with reference to their symptoms, presence of goiter, thyroid function status, antibody levels and ultrasound picture. Detailed cytological study was conducted in selected patients. Results: A total of 144 patients with cytological proven HT/lymphocytic thyroiditis were studied. Ninety per cent of the patients were females and most of them presented within five years of onset of symptoms. Sixty eight per cent patients had diffuse goiter, 69 per cent were clinically euthyroid and 46 per cent were biochemically mildly hypothyroid. Antibody levels were elevated in 92.3 per cent cases. In majority of patients the sonographic picture showed heterogeneous echotexture with increased vascularity. Cytological changes were characteristic. Interpretation & conclusions: Our study showed predominance of females in the study population in 21-40 yr age group with diffuse goiter. We suggest that in an endemic zone for goiter, all women of the child bearing age should be screened for HT. PMID:25758571

  17. Benign thyroid disorders, radioiodine therapy and diagnosis related groups (DRGs): aspects of cost/benefit; Benigne Schilddruesenerkrankungen, Radioiodtherapie und Diagnosis Related Groups (DRGs): Kosten-Nutzen-Aspekte

    Dietlein, M.; Schicha, H. [Klinik und Poliklinik fuer Nuklearmedizin der Univ. zu Koeln (Germany)


    The increasing prevalence of goiter and thyroid nodules in older patients is accompanied by an increasing frequency of treatment and cost. Cost-effectiveness is given for programs of prophylaxis (primary prevention, e.g. alimentary iodine supplementation), for programs of screening (secondary prevention. e.g. TSH-screening), and for therapeutic strategies to avoid complications of thyroid dysfunction (atrial fibrillation, myocardial infarction, death for cardiac reasons) and to minimize iatrogenic complications (tertiary prevention). Examples of tertiary prevention are radioiodine-therapy of Graves' disease in patients who have an increased risk of relapse after antithyroid drugs (ATD), radioiodine therapy of ouvert or subclinical hyperthyroidism, and radioiodine therapy of large goiters in older patients or in patients suffering from a relevant co-morbidity. A cost-effectiveness-analysis for different therapeutic strategies of Graves' disease has been published using a lifelong time-horizon. The ablative radioiodine dose-regime is cost-effective as a first line therapy if the risk of relapse after ATD exceeds 60%. Cost-minimization-analysis, comparing resection of goiter and radioiodine, has shown lower cost of radioiodine therapy for toxic multinodular goiter up to 100 ml and for Graves' disease up to 60 ml goiter volume. Medical aspects (volume of goiter, uptake of nodules, regressive goiter, suspicion on malignancy, patients' age, co-morbidity, patients' decision) remain decisive for the choice of treatment. (orig.)

  18. Effect of Qi-Boosting Phlegm-Transforming and Goiter-Dispersing on Serum Thyroglobulin Antibody and Thyroperoxydase Antibody in Hashimoto's Thyroiditis Patients%益气化痰消瘿法对桥本甲状腺炎患者血清甲状腺球蛋白抗体、甲状腺过氧化物酶抗体的影响

    张敏; 张毅


    目的 观察益气化痰消瘿法中药对桥本甲状腺炎血清中甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)的影响. 方法 将60例桥本甲状腺炎患者随机分为治疗组30例和对照组30例.两组患者甲状腺功能均经西药控制在正常范围;治疗组在此基础上加用益气化痰消瘿中药治疗. 结果 在降低TGAb、TPOAb值方面,治疗组治疗前后自身比较及治疗组与对照组治疗后相互比较差异均有显著性意义(P<0.05或P<0.01).在改善甲状腺肿大方面,治疗组疗效也具有显著性意义(P<0.05). 结论 中药治疗能有效降低甲状腺自身免疫性抗体指标,并且对甲状腺肿大有效.

  19. A stereological study on goiter of iodine deficient rats treated by different dosage of KIO3 and KI%不同剂量的碘制剂对缺碘性甲状腺肿治疗效果的体视学研究

    叶振坤; 罗玉玉; 项建梅; 阎玉芹; 陈祖培




    Siti Madanijah


    Full Text Available 800x600 Normal 0 false false false IN X-NONE X-NONE MicrosoftInternetExplorer4 The objective of this study is to identify the factors that affect the high prevalence of goiter among elementary school students in goiter endemic area.  The specific objective are to identify the socio-economic characteristics of the sample family, to analyze food consump­tion related to goiter, to identify the variety of food contains of goitrogenic sub­stances, to measure the iodium salt concentration, to analyze the correlation between mother knowledge about IDD, food consumption and the quality of salt with the goiter status. This research was designed with cross sectional study with purposive method.  This research was conducted at Kabupaten Tasikmalaya, West Java from April to May 2005. The respon­dent consisted of 60 elementary school students, which 30 of them classified as normal group and the rest of them belong to the goiter group. The two sample groups were analyzing by the t-test and Mann Whitney test. The correlation variables were analyzed by the Spearman test. There were significant difference between the income on the normal group and the goiter group; the normal group had higher income than the rest. There were significant difference between the adequacy level of energy on the normal group (73.5% and the goiter group (55.8% and the average of the variety of goitrogenic food consumption. The Mann Whitney test showed there were also significant differences for the quality of salt. There were significant correlations between mother knowledge about IDD with the adequacy of iodium, and between the cases of goiter with the quality of salt consumed by the family. Intensive nutrition education of IDD is needed to improve the nutrition knowledge of the mothers, as well as the availability of the accessible iodized salt. Keywords: goiter, iodium, mother knowledge

  1. [X-ray fluorescent analysis of the content of stable iodine in the diagnosis of thyroid gland diseases].

    Tomasnevskiĭ, I O; Tomashevskiĭ, D I


    Radiofluorescent analysis (RFA) with the help of various devices and a new method of investigation was employed for a combined in vivo study of 1) the concentration (in micrograms/l g); and 2) the total amount (in mg) of stable iodine in the thyroid; 3) a scan of the distribution of halogen in the organ; 4) organ mass (in g) in the control groups, in 15 patients with toxic goiter before and after mercasolil therapy, and in 6 patients with endemic goiter after iodine prophylaxis. The importance of some of the indices in the diagnosis and therapy of patients with toxic goiter was shown.

  2. T4 test

    ... an overactive thyroid Symptoms of an underactive thyroid Hypopituitarism (the pituitary gland does not produce enough of ... thyroiditis (Hashimoto disease) Goiter - simple Graves disease Hyperthyroidism Hypopituitarism Hypothalamus Hypothyroidism Kwashiorkor T3 test Thyrotoxic periodic paralysis ...

  3. 21 CFR 866.5870 - Thyroid autoantibody immunological test system.


    ... the thyroid autoantibodies (antibodies produced against the body's own tissues). Measurement of thyroid autoantibodies may aid in the diagnosis of certain thyroid disorders, such as Hashimoto's disease (chronic lymphocytic thyroiditis), nontoxic goiter (enlargement of thyroid gland), Grave's...

  4. Thyroid and Weight

    ... weight) weight loss. As in the treatment with hyperthyroidism, treatment of the abnormal state of hypothyroidism with thyroid ... Goiter Graves’ Disease Graves’ Eye Disease Hashimoto’s Thyroiditis Hyperthyroidism ... & Weight Thyroiditis Thyroid ...

  5. Blood transfusion, antibiotics use, and surgery outcome in thyroid ...


    Jan 23, 2012 ... Conclusion: Thyroidectomy is a safe surgery with minimal risk of complications. ... Key words: Antibiotics, blood transfusion, complications, endemic goiter, iodine deficiency, .... [5] These have also been identified as factors.

  6. Uptake of thallium-201 in enlarged thyroid glands. Concise communication

    Fukuchi, M.; Kido, A.; Hyodo, K.; Tachibana, K.; Onoue, K.; Morita, T.; Nagai, K.


    We have investigated the thyroid uptake of Tl-201 in 37 patients with various types of goiter, and in six with normal thyroids. Significant thallium uptake was found in all cases in which there was thyroid enlargement, including Graves' disease, toxic thyroid nodule, primary hypothyroidism, simple goiter, Hashimoto's disease, thyroid carcinoma, and thyroid adenoma. If goiter was absent, however, there was no demonstrable uptake - e.g., in secondary hypothyroidism, subacute thyroiditis, and the normal controls. Thallium uptake did not correlate with thyroid function tests such as BMR, T/sub 3/-RU, T/sub 3/, T/sub 4/, TSH, antithyroid antibodies, or the 24-hr I-131 uptake. In 23 patients with diffuse goiter, on the other hand, maximum Tl-201 uptake correlated well with thyroid weight: r = 0.836 (p < 0.001); y = 0.02 x + 0.06.

  7. Hyperthyroidism

    ... affect quality of life. Possible Complications Thyroid crisis (storm) is a sudden worsening of hyperthyroidism symptoms that ... hyperthyroidism; Thyroid hormone - hyperthyroidism Images Endocrine glands Goiter Brain-thyroid link Thyroid gland References Bahn RS, Burch ...

  8. Common Acupoints in Chest and Abdomen

    Journal of Acupuncture and Tuina Science Editor; CUI Xue-jun


    @@ Tiantu (CV 21) Location: In the center of the suprasternal fossa(Fig. l ). Indications: Cough, dyspnea, chest pain, pharyngolaryngeal swelling and pains, sudden hoarseness of the voice, goiter, globus hystericus, and dysphagia.

  9. Iodine deficiency and iodine excess in Jiangsu Province, China

    Zhao, J.


    iodine deficiency, iodine excess, endemic goiter, drinking water, iodine intake, thyroid function, thyroid size, iodized salt, iodized oil, IQ, physical development, hearing capacity, epidemiology, meta-analysis, IDD, randomized trial, intervention, USA, Bangladesh, China

  10. Iodine Deficiency Disorders (IDD) in Burie and Womberma Districts ...

    Recent findings show that both endemic and non-endemic areas have high goiter ... iodine level and concentration of iodized salt is dietary iodine deficiency. ... on adverse effects of IDD and benefits of iodine nutrition is highly recommended.

  11. Hyperthyroidism (Overactive Thyroid)

    ... Plummer's disease (toxic multinodular goiter) and thyroiditis, can cause hyperthyroidism. Your thyroid is a butterfly-shaped gland at ... too much T-4, is the most common cause of hyperthyroidism. Normally, your immune system uses antibodies to help ...

  12. Choice of the protocol for the realisation of the parathyroid scintigraphy; Choix du protocole pour la realisation de la scintigraphie parathyroidienne

    Nacer-Khodja, M.; Medjaher, M.; Menad, F.; Haffaf, E.M. [Service de medecine nucleaire, hopital central de l' armee, Alger, (Algeria)


    The objective was to have the choice between the different protocols of parathyroid scintigraphy realisation, for a population having a nodule (or multi nodules) goiter with the non availability to iodine 123. The factorial analysis of a dynamic sequence with sestamibi {sup 99m}Tc is the most used protocol in first intention for a population with a nodule goiter in the lack of iodine 123 during the realization of a parathyroid scintigraphy. (N.C.)

  13. Naval Shipboard Non-Tactical ADP Program (SNAP) Automated Medical System (SAMS) Computer Assisted Medical Diagnosis (CAMD) Module System/Subsystem Specification


    Intermittent Site of Pain 1 = Substernal, 2 = Across, 3 = Left Side, 4 = Right Side, 5 = Epigastric , 6 = Other Radiation of Pain 1 = Left Arm, 2...ULCER DISEASE" GOAL "MESENTERIC ADENITIS" GOAL "DIVERTICULITIS" GOAL "INGUINAL HERNIA " GOAL "ACUTE PANCREATITIS" GOAL "MYOCARDIAL INFARCTION" GOAL...34 == "CHEST" 11 "SITE OF PAIN" == "ACROSS" 12 "SITE OF PAIN" == "L SIDE" 13 "SITE OF PAIN" == "R SIDE" 14 "SITE OF PAIN" == " EPIGASTRIC " 15 "SITE OF

  14. Treatment Following Intoxication With Lethal Dose of Paraquat: A Case Report and Review of Literature

    Davarpanah, Mohammad Ali; Hosseinzadeh, Farideh; Mohammadi, S. Saeed


    Introduction: Paraquat is a widely used nitrogen-based herbicide which is lethal and causes multi-organ failure by accumulation in cells, which subsequently leads to death. Case Presentation: The present case report introduced a 25-year-old male with nausea, vomiting, and severe substernal burning sensation after incidentally ingestion of a large amount of paraquat. The treatment of the patient with antioxidants (N-acetylcysteine and vitamin E) and hemodialysis started immediately after arriving to the hospital. Conclusions: Immediate and adequate use of antioxidants and hemodialysis has an undeniable and important role in survival of patients after ingestion of a large amount of paraquat. PMID:26568853

  15. A case of pericardial cyst appearing as right hilar mass

    Oh, K. K.; Suh, J. H.; Choi, B. S. [Yonsei University College of Medicine, Seoul (Korea, Republic of)


    A case of pericardial cyst appearing on chest x-ray finding of right hilar mass in 37 year old man is reported. He has been complaint of cough and substernal discomfort, on and off for 5 years. Thoracostomy revealed a fluid filled pericardial cyst of 6 X 5 X 3 cm{sup 3} in size without communication with pericardial cavity, and confirmed as congenital pericardial cyst. Since the majority of pericardial cyst and diverticula are located in either cardiophrenic angle, the location at right hilum in this case is most unusual. And the literatures were reviewed.

  16. Endoscopic appearance of esophageal hematomas

    Rodica Ouatu-Lascar; Gayatri Bharadhwaj; George Triadafilopoulos


    @@INTRODUCTION Esophageal hematomas develop from the dissection of the mucosa from the muscular layers of the esophageal wall and represent an uncommon condition affecting all ages[t-3]. Although the most common cause of esophageal hematomas is iatrogenic mechanical injury-induced by prolonged nasogastric intubation, difficult or forceful endoscopic intubation, or the result of variceal injection sclerotherapy- some may be spontaneous,particularly in patients receiving anticoagulants[3-6]. Presenting symptoms most commonly include dysphagia, hematemesis, and sub-sternal or epigastric pain[5,9].

  17. Staphylococcus aureus sternal osteomyelitis: a rare cause of chest pain

    Kaur M


    Full Text Available Chest pain is a common presenting symptom with a broad differential. Life-threatening cardiac and pulmonary etiologies of chest pain should be evaluated first. However, it is critical to perform a thorough assessment for other sources of chest pain in order to limit morbidity and mortality from less common causes. We present a rare case of a previously healthy 45 year old man who presented with focal, substernal, reproducible chest pain and Staphylococcus aureus bacteremia who was later found to have primary Staphylococcus aureus sternal osteomyelitis.

  18. Preoperative localization of lesions of the parathyroid gland using thallium-technetium scintiscanning

    Kim, D.Y.; Fine, E.J.; Silver, C.E.


    Double tracer scanning of the neck after injection of thallium-210 and technetium pertechnetate was performed upon 33 patients with biochemically proved hyperparathyroidism operated upon during the past 14 months. Operative findings were correlated with the scans. Twenty-two of 29 single lesions of the parathyroid gland were successfully localized. There were ten unsuccessful studies, including three instances in which diffuse hyperplasia was incompletely identified. In one instance of diffuse hyperplasia, the bilateral pathologic finding was diagnosed correctly. Two of three substernal lesions were demonstrated in patients who had undergone previous unsuccessful explorations. An additional substernal lesion was localized in a patient prior to initial exploration. Nineteen of 21 lesions weighing more than 300 milligrams were identified, whereas only 50 per cent of the lesions weighing less than 300 milligrams could be seen. The scans demonstrated 12 of 14 lesions with C-terminal parathyroid hormone levels of more than 900 picograms per milliliter but only 60 per cent of the lesions that produced levels of less than 900 picograms per milliliter. Thallium-technetium scanning is a useful procedure for preoperative localization of parathyroid lesions and may preclude the need for more invasive testing in previously operated upon patients.

  19. Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery.

    Girish, M; Trayner, E; Dammann, O; Pinto-Plata, V; Celli, B


    Thoracotomy, sternotomy, and upper abdominal laparotomy are associated with high rate of postoperative cardiopulmonary complications (POCs). We hypothesized that symptom-limited stair climbing predicts POCs after high-risk surgery. A prospective evaluation of 83 patients undergoing thoracotomy, sternotomy, and upper abdominal laparotomy surgery. The 52 men and 31 women completed symptom-limited stair climbing. A separate investigator, blinded to the number of flights of stairs climbed, assessed 30-day actual outcomes for POCs, including pneumonia, atelectasis, mechanical ventilation for > 48 h, reintubation, myocardial infarction, congestive heart failure, arrhythmia, pulmonary embolus, and death within 30 days of surgery. The operations performed included 31 lobectomies, 6 wedge resections, 3 pneumonectomies, 3 substernal thymectomies, 1 substernal thyroidectomy, 23 colectomies, 3 laparotomies, 7 abdominal aortic aneurysm repairs, 5 esophagogastrectomies, and 1 nephrectomy. POCs occurred in 21 of 83 patients (25%) overall, in 9 of 44 patients undergoing thoracotomy/sternotomy (20%), and in 12 of 39 patients undergoing upper abdominal laparotomy (31%). Of those unable to climb one flight of stairs, 89% developed a POC. No patient able to climb the maximum of seven flights of stairs had a POC. The inability to climb two flights of stairs was associated with a positive predictive value of 82% for the development of a POC. The number of days in the hospital postoperatively decreased with a patient's increased ability to climb stairs. Symptom-limited stair climbing offers a simple, inexpensive means to predict POCs after high-risk surgery.

  20. [Symptom Clusters in Korean Patients with Acute Myocardial Infarction].

    Park, Eunjin; Lee, Jia


    Acute myocardial infarction (AMI) leads to death if the patient does not receive emergency treatment. Thus it is very important to recognize the symptoms in the early stage. The purpose of this study was to identify clusters of symptoms that represent AMI in Koreans. The study used a retrospective, descriptive design with secondary data analysis. Data were abstracted from 725 medical records of AMI patients admitted from June 1, 2006 to August 15, 2014 at a university hospital. Analysis of the AMI symptoms revealed five symptom clusters; Cluster 1 (n=140): middle chest pain (100%), shortness of breath, and cold sweating, Cluster 2 (n=256): substernal pain (100%), cold sweating, and shortness of breath, Cluster 3 (n=47): substernal pain (95.7%), left arm pain, shortness of breath, cold sweating, left shoulder pain, right arm pain, and the lower neck pain, Cluster 4 (n=212): shortness of breath (28.3%), left chest pain, and upper abdominal pain, and Cluster 5 (n=70): cold sweating (100%), left chest pain, shortness of breath, left shoulder pain, and upper abdominal pain. Length of hospital stay and mortality rate were significantly different according to symptom clusters (F=2.52, p=.040; F=3.62, p=.006, respectively). Symptom clusters of AMI from this study can be used for AMI patients in order to recognize their symptoms at an early stage. The study findings should be considered when developing educational prevention programs for Koreans with AMI.

  1. Turmeric use is associated with reduced goitrogenesis: Thyroid disorder prevalence in Pakistan (THYPAK study

    Ali Jawa


    Full Text Available Introduction: South Asian population has a particularly high prevalence of thyroid disorders mainly due to iodine deficiency and goitrogen use. There is no data available for prevalence of thyroid disorders in the general population living in nonmountainous regions of Pakistan. Materials and Methods: A total of 2335 residents of Pak Pattan, Punjab, Pakistan were interviewed about demographic, dietary, medical and environmental history as well as screened for goiter. Individuals of all ages and either gender were included. Results: Median age was 34 (10-88 years and 1164 (49.9% were males. Median monthly income was 49 (3.9-137 USD. Six hundred and sixty-nine (28.7% subjects had palpable goiter. 77.5% (n = 462 and 22.5% (n = 133 had World Health Organization Grade I and Grade II goiters respectively, further screened by measuring thyroid-stimulating hormone (TSH. In subjects with TSH <0.4 mg/dL, free T3 and free T4 levels were measured. In 185 goiter subjects when TSH was measured, 50% (n = 93 were euthyroid, 48% (n = 89 were hyperthyroid, and one subject each was hypothyroid and subclinically hyperthyroid. 29/89 hyperthyroid subjects underwent radionuclide scanning. Twelve subjects had heterogeneous uptake consistent with multinodular goiter, 12 subjects had diffuse uptake, two had cold nodules and two had hyperfunctioning single nodules. Goiter was significantly more common among females, unmarried individuals and individuals drinking tube well (subterranean water. Goiter was less common among those who consumed daily milk, daily ghee (hydrogenated oil, spices, chilies, and turmeric. Discussion: In our study population, goiter was endemic with very high prevalence of hyperthyroidism. Turmeric use was association with reduced goitrogenesis. Further studies to assess iodine sufficiency, thiocyanate exposure and autoimmunity need to be conducted. Masses consuming high goitrogen diets should be educated to incorporate turmeric, spices and green

  2. [Impact of the actions for the sustainable elimination of iodine deficiency in Cuba].

    Terry-Berro, C Blanca; Quintana-Jardines, Ibrahim; de la Paz-Luna, Maytell; García, Julieta; Fernández-Bohórquez, Raúl; Silvera-Téllez, Denise; Díaz-Fuentes, Yoandry; Ferret-Martínez, Ana; Reyes-Fernández, Denia


    To assess the effectiveness of the Sustainable Elimination of Iodine Deficiency Program through determination of urinary iodine and goiter prevalence. A cross-sectional study was conducted in Cuban school children aged 6 to 11 years old in 2011-2012. A stratified multistage sample was used in which the levels of iodine excretion in urine (urinary iodine) and the presence of goiter were determined. The median urinary iodine was 176.3 µg/L; 7.6% of the students showed some deficiency of iodine, only 2.2% were below 50 µg/L (severe deficiency), and 15.3% had urinary iodine above 300 µg/L. The percentage of school children with optimal iodine nutrition was 43.5%, this category showed a significantly higher frequency (p=0.03) in the mountain areas (52.5%). Goiter prevalence was 17.6% which corresponds to a mild endemic. However, in the mountain area the prevalence was 32.6% (severe endemic). The comprehensive analysis of the impact of iodine deficiency control measures assessed by urinary iodine excretion and goiter prevalence reflects that it is no longer a population health problem in urban and rural areas of Cuba, attributable to a proper process of salt iodization. Nevertheless, high goiter prevalence is still observed in the mountain area of Cuba.

  3. High prevalence of thyroid ultrasonographic abnormalities in primary aldosteronism.

    Armanini, Decio; Nacamulli, Davide; Scaroni, Carla; Lumachi, Franco; Selice, Riccardo; Fiore, Cristina; Favia, Gennaro; Mantero, Franco


    The study was performed to evaluate the prevalence of thyroid abnormalities detected by ultrasonography and, in particular, of multinodular nontoxic goiter in primary aldosteronism. We analyzed 80 consecutive of patients with primary hyperaldosteronism (40 with unilateral adenoma and 40 with idiopathic hyperaldosteronism) and 80 normotensive healthy controls, comparable for age, sex, iodine intake, and geographical area. Blood pressure, thyroid palpation, thyroid function, and ultrasonography were evaluated. The prevalence of ultrasonographic thyroid abnormalities was 60% in primary aldosteronism and 27% in controls (p < 0.0001). There was a statistically significant difference in prevalence of these abnormalities in unilateral adenoma and idiopathic hyperaldosteronism with respect to controls (p < 0.05 and p < 0.0001, respectively). The prevalence of multinodular nontoxic goiter in idiopathic hyperaldosteronism was higher than in controls (p < 0.001) and, in particular, in female patients. From these data it seems to be worth considering the existence of primary hyperaldosteronism in patients with multinodular goiter and hypertension.

  4. Guideline for radioiodine therapy for benign thyroid diseases (version 4); Leitlinie zur Radioiodtherapie (RIT) bei benignen Schilddruesenerkrankungen (Version 4)

    Dietlein, M.; Schicha, H. [Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Dressler, J. [Nuklearmedizinische Klinik der Henriettenstiftung, Hannover (Germany). Abteilung fuer Nuklearmedizin; Gruenwald, F. [Frankfurt Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Leisner, B. [Nuklearmedizinische Klinik der Henriettenstiftung des allgemeinen Krankenhauses St. Georg, Hamburg (Germany); Moser, E. [Nuklearmedizinische Klinik der Henriettenstiftung der Radiologischen Universitaetsklinik Freiburg (Germany); Reiners, C.; Schneider, P. [Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Schober, O. [Muenster Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin


    Version 4 of the guideline for radioiodine therapy for benign thyroid diseases includes an interdisciplinary consensus ondecision making for antithyroid drugs, surgical treatment and radioiodine therapy. The quantitative description of a specific goiter volume for radioiodine therapy or operation was cancelled. For patients with nodular goiter with or without autonomy, manifold circumstances are in favor of surgery (suspicion on malignancy, large cystic nodules, mediastinal goiter, severe compression of the trachea) or in favor of radioiodine therapy (treatment of autonomy, age of patient, co-morbidity, history of prior subtotal thyroidectomy, profession like teacher, speaker or singer). For patients with Graves' disease, radioiodine therapy or surgery are recommended in the constellation of high risk of relapse (first-line therapy), persistence of hyperthyroidism or relapse of hyperthyroidism. After counseling, the patient gives informed consent to the preferred therapy. The period after radioiodine therapy of benign disorders until conception of at least four months was adapted to the European recommendation. (orig.)

  5. Twenty-four hour radioactive iodine uptake in 35 patients with amiodarone associated thyrotoxicosis

    Martino, E.; Aghini-Lombardi, F.; Lippi, F.; Baschieri, L.; Safran, M.; Braverman, L.E.; Pinchera, A.


    Amiodarone associated thyrotoxicosis (AAT) occurs in approximately 10% of patients treated with this iodine rich drug in areas of mild iodine deficiency. The thyroid radioactive iodine uptake (RAIU) is usually undetectable or very low in iodine-induced thyrotoxicosis. In the present study, 35 patients with AAT were evaluated. Twelve patients had no thyroid abnormalities by physical exam and all had 24-hr RAIU less than or equal to 4%. In contrast, nine of 11 patients with AAT and diffuse goiters and eight of 12 patients with AAT and nodular goiters had RAIU values greater than 8%. In patients with AAT and goiter it appears possible that the thyroid fails to adapt normally to the excess iodide load, resulting in an inappropriately high RAIU in the presence of excess plasma iodine.

  6. Radioiodine therapy in hyperthyroid disease: poorer outcome in patients with high 24 hours radioiodine uptake

    Kristoffersen, Ulrik Sloth; Hesse, Birger; Rasmussen, Ase Krogh


    PURPOSE: To evaluate the importance of 24 h radioiodine uptake (24 h RIU) for the outcome of radioiodine treatment of hyperthyroidism. METHODS: Retrospective analysis of 72 patients who underwent radioiodine treatment for toxic goiter at our outpatient clinic [29 diffuse goiters (DG), 30 toxic...... multinodular goiters (TMG) and 13 toxic adenomas (TA)]. Thyroid status was determined by TSH, fT3 and fT4 levels, and outcome was rendered successful when hyperthyroidism was absent. Relation between low 24 h RIU (below median) or high 24 h RIU (above or equal to median) and outcome was evaluated. RESULTS......: Of patients with DG and low 24 h RIU, 15% remained hyperthyroid, as opposed to 56% of patients with DG and high 24 h RIU (Phyperthyroid, as opposed to 44% of patients with TMG and high 24 h RIU (P

  7. In vitro imaging of thyroid tissues using two-photon excited fluorescence and second harmonic generation.

    Huang, Zufang; Li, Zuanfang; Chen, Rong; Lin, Juqiang; Li, Yongzeng; Li, Chao


    To evaluate the feasibility of two-photon excited fluorescence (TPEF) and second harmonic generation (SHG) imaging to discriminate the normal, nodular goiter and papillary cancerous thyroid tissue. In total, 45 fresh thyroid specimens (normal, 15; nodular goiter, 12; and papillary cancerous, 18) from 31 subjects were directly imaged by the TPEF and SHG combination method. The microstructure of follicle and collagen structure in thyroid tissue were clearly identified, morphologic changes between normal, nodular goiter, and papillary cancerous thyroid tissue were well characterized by using two-photon excitation fluorescence. SHG imaging of the collagen matrix also revealed the differences between normal and abnormal. Our preliminary study suggests that the TPEF and SHG combination method might be a useful tool in revealing pathologic changes in thyroid tissue.

  8. A Case of Painful Hashimoto Thyroiditis that Mimicked Subacute Thyroiditis.

    Seo, Hye Mi; Kim, Miyeon; Bae, Jaeseok; Kim, Jo-Heon; Lee, Jeong Won; Lee, Sang Ah; Koh, Gwanpyo; Lee, Dae Ho


    Hashimoto thyroiditis (HT) is an autoimmune thyroid disorder that usually presents as a diffuse, nontender goiter, whereas subacute thyroiditis (SAT) is an uncommon disease that is characterized by tender thyroid enlargement, transient thyrotoxicosis, and an elevated erythrocyte sedimentation rate (ESR). Very rarely, patients with HT can present with painful, tender goiter or fever, a mimic of SAT. We report a case of painful HT in a 68-year-old woman who presented with pain and tenderness in a chronic goiter. Her ESR was definitely elevated and her thyroid laboratory tests suggested subclinical hypothyroidism of autoimmune origin. (99m)Tc pertechnetate uptake was markedly decreased. Fine needle aspiration biopsy revealed reactive and polymorphous lymphoid cells and occasional epithelial cells with Hürthle cell changes. Her clinical symptoms showed a dramatic response to glucocorticoid treatment. She became hypothyroid finally and is now on levothyroxine therapy.


    V.R. Kuchma


    Full Text Available A complex examination detected that kalium iodide dosage 100 mkg daily promote a rapid normalization of median of ioduria in children aged 8 to 12 years. Even in a case of normal initial level of ioduria iod active at the same dosage doesn't promote an increase of median of ioduria over than optimum level. It wasn't detected any decrease of goiter frequency during 6 months of prophylaxis, while the level of some cognitive indexes (an attention and the frequency of absence from school by the reason of acute respiratory deseases significantly increased. It could be concluded, that iodine prophylaxis using iod active is more effective in mild goiter endemia combine to decrease of attention in prepubertal children. In the case of combination of moderate endemic goiter and normal cognitive function kalium iodide is more preferable in prophylaxis in children.Key words: children, iod deficiency, prophylaxis.

  10. Computed tomography in the evaluation of thyroid disease

    Silverman, P.M.; Newman, G.E.; Korobkin, M.; Workman, J.B.; Moore, A.V.; Coleman, R.E.


    Traditionally, thyroid imaging has been performed primarily using radionuclide scanning. High-resolution computed tomography (CT) was performed in 18 patients to evaluate the CT appearance of various thyroid abnormalities including diffuse toxic goiter, multinodular goiter, Hashimoto thyroiditis, thyroid adenoma, and malignant thyroid tumors. CT images of the thyroid were correlated with radionuclide scanning, surgical findings, and clinical and laboratory results. CT provided a complementary method for evaluation of the thyroid by defining the morphology of the thyroid gland and more precisely defining the anatomic extent of thyroid abnormalities in relation to the normal structures of the neck and mediastinum.

  11. Gastroesophageal reflux.

    Slater, Bethany J; Rothenberg, Steven S


    Gastroesophageal reflux disease (GERD) is a very common condition and affects approximately 7-20% of the pediatric population. Symptoms from pathological GERD include regurgitation, irritability when feeding, respiratory problems, and substernal pain. Treatment typically starts with dietary modifications and postural changes. Antireflux medications may then be added. Indications for operative management in the pediatric population include failure of medical therapy with poor weight gain or failure to thrive, continued respiratory symptoms, and complications such as esophagitis. Laparoscopic Nissen fundoplication has become the standard of care for surgical treatment of children with GERD. The key technical aspects of laparoscopic Nissen fundoplication include creation of an adequate intra-abdominal esophagus, minimal dissection of the hiatus with exposure of the right crus to identify the gastroesophageal junction, crural repair, and creation of floppy, 360° wrap that is oriented at the 11 o׳clock position. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Cardiac MRI-confirmed mesalamine-induced myocarditis.

    Baker, William L; Saulsberry, Whitney J; Elliott, Kaitlyn; Parker, Matthew W


    A 38-year-old Caucasian man with a medical history significant for inflammatory bowel disease (IBD) and mesalamine use presented to the emergency department with stabbing, pleuritic, substernal chest pain over the previous 2 days. Findings of leucocytosis, elevated cardiac enzymes and inflammatory markers, T-wave or ST-segment abnormalities and left ventricular systolic dysfunction suggested mesalamine-induced myocarditis. However, a cardiac MRI confirmed the diagnosis. Signs and symptoms improved within days of withdrawal of mesalamine, and initiation of corticosteroids and follow-up studies within the next year were unremarkable. Importantly, the diagnosis of mesalamine-induced myocarditis confirmed via cardiac MRI is a step rarely performed in published cases.

  13. The primary percutaneous coronary intervention for acute anterior myocardial infarction in a middle-aged male patient with bilateral coronary artery to pulmonary artery fistulas.

    Altay, Servet; Cakmak, Huseyin Altug; Velibey, Yalcin; Erer, Betul


    A 38-year-old man admitted to emergency department with 2 h of typical substernal chest pain, shortness of breath and nausea. The ECG revealed sinus rhythm with a 3 mm ST elevation in precordial leads V1-V6. The coronary angiography revealed acute total occlusion in left anterior descending artery (LAD) with normal circumflex and right coronary artery (RCA) along with bilateral fistulas arising from the proximal LAD and ostial RCA draining into the main pulmonary artery. Therefore, primary percutaneous coronary intervention and bare metal stent implantation was performed to culprit LAD lesion. The electrocardiographically gated 64-slice multidetector-row CT showed two large, tortuous abnormal vessels which arose from the both ostial part of the RCA and LAD draining into the main pulmonary artery. We report an unusual case of bilateral coronary artery to pulmonary artery fistulas leading to acute anterior myocardial infarction in a middle-aged male patient.

  14. Minimally invasive repair of pectus excavatum in a 17-year-old boy with a history of congenital diaphragmatic hernia and lack of pericardium

    Stefan M. van der Heide


    Full Text Available We reported a 17-year-old boy with very deep asymmetric pectus excavatum and with a history of congenital diaphragmatic hernia repair and hypoplastic left lung. We performed a minimally invasive repair of pectus excavatum as described by Nuss et al., in 1998. We performed a left-sided thoracoscopy, instead of the right-sided according our normal routine, to provide a safe route. We created a substernal tunnel to have a clear definition of the deviant anatomy after congenital diaphragmatic hernia repair. However, we noticed an absence of the pericardium, which, by itself, can increase the risk of cardiac injury in both bar insertion and removal. Instead of the usual right-sided thoracoscopy, we recommend providing a safe view by left-sided thoracoscopy in comparable cases (e.g. congenital diaphragmatic hernia, other cardiac or vascular malformations to reduce the risk of rupture or perforation of cardiac structures.

  15. Thoracic wall reconstruction using ultrasound images to model/bend the thoracic prosthesis for correction of pectus excavatum

    Fonseca, João Gomes; Moreira, Antonio H. J.; Rodrigues, Pedro L.; Fonseca, Jaime C.; Pinho, A. C. M.; Correia-Pinto, Jorge; Rodrigues, Nuno F.; Vilaça, João L.


    Pectus excavatum is the most common congenital deformity of the anterior thoracic wall. The surgical correction of such deformity, using Nuss procedure, consists in the placement of a personalized convex prosthesis into sub-sternal position to correct the deformity. The aim of this work is the CT-scan substitution by ultrasound imaging for the pre-operative diagnosis and pre-modeling of the prosthesis, in order to avoid patient radiation exposure. To accomplish this, ultrasound images are acquired along an axial plane, followed by a rigid registration method to obtain the spatial transformation between subsequent images. These images are overlapped to reconstruct an axial plane equivalent to a CT-slice. A phantom was used to conduct preliminary experiments and the achieved results were compared with the corresponding CT-data, showing that the proposed methodology can be capable to create a valid approximation of the anterior thoracic wall, which can be used to model/bend the prosthesis.

  16. In the Presidium of the Scientific Medical Council of the Ministry of Health RSFSR.


    vaccine, with highly immunogenic influenza virus strains and to exercise control on the timely renewal of manufacturing strains, in charging these...cities observations of the strains of influenza viruses circulating among the - 4 - Population. All information must be directed in due time to...problems of regional pathology (including: the regional pathology of the population in the Par North, endemic goiter, pneuconiosis, poliomyelitis

  17. Iodine in diet

    ... in a person's diet may cause goiter or hypothyroidism . Without enough iodine, the thyroid cells and the thyroid gland become enlarged. Deficiency happens more often in women than in men. It is also more common in pregnant women and older children. Getting enough iodine in ...

  18. Recommendation of an Occupational Exposure Level for Perfluro-N-Butyl Iodide


    Symposium 2003 considered, “…developmental deficits or delays, and goiter and other effects of frank hypothyroid condition to be adverse effects...Health Effects Testing Guidelines OPPTS 870.1000 Acute Toxicity Testing – Background . Office of Prevention, Pesticides and Toxic Substances, U.S

  19. Intratorakal struma med differentialdiagnostiske vanskeligheder

    Scherer, Susanne; Abd-Elrahmane, Dunia Gazi; Petersen, René Horsleben


    Intrathoracic goiter represents an important differential diagnosis in the examination of lung tumours. A 71-year-old healthy woman presented with dyspnoea, stridor and an inhomogeneous tumour compressing the upper part of the right lung at the level of the left atrium. Computed tomography showed...

  20. Thyroid disorders in mild iodine deficiency

    Laurberg, P; Nøhr, S B; Pedersen, K M


    in elderly subjects, especially women, with risk of cardiac arrhythmias, osteoporosis, and muscle wasting. The hyperthyroidism is caused by autonomous nodular growth and function of the thyroid gland and it is accompanied by a high frequency of goiter. Pregnant women and small children are not immediately...

  1. Genetics Home Reference: McCune-Albright syndrome

    ... Albright syndrome . The thyroid gland , a butterfly-shaped organ at the base of the neck, may become enlarged (a condition called a goiter) or develop masses called nodules. About 50 percent of affected individuals produce excessive amounts of thyroid hormone (hyperthyroidism), ...

  2. Nutritional Problems and Policy in Tanzania. Cornell International Nutrition Monograph Series, Number 7 (1980).

    Mgaza, Olyvia

    This monograph discusses policies designed to deal with food and nutrition problems in Tanzania. Available information on food supplies and nutritional conditions in Tanzania clearly shows that the country faces nutritional problems; protein energy malnutrition is the most serious and requires priority action. Iron deficiency anemia, goiter, and…

  3. A Study to Design a System to Identify Handicapped Family Members of Active Duty Soldiers at Fort Benning, Georgia


    2 (June 1975): 341-351. 51 "Consumer Services for Handicapped People at Home." Physiotherapy , March 1981, 77. Feuerstein, et al. "Categories of...glasses Sinus trouble, repeated attacks of Speech defect, any Stomach ulcer Stroke Thyroid trouble or goiter Tuberculosis Tumor, cyst, or growth Varicose

  4. 13

    Items 701 - 750 of 769 ... Vol 17, No 3 (2008), The Prevalence of Obesity as Indicated by BMI and ... The Relationship between Prostate Volume and International Prostate ... Vol 19, No 4 (2010), Thyroid cancers amongst goiter population in a ...

  5. Cervical plexus block for thyroidectomy


    roidectomy in some parts of the world.3,5 This particular an- aesthetic option has not ... Subjects: The study included seventeen (17) Patients above the age of 18 years who presented with goiter and had elective ..... Great prizes to be won !!

  6. Longterm results and their prognosis in surgical treatment of Grave's disease

    I V Makarov


    Full Text Available This study focuses on improving the results of surgical treatment of patients with diffuse toxic goiter way jus tify the selection of thyroid residue and thyroid status in predicting longterm periods. The basis of the study is the immediate and longterm results of surgical treatment of 138 patients suffering from diffuse toxic goi ter. As a result of the research, with a modern point of clinical and statistical analysis proved the effective ness of fascial subtotal resection of the thyroid gland in patients with diffuse toxic goiter (Graves' disease. The dependence of disorders of the thyroid is remainded of its volume, autoimmune changes and limitations of the operation. The quality of life of patients in the late postoperative period is studied. The tactics of sur gical treatment of patients with diffuse toxic goiter, aimed at the prevention of postoperative recurrence of hyperthyroidism and hypothyroidism on the basis of prediction of the functional state of the thyroid residue in the longterm period, is proposed. Detected optimal sizes of thyroid balance after subtotal resection of the thyroid gland in patients with diffuse toxic goiter permit to objectify the technique of intervention.

  7. Iodine deficiency disorders in the iodine-replete environment.

    Nyenwe, Ebenezer A; Dagogo-Jack, Samuel


    Iodine deficiency disorders (IDD) constitute significant public health problems in parts of the world with poor iodine nutrition, but have been eradicated in North America and other regions. We herein report 3 cases of IDD, which occurred in women living in iodine-replete environments. The clinical presentation, biochemical findings, and radiological features of the patients were analyzed and presented in 3 case reports. The radiological features are illustrated in sonographic and scintigraphic images. A literature review and discussion, which highlight the risk factors, pathogenesis, ancillary investigations, and rational treatment of iodine deficiency goiter and hypothyroidism are provided. All 3 patients were young women, aged 24 to 38 years, who had goiter. Two of them presented with goitrous hypothyroidism. Radioactive iodine scintigraphy showed a characteristic finding of diffusely increased uptake (in the absence of clinical and biochemical evidence of hyperthyroidism). This scintigraphic pattern was found to be pathognomonic. Dietary iodine supplementation alone resulted in complete remission of IDD in the subjects, including the 2 patients with hypothyroidism. IDD can occur in iodine-replete environments. A high index of suspicion is needed to recognize these cases. It is pertinent that the correct diagnosis be made to avoid unwarranted life-long thyroxine therapy in patients presenting with goiter and hypothyroidism, which is easily treatable with iodized salt. These cases underscore the need for considering iodine deficiency in the etiologic diagnosis of goiter and hypothyroidism, even in iodine-sufficient regions.

  8. Dietary flavonoids and iodine Metabolism

    Elst, van der J.P.; Smit, J.W.A.; Romijn, H.A.; Heide, van der D.


    Flavonoids have inhibiting effects on the proliferation of cancer cells, including thyroidal ones. In the treatment of thyroid cancer the uptake of iodide is essential. Flavonoids are known to interfere with iodide organification ill vitro, and to cause goiter. The influence of flavonoids on iodine

  9. Effect of occupational exposure to cobalt blue dyes on the thyroid volume and function of female plate painters

    Prescott, E; Netterstrøm, B; Faber, J


    It has previously been shown that long-term oral exposure to cobalt can cause goiter and myxedema. The effect of industrial cobalt exposure on thyroid volume and function was determined for 61 female plate painters exposed to cobalt blue dyes in two Danish porcelain factories and 48 unexposed ref...

  10. Hyperthyroidism in a renal transplant recipient.

    Peces, R; Navascués, R A; Baltar, J; Laurés, A S; Ortega, F; Alvarez-Grande, J


    We report a case of toxic multinodular goiter with severe symptomatic hyperthyroidism in a female diagnosed 5 months after successful renal transplantation. To our knowledge, this is the first well-documented case of hyperthyroidism in a renal transplant recipient that responded well to methimazole. Special attention should be made to the use of methimazole and the possible interaction with immunosuppressive drugs.

  11. Iodine deficiency and functional performance of schoolchildren in Benin

    Briel-van Ingen, van den T.


    The notion that iodine deficiency may lead not only to goiter and cretinism, but to a much wider range of disorders, from stillbirth and abortions, to hearing problems and mental and physical underdevelopment began to be accepted beyond the research community since the early 1980's. In 1990 it was e

  12. Avicenna, the first to describe thyroid-related orbitopathy.

    Nabipour, Iraj; Burger, Albert; Moharreri, Muhammad-Reza; Azizi, Fereidoun


    The history of the association of goiter and orbital disease is discussed. Although Graves and Basedow are credited with the first descriptions of this association, it was described many years earlier between AD 1000 and 1110 by two Persian physicians and philosophers, Avicenna and Al-Jurjani.

  13. Clinical scoring scales in thyroidology: A compendium

    Sanjay Kalra


    Full Text Available This compendium brings together traditional as well as contemporary scoring and grading systems used for the screening and diagnosis of various thyroid diseases, dysfunctions, and complications. The article discusses scores used to help diagnose hypo-and hyperthyroidism, to grade and manage goiter and ophthalmopathy, and to assess the risk of thyroid malignancy.

  14. Treatment options for hyperthyroidism.

    Wartofsky, L


    Antithyroid drugs induce sustained remission in only 55% of cases. Radioiodine, the overwhelming choice of specialists, may pose risks, including aggravation of ophthalmopathy. Surgical ablation should be considered only if a highly skilled surgeon is available. Thyroid storm requires aggressive management, and definitive treatment is needed for toxic adenoma or toxic multinodular goiter.

  15. Ultrasonographic determination of the thyroid volume in 7- 10 years old children of Bushehr port 2007

    Farzad Morad Haseli


    Full Text Available Background: Determination of thyroid volume using ultrasound has been recommended for monitoring public control of iodine deficiency programs in areas with mild iodine deficiency or with no iodine deficiency, instead of physical examination, in order to estimate the prevalence rate of goiter. The aim of this study was to determine the reference ranges of thyroid volume in Bushehr port. Methods: Thyroid volume of 1247 primary schoolchildren aged 7-10 years who were selected by probability proportionate to size method from rural and urban areas of Bushehr port was determined using ultrasonography. Medians and percentiles of thyroid volumes for age and body surface area were calculated for both genders. Results: The 97th percentiles of thyroid volume of Bushehr port schoolchildren according to age and sex were all lower than the corresponding sex-specific normative WHO reference values. Goiter prevalence was 1.68% according to WHO thyroid volume references for age in the studied population. The goiter prevalence according to age and body surface area-specific new normative WHO reference values were 7.13 and 7.17%, respectively. Conclusion: The 97th percentile for thyroid volume, calculated by ultrasonography in Bushehr port schoolchildren, were lower than the international WHO newly recommended reference values in all ages. Therefore, determination of a native reference value for estimating the prevalence rate of thyroid is highly recommended. According to ultrasonographically determined goiter prevalence, Bushehr is an iodine sufficient area.

  16. Lack of Dietary Sources of Iodine and the Prevalence of Iodine ...

    Lack of Dietary Sources of Iodine and the Prevalence of Iodine Deficiency in Rural Women ... Log in or Register to get access to full text downloads. ... to assess urinary iodine concentration (UIC), goiter and dietary intake of iodine in a sample of ... Hence, there is a need to supply iodized salt in order to achieve the goal of ...




    Apr 1, 2014 ... RESULTS: The total goiter prevalence was 39.5%; 60% of the salt samples contained no iodine. The ... In Ethiopia, iodine deficiency disorders have been ... children was used based on the recommendation ... is proportional to the amount of iodine present in .... iodated. The coverage is much below what is.

  18. Predictors of Change in Serum TSH after Iodine Fortification: An 11-Year Follow-Up to the DanThyr Study

    Bjergved, Lena; Jørgensen, Torben; Perrild, Hans;


    of iodine intake between otherwise comparable populations are associated with considerable differences in TSH change at the 11-yr follow-up. Multinodular goiter predicted a less pronounced TSH increase during follow-up, which may be explained by iodine-dependent activity of autonomous nodules....

  19. Iodine deficiency and functional performance of schoolchildren in Benin

    Briel-van Ingen, van den T.


    The notion that iodine deficiency may lead not only to goiter and cretinism, but to a much wider range of disorders, from stillbirth and abortions, to hearing problems and mental and physical underdevelopment began to be accepted beyond the research community since the early 1980's. In 1990 it was e

  20. Iodine intake is still inadequate among pregnant women eight years after mandatory iodination of salt in Turkey.

    Kut, A; Gursoy, A; Senbayram, S; Bayraktar, N; Budakoğlu, I Irem; Akgün, H S


    A recent study showed first sign of reduction in goiter prevalence and elimination of iodine deficiency state among school-age children in Turkey after a decade of mandatory iodination of table salt. However, iodine status among pregnant women is a still debated issue in our country. To investigate iodine status, iodized salt consumption rate, and goiter prevalence in 1st trimester pregnant women 8 yr after the mandatory iodination. MATERIAL/ SUBJECTS AND METHODS: One hundred and forty-one 1sttrimester pregnant women who had been followed-up between January and October 2006 in the obstetric outpatient clinics in Turkey were included. Besides a physical examination, subjects underwent laboratory investigations for free T(3), free T(4), and urinary iodine concentration (UIC). All subjects completed a questionnaire regarding sociodemographic parameters, use of iodized salt, and pregnancy history. Goiter status was revealed by a palpation method according to World Health Organization (WHO) guidelines. In this study, we found that the median UIC of pregnant women was 149.7 microg/l (range 20.9-275.1 microg/l). Almost half of the subjects were below the WHO, United Nations Children's Fund, and International Council for the Control of Iodine Deficiency Disorders lower median reference limits of 150 microg/l. Total goiter prevalence was 24.8%, of which 9.2% were visible goiters. Among the study patients, 2.1% had subclinical hypothyroidism, and 0.7% had overt hypothyroidism. The rate for iodized salt use among the pregnant women was 95%. Our study revealed that iodine deficiency still remains a serious problem for pregnant women. Based on our results, antenatal follow-up protocols in the primary care setting in Turkey must include iodine supplementation.

  1. The diagnostic evaluation of fine needle aspiration cytology of thyroid and its clinical application

    Jiayu Zhang; Jian Wang


    Objective: The aim of the study was to investigate the diagnostic value of fine needle aspiration cytology (FNAC) and its clinical application. Methods: From April 2009 to February 2011, thyroid FNAC were performed in a total of 186 patients with thyroid nodule or mass in our hospital and 78 of those 186 patients subsequently underwent thyroidectomy. The FNAC findings were compared with the results of the corresponding histological diagnosis. Results: The results of thyroid FNAC for 186 patients showed that, (1) 166 cases of benign lesions, the detection rate was 89.24% (166/186), including 96 cases of nodular colloid goiter (51.61 %), 28 cases of simple colloid goiter (15.05%), 38 cases of Hashimoto's thyroiditis (HT) (20.43%) and 4 cases of thyroid adenoma (2.15%); (2) 4 cases of suspicious malignant lesion, the detection rate was 2.15% (4/186); (3) 16 cases of malignant tumor, the detection rate was 8.60% (16/186). Seventy eight patients including malignant (16), suspicious malignant (4), HT (20) and nodular colloid goiters (38) cases diagnosed by FNAC were performed operation with thyroidectomy and the postoperative histopathologic results showed that there were 2 cases HT combined thyroid papillary carcinoma in HT 20 cases by FNAC, 15 cases of thyroid papillary carcinoma and 1 case of follicular carcinoma in 16 cases of malignant tumor by FNAC and 4 case of thyroid papillary carcinoma in 4 cases of suspicious malignant by FNAC. Conclusion: Thyroid FNAC is a valuable and reliable method for the diagnosis of the thyroid nodules or mass or even most diffuse thyroid diseases. Diagnosis of HT and thyroid papillary carcinoma can be made by thyroid FNAC. There was larger hint value for nodular colloid goiter and simple colloid goiter according to thyroid FNAC.

  2. [The condition and prospects of Russian endocrinology].

    Dedov, I I; Iudenich, O N


    The article presents a brief essay dedicated to the development of endocrinology in our country since pre-war time. The article covers the most promising areas of endocrinology, from endemic goiter to the introduction of the newest technologies to endocrinology, and informs the readers about structural and organizational changes in the diabetological service, including the establishment of Institute of Diabetes and Institute of Pediatric Endocrinology, the first ones in Russia, the establishment of diabetological service, including State Registry of Diabetic Patients, a school for adult patients, etc. Another issue is the establishment of Growth Center and the introduction of genetic engineering growth hormone preparations into the practice of treatment of short children. Once again, the authors emphasize the issue of fighting endemic goiter. Many tasks of Russian endocrinology are now considered weighty matters of state.

  3. Thyroid disorders in women.

    Li, H; Li, J


    Thyroid disorders include autoimmune thyroid diseases (AITD), thyroid goiter, nodule and cancer. AITD mainly consist of autoimmune thyroiditis and Graves disease. The common characteristic of thyroid disorders is female preponderance in their prevalence. The female-to-male rate ratio is reported at 4~6:1 for AITD and about 3~4:1 for thyroid nodule. For PTC, it is greatest during reproductive age and drops from five and more in patients aged 20-24, to 3.4 in patients aged 35-44 to one in patients over 80. The effects of female gonadal hormones and X chromosome inactivation on thyroid gland and immune system greatly contribute to the female predilection of AITD. The former mainly include prolactin and estrogen. The direct actions of estrogen on the thyroid tissue contribute to the development of thyroid goiter, nodule and cancer in women.

  4. Endogenous subclinical hyperthyroidism and cardiovascular system: time to reconsider?

    Patanè, Salvatore; Marte, Filippo; Sturiale, Mauro


    Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. Exogenous sublinical hyperthyroidism is a thyroid metabolic state caused by L-thyroxine administration. Endogenous subclinical hyperthyroidism is a thyroid metabolic state in patients with autonomously functioning thyroid nodule or multinodular goiter, various forms of thyroiditis, in areas with endemic goiter and particularly in elderly subjects. Endogenous subclinical hyperthyroidism is currently the subject of numerous studies and it yet remains controversial particularly as it relates to its treatment and to cardiovascular impact nevertheless established effects have been demonstrated. Recently, acute myocardial infarction without significant coronary stenoses and recurrent acute pulmonary embolism have been reported associated with subclinical hyperthyroidism without L-thyroxine administration. So, it is very important to recognize and to treat promptly also endogenous subclinical hyperthyroidism. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  5. Syndrome of Reduced Sensitivity to Thyroid Hormones: Two Case Reports and a Literature Review

    Anyfantakis, Anastasios; Vourliotaki, Irene


    Resistance to thyroid hormone (RTH) is an extremely rare dominantly inherited condition of impaired tissue responsiveness to thyroid hormone (TH). Most patients with RTH have mutations in the gene that encodes the β isoform of the receptor of thyroid hormone (THR-β gene). Mutant receptors are unable to activate or repress target genes. The majority of them are asymptomatic or rarely have hypo- or hyperthyroidism. RTH is suspected by the finding of persistent elevation of serum levels of free T3 (FT3) and free T4 (FT4) and nonsuppressed TSH. We present two cases of RTH diagnosed after total thyroidectomy. The first patient was initially diagnosed with primary hyperthyroidism due to toxic multinodular goiter. The second patient had undergone thyroidectomy for multinodular goiter 16 years before diagnosis of RTH. After thyroidectomy, although on relatively high doses of levothyroxine, both of them presented with the laboratory findings of RTH. Genetic analysis revealed RTH.

  6. Improving a newly developed patient-reported outcome for thyroid patients, using cognitive interviewing

    Watt, Torquil; Rasmussen, Ase Krogh; Groenvold, Mogens;


    was within the set of problems involving attribution. Conclusion The cognitive interview methodology was effective in identifying and reducing problems within the questionnaire responding process. Patients tended to selectively report problems they considered to be caused by their thyroid disease even when......Objective To improve a newly developed patient-reported outcome measure for thyroid patients using cognitive interviewing. Methods Thirty-one interviews using immediate retrospective and expansive probing were conducted among patients with non-toxic goiter (n = 4), nodular toxic goiter (n = 5.......e. whether or not to report only issues considered of thyroid causality. Within each round of interviews, the number of problems declined from an initial average of six per interview to two, mainly due to a reduction in the number of problems associated with comprehension. The least amount of reduction...

  7. Oncogenic Activation of MAP Kinase by BRAF Pseudogene in Thyroid Tumors

    Minjing Zou


    Full Text Available Activating BRAF mutations have been reported in 40% of papillary thyroid carcinomas (PTCs. The involvement of BRAF pseudogene in thyroid tumorigenesis has not previously been studied. We investigated BRAF pseudogene expression in 68 thyroid tumors: 16 multinodular goiters, 43 classic PTCs, 6 follicular variants of PTC, and 3 anaplastic thyroid carcinomas. BRAF pseudogene function was studied by Western blots, soft agar assay, and tumorigenesis in nude mice. BRAF pseudogene expression was detected in 7 multinodular goiters, 18 classic PTC, and 1 follicular variants of PTC. There is an inverse correlation between BRAF pseudogene expression and BRAF mutation. The pseudogene transcripts were more frequently detected in tumors without BRAF mutation than those with BRAF mutation. Furthermore, BRAF pseudogene expression could activate the MAP kinase signaling pathway, transform NIH3T3 cells in vitro, and induce tumors in nude mice. These data suggest that BRAF pseudogene activation may play a role in thyroid tumor development.

  8. Effect of universal salt iodization on antithyroid drugs

    DAI Wei-xin; LIAN Xiao-lan; LU Lin; LI Su-mei; LI Shu-hua; LI Xiu-wei


    @@ Iodine deficiency disease (IDD) is common in China.An universal salt iodization (USI) program has been implemented by the Chinese government since 1996. As a result, the goiter rate in 8- to 10-year old children decreased from 20.4% in 1995 to 5.8% in 2002.1 But the adverse effects of iodine excess such as iodine-induced hyperthyroidism, iodine-induced goiters, iodine-induced hypothyroidism, etc. have become a great concern to healthcare professionals as well as the general population. The impact of USI on antithyroid drugs (ATDs) might become a potential challenge to address. With a special grant from the Department of Disease Control, the Health Ministry of China, we conducted a prospective study on the effects of USI on ATDs at the thyroid section of the Endocrinology Clinic of Peking Union Medical College Hospital (PUMCH), Beijing.

  9. Salt fluoridation and oral health

    Thomas M. Marthaler


    The aim of this paper is to make known the potential of fluoridated salt in community oral health programs, particularly in South Eastern Europe. Since 1922, the addition of iodine to salt has been successful in Switzerland. Goiter is virtually extinct. By 1945, the cariesprotective effect of fluorides was well established. Based on the success of water fluoridation, a gynecologist started adding of fluoride to salt. The sale of fluoridated salt began in 1956 in the Swiss Canton of Zurich,...

  10. Dietary Seaweed and Early Breast Cancer: A Randomized Trial


    CONTRACTING ORGANIZATION : University of South Carolina Columbia, SC 29208 REPORT DATE: May 2005 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical...vast and range from topical burn therapy to goiter ther- In an earlier study, we and others reported that dietary apy to softening of tumors (15). As...even for the King himself (11)." Tax records excess iodine intake might adversely affect thyroid function. from the eighth century indicate that more

  11. Hypothyroidism Among Military Infants Born in Countries of Varied Iodine Nutrition Status


    1.9 billion people, 31% of the world’s population, live in areas of iodine deficiency [1]. Iodine deficiency disorders affect over 200 million people...iodine nutrition varies between countries. Early public health efforts focused on severe iodine deficiency with the goal of preventing goiter and cretin...NHANES) III, performed from 1988 to 1994, the World Health Organization (WHO) has classified US iodine intake as “more than adequate” [3]. However, the

  12. Primary goitrous hypothyroidism in a young adult domestic longhair cat: diagnosis and treatment monitoring

    Mark E Peterson


    Full Text Available Case summary Primary goitrous hypothyroidism was diagnosed in a 12-month-old cat examined because of small stature, mental dullness, severe lethargy, generalized weakness and gait abnormalities. Radiographs of the long bones and spine revealed delayed epiphyseal ossification and epiphyseal dysgenesis. Diagnosis of primary hypothyroidism was confirmed by low serum concentrations of total and free thyroxine (T4 with high thyroid-stimulating hormone (TSH concentrations. Thyroid scintigraphy revealed severe enlargement of both thyroid lobes, as evidenced by a seven-fold increase in calculated thyroid volume above the reference interval. In addition, this bilateral goiter had an extremely high radionuclide uptake, about 10-fold higher than the normal feline thyroid gland. Treatment with twice-daily levothyroxine (L-T4, administered on an empty stomach, resulted in increased alertness, playfulness, strength and improvement in gait, as well as an increase in body length and weight. L-T4 replacement also led to normalization of serum thyroid hormone and TSH concentrations, and complete resolution of goiter. Relevance and novel information Spontaneous hypothyroidism is rarely reported in cats, with congenital hypothyroidism in kittens diagnosed most frequently. Despite the fact that this cat was a young adult, it likely had a form of congenital hypothyroidism caused by dyshormonogenesis (defect in thyroid hormone synthesis that led to compensatory development of goiter. In hypothyroid cats, treatment with L-T4 is best given twice daily on an empty stomach to ensure adequate absorption. Normalization of serum TSH and shrinkage of goiter, as well as improvement in clinical signs, is the goal of treatment for cats with goitrous hypothyroidism.

  13. Recent developments in the synthesis of five- and six-membered heterocycles using molecular iodine

    Parvatkar, P.T.; Parameswaran, P.S.; Tilve, S.G.

    : Chem. Eur. J., vol.18; 2012; 5460 -5489 Recent Developments in the Synthesis of Five- and Six- Membered Heterocycles Using Molecular Iodine Prakash T. Parvatkar, [a,b] Perunninakulath S. Parameswaran,* [c] and Santosh G. Tilve* [b] IODINE N CH 3 R... problems in animals and human beings. Iodine provides the substrate for synthesis of the thyroid hormones, thyroxine and triiodothyronine, which are crucial for normal growth and development. Deficiency of this element is known to cause goiter and even...


    Bera Swati


    Full Text Available Anti-TPO antibody level was evaluated in 86 patients, along with 25 healthy controls to detect its change in various forms of thyroid nodules particularly in thyroid malignancy when compared with healthy controls. The study revealed that Anti-TPO antibody level was increased in Benign & toxic form of Multi nodular goiter and papillary carcinoma but there is no elevation of Anti- TPO antibody level in follicular adenoma or follicular carcinoma.

  15. Medical Geology : a globally emerging discipline

    Joseph E. Bunnell; Robert B. Finkelman; Centeno, Jose A.; Selinus, O. (Olle)


    Medical Geology, the study of the impacts of geologic materials and processes on animal and human health, is a dynamic emerging discipline bringing together the geoscience, biomedical, and public health communities to solve a wide range of environmental health problems. Among the Medical Geology described in this review are examples of both deficiency and toxicity of trace element exposure. Goiter is a widespread and potentially serious health problem caused by deficiency of iodine. In many l...

  16. Combination of ultrasound-guided percutaneous microwave ablation and radioiodine therapy in benign thyroid disease. A 3-month follow-up study

    Korkusuz, H.; Happel, C.; Koch, D.A.; Gruenwald, F. [Frankfurt University Hospital (Germany). Dept. of Nuclear Medicine


    Pilot studies of combined therapies treating benign nodular goiters reported promising results. The aim of this study was to investigate the effectiveness of combined microwave ablation (MWA) and radioiodine therapy (RIT) with a special focus on thyroid function at the 3-month follow-up. 15 patients (median age: 55 years) with a large goiter and benign thyroid nodules or Graves' disease were treated with the combined therapy. Serum levels of triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyroglobuline (Tg) and, additionally, antibody levels against thyroglobulin (TgAb), thyrotropin receptors (TRAb) and thyroid peroxidase (TPOAb) were measured at enrollment, post MWA and at the 3-month follow-up (3MFU). Furthermore, the goiter volume, I-131 dose and hospitalization time were analyzed to evaluate effectiveness. MWA was operated under local anesthesia with a system working in a wavelength field of 902 to 928 MHz. TSH, T4, T3 and Tg did not change at 3MFU, except for in two patients in whom the initial TSH levels improved to normal thyroid functioning levels at follow-up. One of the patients developed a high TRAb-level that receded back into the normal range. At 3MFU, the combined therapy showed a mean thyroid volume reduction of 26.4 ml ± 7.9 ml (30.5 % ± 4.6 % (p < 0.05)). By utilizing the combined therapy, administered activity could be reduced by 26.6 % ± 4.8 % (p < 0.05) and hospitalization time by 30.9 % ± 19.9 % (p < 0.05). The data confirmed the effectiveness of the combination of MWA with RIT. The combined therapy is an innovative and conservative approach and could become a safe alternative to surgery for the treatment of very large benign nodular goiters. Due to the short follow-up and the limited number of patients, further studies will be necessary.

  17. Evaluación de parámetros físico químicos en tres marcas de sal de consumo nacional en el Ecuador continental

    Obando Rodríguez, Miriam del Rocío


    Iodine is an essential micronutrient for the functions of the human organism. The lacking of this is actually recognized as the principal cause of disability that can be prevented. According to World Health Organization (WHO) among the most frequent disorders for the lacking of Iodine are: Hypothyroidism, goiter, cretinism and serious problems in pregnancy. The problem that this study focuses is the acknowledgement of the consumer about the characteristics of the salt; therefore, there is ...

  18. Nonsurgical, image-guided, minimally invasive therapy for thyroid nodules

    Gharib, Hossein; Hegedüs, Laszlo; Pacella, Claudio Maurizio


    , with the focus on large-scale and preferably randomized studies, available via PubMed search in authors' files, using appropriate searches and keywords. Main Findings: In large centers with experienced hands, minimally invasive approaches appear effective and safe. At present, percutaneous ethanol injection...... evaluation. These techniques have also been applied to recurrent locoregional cervical thyroid cancer with encouraging initial results, although still limited data. Conclusions: Surgery and radioiodine remain as conventional and established treatments for nodular goiters. However, the new image...

  19. Ecological Impact Assessment of Isfahan’s West Ringway on Ghamishloo Wildlife Refuge Using Habitat Evaluation Procedure (HEP

    T. Makki


    Full Text Available Development of roads through protected areas and ecological sensitive regions can have catastrophic effects on wildlife. In Iran, road construction in sensitive habitats and protected areas has been expanding during the past decades. This study focuses on the ecological impacts of Isfahan’s west ringway, which passes through Ghamishloo wildlife refuge, I.U.C.N category IV, in Isfahan Province. The key affected species of the study area goitered gazelle (Gazella subgutturosa subgutterosa, was considered for impact analysis. We used HEP (Habitat Evaluation Procedure as a habitat-based impact assessment methodology which considers habitat quality and quantity. Habitat quality was measured as habitat suitability index for the species. By literature review and field observations (293 presence points, five effective variables in habitat suitability including vegetation cover, slope, elevation, distance to water and distance to road were identified, and habitat units (HUs were derived from multiplying the HSI for goitered gazelle by the species habitat area at two times (before and after road construction. The results showed that due to the presence of the ringway, 7710 HUs for goitered gazelle have been lost. In addition, we used landscape ecology approach for quantifying landscape pattern change due to road construction and landscape metrics including NP (Number of Patches, MNN (Mean Nearest Neighbor and CONTAG (Contagion. Our results provided quantitative data on habitat loss and landscape fragmentation in Ghamishloo wildlife refuge and indicated negative impacts of the ringway on goitered gazelle populations by restricting their movement between habitat patches in this region, which presents a concern for the conservation of this vulnerable species.


    N. N. Tsybikov


    Full Text Available The patients with autoimmune thyroiditis and various functional states of thyroid gland, and diffuse toxic goiter with pronounced thyrotoxicosis were studied for neurospecific enolase and enolase-specific autoantibodies levels in blood serum. Increased concentrations of neurospecific enolase and specific autoantibodies were revealed in all groups of the patients. A conclusion was drawn that nervous system may be involved into pathological process during development of thyropaties.


    Alfredo ePontecorvi


    Full Text Available Objective. Thyroid-related emergencies are caused by overt dysfunction of the gland that are so severe that require admission to intensive care units frequently. Nonetheless, in the ICU setting, it is crucial to differentiate patients with non-thyroidal illness and alterations in thyroid function tests from those with intrinsic thyroid disease. This review presents and discusses the main etiopathogenetical and clinical aspects of hypothyroid coma (HC and thyrotoxic storm (TS, including therapeutic strategy flow-charts. Furthermore, a special chapter is dedicated to the approach to massive goiter, which represents a surgical thyroid emergency.Data source. We searched the electronic MEDLINE database to September 2013.Data selection and Data extraction. Reviews, original articles and case reports on myxedematous coma, hypothyroid coma, thyroid storm, thyrotoxic storm, massive goiter, huge goiter, prevalence, etiology, diagnosis, therapy, prognosis were selected.Data synthesis and conclusions. Severe excess or defect of thyroid hormone are rare conditions which jeopardize the life of patients in most cases. Both HC and TS are triggered by precipitating factors, which occur in patients with severe hypothyroidism or thyrotoxicosis, respectively. The pillars of HC therapy are: high dose l-thyroxine and/or tri-iodothyroinine; i.v. glucocorticoids; treatment of hydro-electrolyte imbalance (mainly, hyponatraemia; treatment of hypothermia; not rarely, endotracheal intubation and assisted mechanic ventilation are needed. Therapy of TS is based on beta-blockers, thyrostatics, and i.v. glucocorticoids; eventually, high-dose iodide compounds or lithium carbonate may be of benefit. Surgery represents the gold standard treatment in patients with euthyroid massive nodular goiter, although new techniques – e.g., percutaneous laser ablation - are helpful in subjects at high surgical risk or refusing operation.

  2. Prevention and treatment of emergencies in thyroid patients


    AimTo evaluate the surgical treatment outcomes for patients with acute complications of thyroid disease (compression syndrome, early postoperative complications - like bilateral recurrent laryngeal nerve injure, bleeding (PB) in thyroid bed and others) performed in the single medical center.Material and methodsAnaplastic Thyroid Cancer (243 patients), multiglandular retrosternal goiter (25 cases), and purulent acute thyroiditis (9 observations) made heavy compression of neck and mediastinal a...

  3. Approach to the Pediatric Patient with Graves’ Disease: When Is Definitive Therapy Warranted?


    remission for pediatric patients should be a routine part of follow-up visits. Risk factors associ- ated with a decreased likelihood of remission include...palpation criteria for determination of goiter prev- alence in regions of mild and severe iodine deficiency . Eur J Endo- crinol 143:727–731 23...Genetic and environmental factors play a role in the pathogenesis of GD, reflected by an increased association with other au- toimmunedisorders and

  4. Neuropathology


    2008113 Experimental study of the apoptosis in rat hippocampus induced by high iodine. YUE Dan(岳丹), et al. Dept Biochem, Liaoning Med Coll, Jinzhou 121001. Chin J Endemiol 2007;26(6):611-615. Objective To investigate the morphological structure and the mechanism of the apoptosis in rat hippocampus induced by high iodine. Methods An animal model of goiter was reconstructed in rat fed with water containing high level of iodine (the

  5. Neurofibromatosis type 1 and autoimmune hyperthyroidism in a 10,5 years-old girl

    Huseyin Demirbilek


    Full Text Available Neurofibromatosis type 1 (NF1 is an autosomal dominant inherited multisystem disease associated with several endocrine disorders. Association of NF1 and hyperthyroidism is extremely rare. All previously reported cases were in adult age group. Herein, we present autoimmune thyrotoxicosis associated to NF1 in a pediatric patient presenting with goiter and symptoms of thyrotoxicosis. [Cukurova Med J 2013; 38(4.000: 805-808

  6. Fisher criteria vs. thyroid aspiration citology in the diagnosis of hashimoto's thyroiditis Valor de cuatro de los criterios de Fischer comarados con la biopsia tiroidea por aspiración en el diagnóstico de la tiroiditis de Hashimoto

    Constanza Díaz González; Arturo Orrego; Mauricio Orrego; John J. Orrego


    One hundred and forty one patients with diffuse goiter were studied In order to evaluate four of Fisher's criteria for the diagnosis of Hashimoto's thyroiditis and to compare them with the result of thyroid aspiration biopsy. The following criteria were Included in the analysis: a) physical characteristics of the gland; b) appearance of the radioisotope scan; c) plasma TSH concentration; d) serum tilters of anti...

  7. The clinical significance evaluation of serum β2-microglobulin for thyroid cancer patients

    Shihong Ma; Qinjiang Liu; Kesheng Li


    Objective: The aim of this study was to investigate the clinical value and relevance on the serum β2-microglobulin (β2-MG) of patients with thyroid cancer. Methods: One thousand and two normal cases, 95 thyroid cancer patients and 243 nodular goiter patients were selected to measure serum β2-MG levels using double-antibody sandwich enzyme-linked immu-nosorbent assay (ELISA). Results: The positive rate of 7.78% in normal population (78/1002) and 31.57% in thyroid cancer patients (30/95). There were significant differences between the normal population and thyroid cancer patients (χ2 = 55.352; P = 0.000). The positive rate of 7.81% in nodular goiter patients (19/243) and there were no significant differences between the normal population and nodular goiter patients (χ2 = 0.0004; P = 0.986), but significant differences between nodular goiter patients and thyroid cancer patients (χ2 = 31.106; P = 0.000). Meanwhile, the significant difference of the positive rate existed in between the various pathological types of thyroid cancer (χ2 = 10.015; P = 0.007), anaplastic thyroid cancer patients with the highest positive rate and The significant difference was found between the positive lymph node metastasis groups and negative lymph node metastasis groups (χ2 = 4.441; P = 0.035), the presence of distant metastasis group and absence of distant metastasis group (χ2 = 9.795; P = 0.002). Conclusion: Serum β2-MG levels and prognosis of thyroid cancer patients was negatively correlated. It showed important clinical value to detect the level of β2-MG in the early diagnosis, prognosis and the clinical observation for thyroid cancer patients.


    Bera Swati; Gupta Soma; Dutta Sumanta K; Chowdhury Kanika M; Bhattacharyya Swati; Saha (Das) Mita


    Anti-TPO antibody level was evaluated in 86 patients, along with 25 healthy controls to detect its change in various forms of thyroid nodules particularly in thyroid malignancy when compared with healthy controls. The study revealed that Anti-TPO antibody level was increased in Benign & toxic form of Multi nodular goiter and papillary carcinoma but there is no elevation of Anti- TPO antibody level in follicular adenoma or follicular carcinoma.

  9. [The wound drainage after operation on thyroid gland].

    Nechay, A P; Smolyar, V A; Voytenko, V V; Sichinava, R M; Larin, A S; Cherenko, S M


    Efficacy of active draining, promoting the most rapid reconvalescence and rehabilitation of the patients, in comparison to passive wound draining was studied up in various diseases of thyroid gland and operative intervention volume. The autors have had concluded, that suturing of operative wound without draining after hemithyroidectomy conduction is possible, as well as a thyroidectomy for nodular and multinodular goiter, if the excised volume of the lobe/gland do not exceed 15 cm3 and in nonapplication of anticoagulants.

  10. Lymphocytic thyroiditis: a correlation of cytological grades with clinical, biochemical and ultrasound findings

    P. Uma; B. V. S. Kartheek; S. Himaja; J. Chandra Lekha; A. Kasi Babu; A. Bhagya Lakshmi


    Background: Hashimoto’s thyroiditis sometimes referred to as goitrous thyroiditis is a synonym of chronic lymphocytic thyroiditis or autoimmune thyroiditis. Chronic lymphocytic thyroiditis (Hashimoto’s thyroiditis) is one of the most common cause of goiter and hypothyroidism, it is found most commonly in middle aged and young female, but can also occur in other age groups, including children. Chronic lymphocytic thyroiditis can be graded based on cytomorphology. In this study an att...

  11. [Diffuse sclerosing papillary carcinoma mimicking chronic lymphocytic thyroiditis. A unusual neoplasm variant].

    Pino Rivero, V; Pardo Romero, G; González Palomino, A; Pantoja Hernández, C G; Trinidad Ramos, G; Marcos García, M; Blasco Huelva, A


    We report the clinical case of a 39 years old female diagnosed as a chronic lymphocytic tiroiditis by F.N.A.B. with multinodular goiter of long evolution. The patient was operated by total thyroidectomy and her final anatomopathologic result was papillary carcinoma diffuse sclerosing variant. During the surgical act several cervical nodes were detected and removed being informed the most of them as metastasic. A review of the literature at respect of this malignant neoplasm is performed.

  12. The structure of thyroid gland in its pathology

    Khayrullin R.M.; Kalmin O.V.; Kalmin O.O.


    Objective: to identify the microscopic features of the structure of the thyroid gland in different forms of its pathology. Materials and Methods. The study is based on the thyroid glands of 199 patients of both sexes aged 21 to 74 years. Results. At the micro-macrofollicular nontoxic goiter was found flattened thyroid epithelium with flattened normochromic nucleus, the small size of cells and nuclei, low nuclear-cytoplasmic index, intrafollicular moderate epithelial proliferation, homogeneous...

  13. [Results of epidemiologic studies performed after the disaster in Czernobyl among the adult part of the population in the region of Krakow].

    Szybiński, Z; Korzeniowska, D; Przybyszowski, A; Przybyłowski, J; Skalski, M; Gołkowski, F; Stanuch, H; Wiśniowski, Z


    Epidemiologic studies following the Czernobyl accident were performed in region Kraków, including Kraków, Nowy Sacz and Kielce district. 1426 males and 2495 females were selected according to the random sample on the whole population of Kraków and Nowy Sacz, as well as in some selected areas in Swietokrzyski Mountains, and in Kielcecity. The aim of the study was to assess the results of the prophylaxis with Kalium iodine after the radiation and the incidence of the goiter in the population. It was stated, that 19.2% of the population in Kraków district, 16.9% in Nowy Sacz and 20% in Kielce received the prophylactic dosis of K.J. 80% took mainly the Lugol solution, between May, the 1st and 5th, 1986. Among 18 of person showing side effects like gastrointestinal disturbances, 16 were of female sex. Goiter incidence according to WHO classification was 50.7%, 67.3% and 49.9% in Kraków, Nowy Sacz and Kielce respectively. The difference between the incidence of goiter in males and females was 1:3. In women it was rather Ist and IInd degree of goiter, in men OB and Ist. Nodules of thyroid gland in the rural region of Kraków, Nowy Sacz and Kielce were seen in women in 10.8%, 1.7%, add 12.3% consecutively. Hormonal studies i.e T3, T4, TSH serum concentration showed normal results in all groups studied. TSH concentration was the highest in the group OB. The microsomal and antithyroglobulin antibodies level was the same independently on the prophylactic dosis of Lugol solution. The high incidence of thyroid diseases not related to the accident was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Hemosiderin laden macrophages and hemosiderin within follicular cells distinguish benign follicular lesions from follicular neoplasms

    Jaffar Reema


    Full Text Available Background: Published criteria to distinguish benign colloid nodules from follicular neoplasms emphasize only three interdependent features: size of follicles, amount of colloid, and cellularity. There is a need for the validation of other independent criteria. Methods: This study quantified the significance of cystic change, defined as presence of macrophages, and the presence of hemosiderin in either the macrophages or follicular cells. The cohort consisted of 165 patients with fine needle aspiration (FNA and histologic follow-up of either goiter (101, follicular adenoma (47, or follicular carcinoma (17. Papillary thyroid carcinomas and Hürthle cell neoplasms were excluded from the cohort, because these categories are known to show cystic change and hemosiderin. FNAs were reviewed blindly with the most cellular slide scored for the presence of macrophages and/or hemosiderin. Results: Hemosiderin within macrophages were seen in 67% (68 of 101 of the goiters and only 6% (four of 64 of follicular neoplasms ( P < .0001. All four follicular neoplasms with hemosiderin in macrophages were adenomas. Three of these four had equivocal features of a benign colloid nodule histologically. None of the 17 follicular carcinomas had hemosiderin in macrophages ( P < .12. Macrophages without hemosiderin also strongly distinguished goiters from neoplasms (83% vs 17% but appears less useful as a criterion since macrophages were present within 3 of 17 follicular carcinomas. Hemosiderin within follicular epithelial cells was present in 18% (18 of 101 of goiters, whereas none of the 64 follicular neoplasms had intraepithelial hemosiderin ( P < .0003. Conclusions: If papillary thyroid carcinoma and Hürthle cell neoplasm are ruled out, our findings indicate that the presence of hemosiderin virtually excludes a clinically significant follicular neoplasm.

  15. Thyrotoxic hypokalemic periodic paralysis in a Hispanic male.

    Zumo, Lawrence A.; Terzian, Christian; Brannan, Timothy


    We report a case of a Hispanic male presenting with acute onset of bilateral lower extremity weakness, without any antecedent viral or bacterial illness, dietary changes, infiltrative orbitopathy, diffuse goiter, infiltrative dermopathy, and family history of periodic paralysis, who was later found to have Graves' disease. This demonstrates a rare case of periodic paralysis as the initial presentation of hyperthyroidism. Thyrotoxic hypokalemic periodic paralysis is common in Asian and Hispanic individuals and uncommon in whites and African Americans. PMID:12069220

  16. Military Nutrition Initiatives


    Tomatoes , canned.............. .... I 2 1.41 2 Tomatoes . dehy....................... . 0.213 Total Tomatoes .................... 1 1- 041 2 1 Total... Tomatoes ......................... 2 1.411 2 Prunes............................. 0.38 0.46 0.5 Apples. evap............................. 0.13 0.131 0.25...scurvy, beriberi, xerophthalmia, and goiter (caused by lack of adequate dietary vitamin D, niacin, vitamin C, thiamin, vitamin A, and iodine

  17. Mineral resource of the month: iodine

    Polyak, Désirée E.


    The article focuses on iodine, its benefits and adverse effects, and its production and consumption. It states that iodine is essential to humans for it produces thyroid hormones to nourish thyroid glands but excessive intake could cause goiter, hyperthyroidism or hypothyroidism. U.S. laws require salt iodization to help prevent diseases. Chile and Japan are the world's leading iodine producer while in the U.S. iodine is mined from deep well brines in northern Oklahoma.

  18. The Mechanistic Role of Iodine in Breast Carcinogenesis


    hyperthyroidism , thyroiditis, and endemic goiter. (3) For example, studies show that the incidence of breast cancer is low in areas where endemic...the cells caused by expression of NIS and/or LPO. The in vivo experiments of tumor growth of the cells lines in mice are currently in progress...Netten C. Hypothesis: iodine, selenium and the development of breast cancer. Cancer Causes Control (2000) 11:121-7. 7. Eskin BA. Iodine and mammary

  19. Boron - A potential goiterogen?

    Popova, Elizaveta V; Tinkov, Alexey A; Ajsuvakova, Olga P; Skalnaya, Margarita G; Skalny, Anatoly V


    The iodine deficiency disorders (IDD) include a variety of disturbances such as decreased fertility, increased perinatal and infant mortality, impaired physical and intellectual development, mental retardation, cretinism, hypothyroidism, and endemic goiter (EG). The occurrence of the latter is determined by interplay between genetic and environmental factors. The major environmental factor is iodine status that is required for normal thyroid hormone synthesis. However, other factors like intake of micronutrients and goiterogens also have a significant impact. Essential and toxic trace elements both play a significant role in thyroid physiology. We hypothesize that in terms of overexposure boron may serve as a potential goiterogen. In particular, it is proposed that boron overload may impair thyroid physiology ultimately leading to goiter formation. Certain studies provide evidential support of the hypothesis. In particular, it has been demonstrated that serum and urinary B levels are characterized by a negative association with thyroid hormone levels in exposed subjects. Single indications on the potential efficiency of B in hypothyroidism also exist. Moreover, the levels of B were found to be interrelated with thyroid volume in children environmentally exposed to boron. Experimental studies also demonstrated a significant impact of boron on thyroid structure and hormone levels. Finally, the high rate of B cumulation in thyroid may also indicate that thyroid is the target for B activity. Chemical properties of iodine and boron also provide a background for certain competition. However, it is questionable whether these interactions may occur in the biological systems. Further clinical and experimental studies are required to support the hypothesis of the involvement of boron overexposure in goiter formation. If such association will be confirmed and the potential mechanisms elucidated, it will help to regulate the incidence of hypothyroidism and goiter in endemic

  20. Prevalence Of Goitre In A Non Endemic Area Of Gujarat

    Kumar P


    Full Text Available A cross-sectional, prevalence-based study comprising a community (22.486 and school survey (19.589 in rural Mehsana, North Gujarat (population: 20,37,367 revealed the goiter prevalence as 3.5% and 7.3% respectively. Grading of goiter by Stanbury’s classification showed 90% -93% of swelling as mid (ob. Application of Stanbury’s criteria over the findings of this study proved the area non-endemic. Prevalence was higher in the school than the age at which prevalence increased in the study area, was delayed to 10 years. Similar to endemic areas, prevalence was higher in females than males in all age groups (except pre-school and the sex difference was most marked in 15-44 years. A marker (ratio of grade I to ob goiter grade has also been suggested for long term, intervention-oriented monitoring of non- endemic areas.

  1. Superior parathyroid gland approach to the recurrent laryngeal nerve.

    Elsheikh, Ezzeddin


    The superior parathyroid gland is known to be almost constant in its location under the false thyroid capsule. Could it be a landmark to point to the site of incision of the false thyroid capsule and find the plane of the recurrent laryngeal nerve (RLN) during thyroidectomy? The study included 48 patients with benign goiter scheduled for hemithyroidectomy or total thyroidectomy; there were 16 cases of solitary thyroid nodules, 27 cases of multinodular goiter, and 5 cases of toxic goiter. This study included 80 lobectomies. All patients showed no evidence of postoperative RLN palsy, bleeding, or hypoparathyroidism. The superior parathyroid gland was consistently found within the false capsule in all cases, whereas the inferior parathyroid was found within the same layer in 64 sides (80%). The described approach can accurately guide dissection between true and false capsules of the thyroid to reach and preserve both the RLN and the superior parathyroid gland. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1287-1290, 2017. © 2017 Wiley Periodicals, Inc.

  2. A case report of thyroid storm induced by acute sepsis

    Chiu-Yin Yeh; Wen-Liang Yu


    Thyroid storm is a rare but life-threatening condition, which can be induced by many critical diseases. We reported a 40-year-old woman with thyroid goiter manifesting with acute sepsis-induced hyperthyroidism. She mainly presented with abdominal bloating, diarrhea, lower limbs edema and exertional dyspnea. The lactate was 9.5 mmol/L and procalcitonin was 3.8 ng/mL, suggesting acute sepsis. The thyroid echo showed bilateral thyroid goiter. Relevant data included a thyroid-stimulating hormone level of 0.03 mIU/mL;free tetraiodothyronine, 5.67 ng/dL;thyroid-stimulating hormone receptor antibody, 76.9%(normal range, < 14%); and antimicrosomal antibody titer, 1:102 400 (normal range,<1:100), suggesting toxic goiter with thyroid storm. Piperacillin/tazobactam, methimazole and Lugol's iodine achieved a good outcome. The symptoms of early sepsis and those of thyroid storm could be similar. Therefore, a careful history taking, a thorough physical examination and a high degree of suspicion could make early diagnosis and appropriate treatment.

  3. A case report of thyroid storm induced by acute sepsis

    Chiu-Yin Yeh


    Full Text Available Thyroid storm is a rare but life-threatening condition, which can be induced by many critical diseases. We reported a 40-year-old woman with thyroid goiter manifesting with acute sepsis-induced hyperthyroidism. She mainly presented with abdominal bloating, diarrhea, lower limbs edema and exertional dyspnea. The lactate was 9.5 mmol/L and procalcitonin was 3.8 ng/mL, suggesting acute sepsis. The thyroid echo showed bilateral thyroid goiter. Relevant data included a thyroid-stimulating hormone level of 0.03 μIU/mL; free tetraiodothyronine, 5.67 ng/dL; thyroid-stimulating hormone receptor antibody, 76.9% (normal range, < 14%; and antimicrosomal antibody titer, 1:102400 (normal range, < 1:100, suggesting toxic goiter with thyroid storm. Piperacillin/tazobactam, methimazole and Lugol's iodine achieved a good outcome. The symptoms of early sepsis and those of thyroid storm could be similar. Therefore, a careful history taking, a thorough physical examination and a high degree of suspicion could make early diagnosis and appropriate treatment.

  4. The frequency of Hashimoto thyroiditis in children and the relationship between urinary iodine level and Hashimoto thyroiditis.

    Doğan, Murat; Acikgoz, Emel; Acikgoz, Mehmet; Cesur, Yasar; Ariyuca, Sevil; Bektas, Mehmet Selcuk


    The aim of this study was to determine the frequency of thyroid autoimmunity in second grade primary school students and to examine the relationship between iodine and Hashimoto thyroiditis (HT). This was a cohort study performed with 1000 students. Urinary iodine levels, antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-Tg) antibodies were determined in all children. Children with anti-TPO or anti-Tg antibody positivity or with goiter were summoned for detailed examinations. In total, 36 cases (3.6%) were diagnosed as HT. The goiter frequency was found in 17.5% of the whole cohort. Additionally, iodine deficiency was found in 64.2% of all children. The median urinary iodine excretion was determined as 132 microg/L (range 382 microg/L) in the HT group, whereas it was 73 microg/L (range 390 microg/L) in children with goiter but without HT and 81 microg/L (range 394 microg/L) in normal children. The urinary iodine level of HT cases was significantly higher than the other two groups (p < 0.001). HT was also determined in 2% of patients with low urinary iodine levels, in 6.2% of patients with normal urinary iodine levels, and in 7.5% of patients with high urinary iodine levels. Our data demonstrates the close relationship between excessive iodine levels and autoimmunity.




    Full Text Available AIM OF THE STUDY: To generate comparative clinical data between Anti TPO antibodies and FNAC in the diagnosis of Hypothyroidism in 18 – 60 year age group. MATERIALS AND METHODS: A total of 30 patients, with Hypothyroidism detected within one year from study onset was evaluat ed by Ultrasonography and FNAC of thyroid to arrive at an etiological diagnosis. Anti - Thyroid peroxidase antibody estimation was done for all the patients and levels were compared and contrasted with respect to various histological diagnosis. RESULTS: Amo ng the cases 15 patients (50% had FNAC proven Hashimoto’s thyroiditis. Among them 11 patients (73% had high Anti TPO levels and 4 patients (23% had normal levels. 6 patients (6.6% had colloid and nodular goiter each. Among those with colloid goiter hig h Anti TPO levels was seen in 3 patients and 3 had normal levels. In those with Nodular goiter high Anti TPO levels was seen in 2 patients and 4 had normal levels. Lymphocytic thyroiditis, Degenerative nodules and Follicular neoplasm was seen in 1 patient each. High Anti TPO antibodies was seen in Lymphocytic thyroiditis and Follicular neoplasm, and normal level in Degenerative nodule. CONCLUSION: Elevated Anti TPO antibodies in a patient with Hypothyroidism is an indicator of autoimmune thyroiditis.

  6. Experience of 1166 Thyroidectomy without Use of Prophylactic Antibiotic

    Qiang Lu


    Full Text Available Background. Although the procedure requires a small surgical incision and a short duration, incision infection rate is very low in thyroidectomy; however, doctors still have misgivings about infection events. Aim. We retrospectively analyzed the prevention of incision infection without perioperative use of antibacterial medications following thyroidectomy. Materials and Methods. 1166 patients of thyroidectomy were not administered perioperative antibiotics. Unilateral total lobectomy or partial thyroidectomy was performed in 68.0% patients with single-side nodular goiter or thyroid adenoma. Bilateral partial thyroidectomy was performed in 25.5% patients with nodular goiter or Graves’ disease. The mean time of operation was 80.6 ± 4.87 (range: 25–390 min. Results. Resuturing was performed in two patients of secondary hemorrhage from residual thyroid following bilateral partial thyroidectomy. Temporally recurrent nerve paralysis was reported following right-side total lobectomy and left-side subtotal lobectomy in a nodular goiter patient. One case had suppurative infection in neck incision 5 days after bilateral partial thyroidectomy. Conclusions. Thyroidectomy, which is a clean incision, involves a small incision, short duration, and minor hemorrhage. If the operation is performed under strict conditions of sterility and hemostasis, antibacterial medications may not be required to prevent incision infection, which reduces cost and discourages the excessive use of antibiotics.

  7. Iodine and Iron Deficiency in Mild Iodine Deficiency Region Under Iodine Supplementation

    L Suplotova


    Full Text Available Objectives: Studying epidemiological criteria deficiency of iron and iodine at the population of Tyumen, on a background of iodine preventive maintenance. Methods: Because iron deficiency may impair the efficacy of iodine supplementation, the aim of this study was to determine the relation between serum ferritin and goiter, urinary iodine following iodized salt supplementation. Schoolboys are included in conformity to recommendations the WHO (1997 in 9—12 years old children (n = 435.. Results: On a background of preventive actions at the Tyumen schoolboys sufficient iodine maintenance (frequency of a craw is determined according to ultrasonic — 1.9%, a median urinary iodine — 113 mkg/l. The average level serum iron has made 13 ± 6.2 mg/dl, serum ferritin — 38.6 ± 30.9 mg/dl. At 30 % of schoolboys deficiency of iron is determined. Conclusion: In conditions compensated endemic goiter authentic correlation between criteria of an exchange of iron and parameters of iodine maintenance it is not established. Key words: iodine deficience, thyroid, goiter, iron, anemia.

  8. A novel insertion-induced frameshift mutation of the SLC26A4 gene in a Korean family with Pendred syndrome.

    Sagong, Borum; Seok, Jun Ho; Kwon, Tae-Jun; Kim, Un-Kyung; Lee, Sang-Heun; Lee, Kyu-Yup


    Pendred syndrome (PS) is an autosomal recessive disorder characterized by congenital bilateral sensorineural hearing loss, goiter, and incomplete iodide organification. Patients with PS also have structural anomalies of the inner ear such as enlarged vestibular aqueducts (EVA) and Mondini's malformation. The goiter, which is a major clinical manifestation of PS, usually develops around adolescence. PS is caused by biallelic mutations of the SLC26A4 gene, while nonsyndromic bilateral EVA is associated with zero or one SLC26A4 mutant allele. We report here a Korean family including a young female with PS who had goiter and progressive, fluctuating sensorineural hearing loss that could be partially recovered by oral steroid treatment. Genetic investigation revealed compound heterozygous mutations for p.R677AfsX11, a novel frameshift mutation, and p.H723R in the SLC26A4 gene. Our findings provide detailed information regarding the distribution of mutant alleles for PS and may serve as a foundation for studies to comprehend the genetic portion of syndromic hearing loss.

  9. Differential diagnosis of hyperthyroidism

    Emrich, D.


    There are probably two reasons for hyperthyroidism: 1. A disturbance in the immune system. This leads to the production of autoantibodies which predominantly stimulate thyroid function. 2. An increased formation of autonomus follicles in the thyroid gland during the development of a goiter. Autonomus follicies can be located within the thyroid gland in a focal or disseminated pattern. They are found predominantly in bigger, long-standing goiters with degenerative areas. The extent of autonomy is probably determined by the amount to autonomous follicles and their activity. In the euthyroid state autonomy can be detected by a subnormal TRH test. Quantitative scintigraphy under suppression is probably more sensitive. In goiters with autonomy, transition from the euthyroid into the hyperthyroid state especially in areas of iodine deficiency is often induced by application of iodine containing drugs and X-ray media. It the patient is already in a hyperthyroid state its immunogenic and non-immunogenic origin can be recognized with rather high probability by certain clinical symptoms and by some simple laboratory investigations. This may have significance for the selection of therapy.

  10. Cardiovascular involvement in patients with different causes of hyperthyroidism.

    Biondi, Bernadette; Kahaly, George J


    Various clinical disorders can cause hyperthyroidism, the effects of which vary according to the patient's age, severity of clinical presentation and association with other comorbidities. Hyperthyroidism is associated with increased morbidity and mortality from cardiovascular disease, although whether the risk of specific cardiovascular complications is related to the etiology of hyperthyroidism is unknown. This article will focus on patients with Graves disease, toxic adenoma and toxic multinodular goiter, and will compare the cardiovascular risks associated with these diseases. Patients with toxic multinodular goiter have a higher cardiovascular risk than do patients with Graves disease, although cardiovascular complications in both groups are differentially influenced by the patient's age and the cause of hyperthyroidism. Atrial fibrillation, atrial enlargement and congestive heart failure are important cardiac complications of hyperthyroidism and are prevalent in patients aged > or = 60 years with toxic multinodular goiter, particularly in those with underlying cardiac disease. An increased risk of stroke is common in patients > 65 years of age with atrial fibrillation. Graves disease is linked with autoimmune complications, such as cardiac valve involvement, pulmonary arterial hypertension and specific cardiomyopathy. Consequently, the etiology of hyperthyroidism must be established to enable correct treatment of the disease and the cardiovascular complications.

  11. Usefulness of ultrasound examination in the evaluation of a neonate’s body fluid status

    Joanna Kieliszczyk


    Full Text Available Appropriate hydration is a very important prognostic factor for the patient’s health. Ultrasonographic assessment of hydration status is rarely used in pediatric medicine and it is not used at all in neonates due to the fact that no reference values have been established for this age group. The aim of the paper was to establish reference values for neonates. Material and methods: The study included 50 neonates from two hospitals in the Lower Silesia region of Poland; 25 of them were healthy patients (full-term newborns with no perinatal complications and 25 were sick patients (newborns with heart defects such as ostium secundum atrial septal defect, ventricular septal defect, permanent foramen ovale and patent ductus arteriosus as well as newborns with neonatal jaundice or pneumonia that occurred during the first days of life. The ultrasound scans were conducted during the first days of the children’s life. For every child inferior vena cava diameter was measured in the substernal area, longitudinal plane, M-mode in two respiratory phases: inhalation and exhalation. In addition, abdominal aorta diameter was determined (substernal area, transverse plane. Results: The study demonstrated a statistically significant difference in the calculated inferior vena cava collapsibility index between both groups. Two other indices included the ratio of the inferior vena cava diameter during the expiratory phase to the diameter of the aorta and the ratio of the inferior vena cava diameter during the inspiratory phase to the diameter of the aorta; a statistically significant difference between both groups was found only for the measurements in the inspiratory phase. Conclusions: Based on the study results normal ranges for hydration indices in neonates were established. The need for the measurement of the abovementioned parameters in the inspiratory phase was determined. In addition, the usefulness of the ultrasound examination for the evaluation of body

  12. Nuss bar procedure: past, present and future

    Obermeyer, Robert J.; Kelly, Robert E.


    Repair of pectus excavatum began at the beginning of the 20th century before endotracheal intubation was standard practice. Surgeons therefore developed techniques that corrected the deformity using an open procedure via the anterior chest wall. Initial techniques were unsatisfactory, but by the 1930s the partial rib resection and sternal osteotomy technique had been developed and was used in combination with external traction post-operatively to prevent the sternum from sinking back into the chest. In 1949, Ravitch recommended complete resection of the costal cartilages and complete mobilization of the sternum without external traction, and in 1961 Adkins and Blades introduced the concept of a substernal strut for sternal support. The wide resection resulted in a very rigid anterior chest wall, and in some instances, the development of asphyxiating chondrodystrophy. The primary care physicians therefore became reluctant to refer the patients for repair. In 1987, Nuss developed a minimally invasive technique that required no cartilage or sternal resection and relied only on internal bracing by means of a sub-sternal bar, which is inserted into the chest through two lateral thoracic incisions and guided across the mediastinum with the help of thoracoscopy. After publication of the procedure in 1998, it became widely accepted and a flood of new patients suddenly started to appear, which allowed for rapid improvements and modifications of the technique. New instruments were developed specifically for the procedure, complications were recognized, and the steps taken to prevent them included the development of a stabilizer and the use of pericostal sutures to prevent bar displacement. Various options were developed for sternal elevation prior to mediastinal dissection to prevent injury to the mediastinal structures, allergy testing was implemented, and pain management improved. The increased number of patients coming for repair permitted studies of cardiopulmonary

  13. Diagnostic value of multi-slice spiral CT in sternum fracture%多层螺旋CT对胸骨骨折诊断价值

    黎健樟; 郭冬梅


    Objective:To explore the clinical value of multi-slice spiral CT expedition in the diagnosis of sternum fracture. Methods:28 cases with sternum fracture were selected from 2011 to 2013.They were as the research objects.At the same time,the multi-slice spiral CT diagnosis data were comprehensively reviewed and analyzed.Results:28 cases in this group were confirmed by multi-slice spiral CT and multiplanar reconstruction (MPR).The diagnose accordance rate was 100%.18 cases(64.29%) were diagnosed manubrium fracture.10 cases(35.71% ) were diagnosed mesosternum fracture.5 cases(17.86% ) were combined with substernal mediastinal emphesema.12 cases(42.86%) were combined with substernal mediastinal hematoma by CT scan and MPR reestablishment.Conclusion:The multi-slice spiral CT in the diagnosis of sternum fracture has ideal and reliable diagnosis effect.It is the key for clinical diagnosis of the disease as early as possible and formulating targeted treatment schedule in the future.It suggests strengthen the popularization in clinical.%目的:探讨在胸骨骨折的诊断中应用多层螺旋CT探查的临床价值。方法:2011-2013年收治胸骨骨折患者28例,作为本次研究对象,同时与其多层螺旋CT诊断资料相结合,进行综合性回顾与分析。结果:本组28例病例均经多层螺旋 CT 检查或多平面重建(MPR)后确诊,诊断符合率100%。包括18例(64.29%)诊断为胸骨柄骨折,10例(35.71%)诊断为胸骨体骨折。其中5例(17.86%)合并胸骨后纵隔气肿,12例(42.86%)经CT扫描、MPR重建后提示合并胸骨后纵隔血肿。结论:为胸部骨折患者提供多层螺旋CT诊断,能够起到理想、可靠的诊断效果,是今后临床尽早诊断本病并制定有针对性治疗方案的关键,建议临床加强普及。

  14. Karyopathological traits of thyrocytes and exposure to radioiodines in Belarusian children and adolescents following the accident at the Chernobyl nuclear power plant

    Nadyrov, Eldar; Rozhko, Alexander; Nikonovich, Sergey [Republican Research Center for Radiation Medicine and Human Ecology, Gomel (Belarus); Kravtsov, Viacheslav; Aleksanin, Sergey [EMERCOM of Russia, Nikiforov Russian Centre of Emergency and Radiation Medicine, St. Petersburg (Russian Federation); Mabuchi, Kiyohiko; Hatch, Maureen [National Cancer Institute, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Rockville, MD (United States); Nakamura, Nori [Radiation Effects Research Foundation, Hiroshima (Japan)


    The Belarus-American (BelAm) thyroid study cohort consists of persons who were 0-18 years of age at the time of exposure to radioactive iodine fallout from the 1986 Chernobyl nuclear power plant accident and who have undergone serial thyroid screenings with referral for fine-needle aspiration biopsy (FNAB) using standardized criteria. We investigated thyrocyte nuclear abnormalities in cytological samples from FNABs in 75 BelAm subjects with single and multiple thyroid nodules and 47 nodular goiter patients from Leningrad, Russia, unexposed to Chernobyl fallout. Nuclear abnormalities examined included internuclear chromosome bridges and derivative nuclei with broken bridges (i.e., ''tailed'' nuclei), which are formed from dicentric and ring chromosomes and thus may be cellular markers of radiation exposure. Among subjects with single-nodular goiter, thyrocytes with bridges were present in 86.8% of the exposed BelAm cohort compared with 27.0% of unexposed controls. The average frequency of thyrocytes with bridges and with tailed nuclei was also significantly higher in the BelAm subjects than in controls. Among subjects with multinodular goiters, thyrocytes with bridges were present in 75.7% of exposed BelAm patients compared with 16.7% of unexposed controls; thyrocytes with tailed nuclei were observed in all of the BelAm subjects but in only 40% of controls, and the mean frequencies of bridges and tailed nuclei were significantly higher in the exposed group. Unusually, long bridges were detected in 29% of BelAm patients with single-nodular goiters and 35% of those with multinodular goiters, while no such abnormalities were observed among patients from the Leningrad region. In the exposed subjects from BelAm, we also found positive correlations between their estimated dose of Iodine-131 from Chernobyl fallout and the frequency of tailed nuclei (p = 0.008) and bridges (p = 0.09). Further study is needed to confirm that these phenomena represent

  15. Bocio en la provincia de Cartago

    María Dolores Fernández-Olaechea


    Full Text Available Justificación y Objetivo: La yodazión de la sal en Costa Rica, establecida en 1972, hizo que el bocio por deficiencia de yodo disminuyera en forma importante. Sin embargo, las notificaciones por bocio en todo el país han aumentado en los últimos años, siendo Cartago una de las provincias más afectadas. En el año 1994 la mitad de los casos de bocio en todo el país provenían de dicha provincia. La presente investigación trata de analizar esta elevada incidencia de bocios provenientes de la zona de Cartago. Métodos: Se analizó una muestra significativa de los casos de bocio reportados en la provincia durante el año 1996. Se eligió dicho año porque eran los últimos datos estadísticos que tenía el Ministerio de Salud en ese momento. A todos los pacientes se les tomó la historia del bocio y se les hizo examen físico. Además se les midió en sangre los niveles de honnona estimulante del tiroides (TSH, tiroxina (T4, anticuerpos antitiroideos y antimicrosomas. También se midió de la excreción urinaria de yodo y se analizó el contenido de yodo en las muestras de sal que los pacientes trajeron de sus hogares. Resultados y Conclusión: El 96% de los pacientes con bocio eran del sexo femenino, la mayoría de edad media y dedicadas a las labores del hogar. Un 68% de los bocios eran pequeños y 72% de crecimiento difuso. En el 24,5% de los casos el bocio se acompañaba de hipotiroidismo. La excreción urinaria actual de yodo se encontró disminuida en un 29% de pacientes. El 91 % de las muestras de sal resultó adecuadamente yodada. Sin embargo se descubrió una sustitución en el uso de la misma por otros condimentos elaborados con sal no yodada.Justification and Objectives: In Costa Rica the iodination of salt, established in 1972, reduced the incidence of endemic goitre. Nonetheless goiter notifications were increased during the last years. The purpose of this study is to determine the causes of the high incidence of goiter in

  16. Impact of the serum thyroglobulin concentration on the diagnostics of benign and malignant thyroid diseases; Stellenwert des Serum-Thyreoglobulinspiegels bei der Diagnostik benigner und maligner Schilddruesenerkrankungen

    Rink, T.; Schroth, H.J. [Abt. fuer Nuklearmedizin, Staedtisches Klinikum, Hanau (Germany); Dembowski, W.; Klinger, K. [Medizinische Klinik, St. Vinzenz Krankenhaus, Hanau (Germany)


    Aim of this study is to evaluate new and controversially discussed indications for determining the thyroglobulin (Tg) level in different thyroid diseases to support routine diagnostics. Methods: The following groups were included: 250 healthy subjects without goiter, 50 persons with diffuse goiter, 161 patients with multinodular goiter devoid of functional disorder (108 of them underwent surgery, in 17 cases carcinomas were detected), 60 hyperthyroid patients with autonomously functioning nodular goiter, 150 patients with Hashimoto's thyroiditis and 30 hyperthyroid patients with Graves' disease. Results: The upper limit of the normal range of the Tg level was calculated as 30 ng Tg/ml. The evaluation of the collective with diffuse goiter showed that the figure of the Tg level can be expected in a similar magnitude as the thyroid volume in milliliters. Nodular tissue led to far higher Tg values then presumed when considering the respective thyroidvolume, with a rather high variance. A formula for a rough prediction of the Tg levels in nodular goiters is described. In ten out of 17 cases with thyroid carcinoma, the Tg was lower than estimated with thyroid and nodular volumes, but two patients showed a Tg exceeding 1000 ng/ml. The collective with functional autonomy had a significantly higher average Tg level than a matched euthyroid group being under suppressive levothyroxine substitution. However, due to the high variance of the Tg values, the autonomy could not consistently be predicted with the Tg level in individual cases. The patients with Hashimoto's thyroiditis showed slightly decreased Tg levels. In Graves' disease, a significantly higher average Tg level was observed compared with a matched group with diffuse goiter, but 47% of all Tg values were still in the normal range (<30 ng/ml). Conclusion: Elevated Tg levels indicate a high probability of thyroid diseases, such as malignancy, autonomy or Graves' disease. However, as low Tg

  17. Does {sup 131}I-treatment of goitre result in an acute increase in the volume a function of the thyroid gland?; Medfoerer {sup 131}I-behandling af strufma en akut foroegelse af glandula thyreoideas volumen og funktion?

    Nygaard, B.; Faber, J.O.; Hegedues, L.


    Many textbooks claim that radioiodine ({sup 131}I) treatment should be avoided in treatment of a goitre with substernal extension, due to fear of acute swelling of the gland with resulting respiratory problems. We examined patients with multinodular goitre, either nontoxic (n=20) or toxic (n=10) after treatment with {sup 131}I. An ultrasonically determined thyroid volume and thyroid function variables were investigated before and two, seven, 14, 21, 28 and 35 days after treatment. In nontoxic goitres the thyroid volume did not increase significantly, the maximum increase in the median volume being 4% on day 7. Serum levels of free T{sub 3} and free T{sub 4} indices increased by 20% (day 7) and 13% (day 14) (p=0.002), respectively. Likewise thyroid volume in toxic nodular goitre did not change significantly after {sup 131}I treatment. None of the patients presented symptoms of tracheal compression. We conclude that {sup 131}I treatment of nontoxic as well as toxic multinodular goitre does not seem to increase thyroid volume. (au) 18 refs.

  18. Huge parathyroid carcinoma: Clinical considerations and literature review

    Marone Ugo


    Full Text Available Abstract Background Parathyroid carcinoma is a rare malignancy, with an incidence of 0.5 to 4% of all cases of primary hyperparathyroidism. Surgery is the only curative treatment. Case presentation We report the case of a 66-year-old man referred for a large suspicious substernal goitre associated with severe hypercalcemia due to hyperparathyroidism. After normalization of serum calcium levels, patient underwent surgery. The voluminous cervicomediastinal firm mass could not be removed through the cervical incision; therefore a cervicothoracic approach was employed. Histopathology revealed a giant parathyroid cancer of 450 grams. A review of the literature was also undertaken to summarize the current treatment approaches for this rare malignancy. Conclusion Parathyroid cancer is usually not recognized either preoperatively or intra-operatively. En bloc resection of the tumour with the adjacent tissue is the treatment of choice and it is very important to avoid the rupture of the capsule during operation. Neither tumour size, nor the lymph node status appears to play a role in prognosis. The management of parathyroid carcinoma is a challenge even for experienced surgeons.

  19. Morgagni-Larrey parasternal diaphragmatic hernia in the adult.

    Arráez-Aybar, L A; González-Gómez, C C; Torres-García, A J


    With a prevalence of 0.3-0.5/1000 births, congenital diaphragmatic hernia (CDH) remains a serious, poorly understood abnormality with a high mortality rate that cannot always be effectively managed. Its reported frequency in Spain is 0.69%00 with a yearly decreasing trend of 0.10%00 during the period 1980-2006. Up to 5% of cases are incidentally identified in adults undergoing studies for other reasons.We report the case of a 74-year-old woman with vomiting for three months due to parasternal diaphragmatic hernia of Morgagni-Larrey (retrochondrosternal, retrocostoxyphoid, retrosternal, subcostal, substernal or subcostosternal hernia), which allowed us to report an update on this condition in the adult, and on thoracoabdominal diaphragm morphogenesis. It is in the embryology of the diaphragm where an explanation may be found for some morphological changes and clinical manifestations, even though a number of uncertainties remain. We also analyze the extent of controversy persisting on some aspects of surgical treatment (access routes, mesh use, hernial sac reduction). Overall, minimally invasive techniques predominate. We consider laparoscopy the approach of choice for adult patients with parasternal hernia eligible for surgery.

  20. Full incorporation of Strattice™ Reconstructive Tissue Matrix in a reinforced hiatal hernia repair: a case report

    Freedman Bruce E


    Full Text Available Abstract Introduction A non-cross-linked porcine acellular dermal matrix was used to reinforce an esophageal hiatal hernia repair. A second surgery was required 11 months later to repair a slipped Nissen; this allowed for examination of the hiatal hernia repair and showed the graft to be well vascularized and fully incorporated. Case presentation A 71-year-old Caucasian woman presented with substernal burning and significant dysphagia. An upper gastrointestinal series revealed a type III complex paraesophageal hiatal hernia. She underwent laparoscopic surgery to repair a hiatal hernia that was reinforced with a xenograft (Strattice™ Reconstructive Tissue Matrix, LifeCell, Branchburg, NJ, USA along with a Nissen fundoplication. A second surgery was required to repair a slipped Nissen; this allowed for examination of the hiatal repair and graft incorporation 11 months after the initial surgery. Conclusion In this case, a porcine acellular dermal matrix was an effective tool to reinforce the crural hiatal hernia repair. The placement of the mesh and method of fixation are believed to be crucial to the success of the graft. It was found to be well vascularized 11 months after the original placement with no signs of erosion, stricture, or infection. Further studies and long-term follow-up are required to support the findings of this case report.

  1. Automatic prebent customized prosthesis for pectus excavatum minimally invasive surgery correction.

    Vilaça, João L; Rodrigues, Pedro L; Soares, Tony R; Fonseca, Jaime C; Pinho, António C M; Henriques-Coelho, Tiago; Correia-Pinto, Jorge


    Pectus excavatum is the most common deformity of the thorax. A minimally invasive surgical correction is commonly carried out to remodel the anterior chest wall by using an intrathoracic convex prosthesis in the substernal position. The process of prosthesis modeling and bending still remains an area of improvement. The authors developed a new system, i3DExcavatum, which can automatically model and bend the bar preoperatively based on a thoracic CT scan. This article presents a comparison between automatic and manual bending. The i3DExcavatum was used to personalize prostheses for 41 patients who underwent pectus excavatum surgical correction between 2007 and 2012. Regarding the anatomical variations, the soft-tissue thicknesses external to the ribs show that both symmetric and asymmetric patients always have asymmetric variations, by comparing the patients' sides. It highlighted that the prosthesis bar should be modeled according to each patient's rib positions and dimensions. The average differences between the skin and costal line curvature lengths were 84 ± 4 mm and 96 ± 11 mm, for male and female patients, respectively. On the other hand, the i3DExcavatum ensured a smooth curvature of the surgical prosthesis and was capable of predicting and simulating a virtual shape and size of the bar for asymmetric and symmetric patients. In conclusion, the i3DExcavatum allows preoperative personalization according to the thoracic morphology of each patient. It reduces surgery time and minimizes the margin error introduced by the manually bent bar, which only uses a template that copies the chest wall curvature.

  2. [Acute oral suicidal intoxication with captan--a case report].

    Chodorowski, Zygmunt; Sein Anand, Jacek; Waldman, Wojciech


    According to the best of our knowledge the second case of acute intoxication with captan was described. In this paper a 22-year old female was admitted to the Department of Toxicology with a nausea, weakness, numbness of upper limbs and substernal pain. She said that these symptoms began two hours after suicidal ingestion of 5.0 g of captan. At admission the patient was alert. Temperature was 37 degrees C, heart rate 100-120 b/min., BP 100-120/60-70 mm Hg and breathing rate 17/min. WBC were slightly elevated 12.4 x 10(3)/microl as well as the creatine kinase activity 329 U/L. ECG showed inversion of a T segment in V1-V4 leads. ECHO-sound made in 4th and 120th day after the onset of intoxication showed no changes, with EF--70%. Temporary increase of creatine kinase activity as well as the presence of inverted T segment in V1-V4 leads may suggest cardiotoxic effects of captan during acute intoxication.

  3. Medical image of the week: focal myopericaditis

    Meenakshisundaram C


    Full Text Available No abstract available. Article truncated at 150 words. A 44-year-old man with no significant past medical history was admitted with a history of two episodes of substernal chest pain unrelated to exertion which had resolved spontaneously. Admission vital signs were within normal limits and physical examination was unremarkable. Basic lab tests were normal and urine toxicology was negative. Electrocardiogram was unremarkable with no ST/T changes. Troponin I was elevated at 4.19 which trended up to 6.57. An urgent cardiac angiogram was done which revealed normal patent coronaries. His transthoracic echocardiogram was also reported to be normal. He continued to have intermittent episodes of chest pain that was partially relieved by morphine. Erythrocyte sedimentation rate and C-reactive protein were elevated. Work up for autoimmune diseases, vasculitis, myocarditis panel were insignificant. Later, magnetic resonance imaging (MRI with gadolinium enhanced contrast (Figure 1 was obtained which showed abnormal epicardial/subepicardial myocardial enhancement within the inferolateral wall and cardiac apex consistent with focal ...

  4. [Mitral valve replacement after previous coronary artery bypass grafting with functioning left internal thoracic artery graft: effectiveness of the method using a direct vision retrosternal approach; report of a case].

    Sakata, Junichi; Saito, Tatsuya; Fujii, Akira; Tsukamoto, Masaru; Date, Osamu; Yokoyama, Hideo; Abe, Tomio; Nakase, Atsunobu; Ohori, Katsumi


    Performing a redo-sternotomy when a mammary artery graft is patent can be rather difficult. We previously reported a redo-sternotomy technique involving direct visualization with a retrosternal dissection (DR) method using a Kent's retractor. The DR method in detail is as follows: 1) A midline skin incision is extended to the abdomen about 5 cm. 2) The bilateral costal arches are divided from the rectal muscle. 3). A pair of retractors is placed under the costal arch. 4) A stainless steel wire is applied to the previous sternal wire at the center of the sternum. 5) The retractor and sternal wire are lifted up using the Kent's retractor to widen the retrosternal space. 6) The sternum and sub-sternal tissue are carefully divided using an electronic scalpel or metal retractor with an entirely sternal length. 7) Routine sternotomy is performed using a Stryker. Herein, we report a patient who had undergone cardiac surgery, coronary artery bypass grafting (CABG), using a left internal mammary artery and mitral annuloplasty 2 years previously, and then developed mitral regurgitation caused by infectious endocarditis. He successfully underwent redo-sternotomy and mitral valve replacement using the DR method. In a patient with a patent internal mammary artery, the DR method greatly reduces the risk of graft injury.

  5. 甲状腺过氧化物酶抗体在甲状腺疾病中的应用价值%Value of thyroid peroxidase antibody in the application of thyroid diseases



    目的:观察不同甲状腺疾病以及自身免疫性甲状腺疾病(AITD)不同临床阶段患者血清甲状腺过氧化物酶抗体(TPOAb)浓度的变化,进而探讨其临床应用价值。方法选取2012年3月~2013年3月在本院内科住院治疗的甲状腺疾病患者共175例,其中结节性甲状腺肿38例、弥漫性毒性甲状腺肿37例、单纯性甲状腺肿35例、亚急性甲状腺炎10例、慢性淋巴细胞性甲状腺炎45例、甲状腺良性肿瘤10例;取健康志愿者35例作为对照组。通过化学发光法测定各组TPOAb以及不同组患者血清中TPOAb的浓度及阳性发生率。结果结节性甲状腺肿、单纯性甲状腺肿与弥漫性毒性甲状腺肿患者血清中TPOAb浓度及阳性率均高于亚急性甲状腺炎和慢性淋巴细胞性甲状腺炎患者,差异有统计学意义(P<0.05)。与对照组比较,差异有统计学意义(P<0.05)。结论ATD患者中的TPOAb浓度明显升高,TPOAb浓度大小对对ATD的诊断有一定的参考价值。%Objective To observe the change of serum thyroid peroxidase antibody (TPOAb) concentration in patients with different thyroid diseases and different clinical stages of autoimmune thyroid disease(AITD), and explore its clinical application value. Methods 175 inpatients with thyroid diseases who were treated in department of internal medicine in our hospital from March 2012 to March 2013 were selected, including 38 cases of nodular goiter, 37 cases of diffuse toxic goiter, 35 cases of simple goiter, 10 cases of subacute thyroiditis, 45 cases of chronic lymphocytic thyroiditis, 10 cases of benign thyroid tumor; 35 healthy volunteers were as the control group. The concentration and positive incidence of serum TPOAb of patients in different groups were determined by using the chemiluminescence method. Results The concentration and positive incidence of serum TPOAb in patients with nodular goiter, or simple goiter, or diffuse toxic

  6. On the cells of origin of radiogenic thyroid cancer: New studies based on an old idea

    Clifton, K.H.; Domann, F.E.; Groch, K.M.


    We have presented evidence that the functional thyroid follicles (follicular units, FU) which are formed in grafts of monodispersed rat thyroid cells, and hence the thyroid tumors which later develop in such grafts, are clonal in origin. Recent studies have been designed to investigate: whether cell number-dependent inhibition of promotion-progression is mediated by remote hormonal feed-back, local cell-cell interactions, or both; the cell population kinetics of the clonogen subpopulation during goitrogenesis and goiter involution; and the effect of prolonged exposure to high levels of TSH (thyrotropin) on the capacity of the clonogens to give rise to functional FU. The results indicate that local cell-cell interactions play an important role in the cell number-dependent suppression of neoplastic promotion-progression. They also show that if sufficient thyroid cells are grafted, the thyroid-pituitary axis can be reestablished in thyroidectomized rats fed normal diets. In such animals given iodine deficient diets, the FU that develop in the thyroid grafts shift their secretory pattern to increase the ratio of T3 (triiodothyronine) to T4 (thyroxine), and thus conserve the available iodine. Finally, the clonogenic subpopulation is conserved during both goitrogenesis and goiter involution. When they are transplanted to thyroidectomized recipients, clonogens from two types of goiters form FU that are morphologically indistinguishable from those that develop in grafts of normal thyroid clonogens. Furthermore, the secretion of T3 and T4 by such grafts is dependent on the grafted clonogen number, and hence FU formation, and not on the total number of thyroid cells transplanted. We conclude that the thyroid clonogens, the presumptive cancer progenitor cells, have many of the characteristics of stem cells.

  7. On the cells of origin of radiogenic thyroid cancer: New studies based on an old idea

    Clifton, K.H.; Domann, F.E.; Groch, K.M.


    We have presented evidence that the functional thyroid follicles (follicular units, FU) which are formed in grafts of monodispersed rat thyroid cells, and hence the thyroid tumors which later develop in such grafts, are clonal in origin. Recent studies have been designed to investigate: whether cell number-dependent inhibition of promotion-progression is mediated by remote hormonal feed-back, local cell-cell interactions, or both; the cell population kinetics of the clonogen subpopulation during goitrogenesis and goiter involution; and the effect of prolonged exposure to high levels of TSH (thyrotropin) on the capacity of the clonogens to give rise to functional FU. The results indicate that local cell-cell interactions play an important role in the cell number-dependent suppression of neoplastic promotion-progression. They also show that if sufficient thyroid cells are grafted, the thyroid-pituitary axis can be reestablished in thyroidectomized rats fed normal diets. In such animals given iodine deficient diets, the FU that develop in the thyroid grafts shift their secretory pattern to increase the ratio of T3 (triiodothyronine) to T4 (thyroxine), and thus conserve the available iodine. Finally, the clonogenic subpopulation is conserved during both goitrogenesis and goiter involution. When they are transplanted to thyroidectomized recipients, clonogens from two types of goiters form FU that are morphologically indistinguishable from those that develop in grafts of normal thyroid clonogens. Furthermore, the secretion of T3 and T4 by such grafts is dependent on the grafted clonogen number, and hence FU formation, and not on the total number of thyroid cells transplanted. We conclude that the thyroid clonogens, the presumptive cancer progenitor cells, have many of the characteristics of stem cells.

  8. Comparison of Na{sup +}/I{sup -} symporter expression rate in malignant and benign thyroid diseases: immunohistochemical study

    Kang, Do Young; Jeong, Young Jin; Lee, Kyung Eun; Park, Heon Soo; Yoo, Young Hyun; Roh, Mee Sook [Donga University College of Medicine, Busan (Korea, Republic of)


    Previous studies have not showed consistent results for the level of expression of sodium/iodide symporter (NIS) in thyroid diseases, especially malignant tumor. We undertook this study to evaluate the distribution of NIS expression in malignant thyroid diseases and compare with that in benign thyoid disease. Total patients were 119 cases (Men 15, 48{+-}13 yrs). Total number of samples were 205 pieces. In malignant thyroid disease, there were 153 samples: 90 in papillary carcinoma, 4 in follicular carcinoma, 2 in medullary carcinoma and 57 in metastatic lymph node. In benign thyroid disease, there were 52 samples: 36 in goiter/cyst, 11 in thyroiditis and 5 in follicular adenoma. Using immunohistochemical methods, we probed 205 samples with monoclonal anti-NIS Ab. Grading of staining was scored as 0 (negative or absent), 1 (weakly positive), 2 (moderately positive) or 3 (strongly positive). Expression rate (ER) of NIS positivity in individual disease entity was expressed as percentage of total number divided by number in 2 plus 3 grade. ERs of malignant thyroid diseases were 63% in papillary carcinoma, 81% in metastatic lymph node, 71% in follicular carcinoma and 100% in medullary carcinoma. ERs of benign thyroid disease were 53% in goiter/cyst, 64% in thyroiditis and 40% in follicular adenoma. ER of benign thyroid deceases was higher than benign thyroid diseases (71% vs 54%). Grading of NIS expression in papillary carcinoma or goiter/cyst was heterogeneously distributed in considerable cases. Normal tissue also showed heterogeneous distribution or NIS expression, which was not correlated with that of primary lesion. In papillary thyroid carcinoma, distribution of NIS expression was heterogeneous and increased, and not different compared with that of benign thyroid disease.


    H. Moayeri Z. Oloomi


    Full Text Available Patients with Turner’s syndrome (TS are at an increased risk of developing autoimmune thyroid disease (ATD. The aim of this study was to determine the frequency of anti-thyroid peroxidase (anti-Tpo antibodies and ATD in children and adolescent girls with TS. It also assessed the influence of karyotype on the development of thyroid disease. Sixty eight patients with TS were compared with 68 age matched healthy unrelated girls in this study. They were screened for anti-Tpo antibodies, free T4 and TSH levels. Sign and symptoms of hypothyroidism and hyperthyroidism and the presence of goiter were also investigated. Anti-Tpo antibodies were found in 18 (26.4% TS patients and 1 (1.4% patient in the control group (P < 0.001, evenly distributed between the karyotypes 45X, 46X, isoXq and mosaicism. Out of 68 TS patients, 8 (11.7% had visible goiter. Subclinical hypothyroidism and hypothyroidism both occurred in 2 patients (5.9%. These patients were characterized by higher levels of anti-Tpo antibodies. Visible goiter was found in 3 (4.4% subjects of the control group, but all of them were euthyroid. We found that younger patients were more likely to be anti-Tpo negative (P < 0.001. Our data demonstrated a high frequency of ATD in a representative sample of Iranian girls with TS which is in accordance with previous observations. Regular follow up assessment of thyroid autoantibodies and thyroid function in patients with TS is recommended for timely diagnosis of thyroid dysfunction and treatment.

  10. NDRG1 protein overexpression in malignant thyroid neoplasms

    Renê Gerhard


    Full Text Available OBJECTIVES: The aim of this study was to examine the expression of the N-myc downstream-regulated gene 1 protein in benign and malignant lesions of the thyroid gland by immunohistochemistry. INTRODUCTION: N-myc downstream-regulated gene 1 encodes a protein whose expression is induced by various stimuli, including cell differentiation, exposure to heavy metals, hypoxia, and DNA damage. Increased N-myc downstream-regulated gene 1 expression has been detected in various types of tumors, but the role of N-myc downstream-regulated gene 1 expression in thyroid lesions remains to be determined. METHODS: A tissue microarray paraffin block containing 265 tissue fragments corresponding to normal thyroid, nodular goiter, follicular adenoma, papillary thyroid carcinoma (classical pattern and follicular variant, follicular carcinoma, and metastases of papillary and follicular thyroid carcinomas were analyzed by immunohistochemistry using a polyclonal anti- N-myc downstream-regulated gene 1 antibody. RESULTS: The immunohistochemical expression of N-myc downstream-regulated gene 1 was higher in carcinomas compared to normal thyroid glands and nodular goiters, with higher expression in classical papillary thyroid carcinomas and metastases of thyroid carcinomas (P < 0.001. A combined analysis showed higher immunohistochemical expression of NDRG1 in malignant lesions (classical pattern and follicular variant of papillary thyroid carcinomas, follicular carcinomas, and metastases of thyroid carcinomas compared to benign thyroid lesions (goiter and follicular adenomas (P = 0.043. In thyroid carcinomas, N-myc downstream-regulated gene 1 expression was significantly correlated with a more advanced TNM stage (P = 0.007 and age, metastasis, tumor extent, and size (AMES high-risk group (P = 0.012. CONCLUSIONS: Thyroid carcinomas showed increased immunohistochemical N-myc downstream-regulated gene 1 expression compared to normal and benign thyroid lesions and is

  11. Expression of prostaglandin E2 and EP receptors in human papillary thyroid carcinoma.

    Sun, Liao; Wei, Xiaohong; Liu, Xueting; Zhou, Danli; Hu, Fang; Zeng, Yingjuan; Sun, Ying; Luo, Shunkui; Zhang, Yu; Yi, Xian Ping


    The objective of the present study is to determine the role of prostaglandin E2 (PGE2) and downstream EP receptors in the development of human papillary thyroid carcinoma (PTC). A total of 90 thyroid specimens excised from patients undergoing total or subtotal thyroidectomy in the Department of General Surgery, the Fifth Affiliated Hospital of Sun Yat-sen University, China, from August 2013 to September 2014, were analyzed. The quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and immunohistochemical analyses were employed to examine the messenger RNA (mRNA) and protein expression, respectively. The expressions and significances of cyclooxygenase-2 (COX-2), microsomal prostaglandin E synthase-1 (mPGES-1), PGE2, and EP receptors in PTC and nodular goiter were investigated. The COX-2 mRNA and protein expression level significantly increased in the PTC tissues than in the paired noncarcinoma tissues adjacent to the PTC or nodular goiter tissues. The mPGES-1 protein expression was also significantly upregulated in the PTC tissues. All the four subtypes of EP receptors (EP1-4) could express in the thyroid tissues, while only the EP4 mRNA and protein levels significantly increased in the PTC tissues. The local production of PGE2 had a higher-level expression in the PTC tissues than in the noncarcinoma thyroid tissues adjacent to the PTC lesion and the benign nodular goiter tissues. The induction of PGE2 biosynthesis as well as the overexpression of EP4 in PTC suggested that this pathway might play an important role in the carcinogenesis and progression of PTC. These observations raise the possibility that pharmacological inhibition of mPGES-1 and/or EP4 may hold therapeutic promise in this common cancer.


    H. Moayeri A. Rabbani


    Full Text Available Type I diabetes mellitus (DM is frequently associated with autoimmune thyroid disease (ATD. Association of ATD and type I DM has been described with varying frequencies but there is still debate about the situation in the Iranian population. We investigated the prevalence of anti thyroid peroxidase (anti-TPO antibodies and ATD in children and adolescents with type I DM. A total of 145 patients with type I DM were participated in this study. They were screened for anti-TPO antibodies and TSH levels. Signs and symptoms of hypothyroidism and hyperthyroidism and the presence of goiter were sought. A group of 50 healthy unrelated girls and boys aged 11-16 years served as controls. Anti-TPO antibodies were found in 34 (23.4% diabetic patients and 1 subject (2% in the control group (P<0.001. Frequency of anti TPO antibodies was significantly higher in girls than boys (P<0.05. We failed to show any significant correlation between thyroid autoimmunity and duration of DM. We found that younger patients at diagnosis are more likely to be anti-TPO negative (P<0.001. Out of 145 diabetic patients, 32 (22% had visible goiter. Subclinical hypothyroidism, hypothyroidism and thyrotoxicosis occurred in 1, 9 and 1 patients, respectively. Visible goiter was found in 2 subjects (4% of the control group, but all of them were euthyroid. In conclusion, the evaluation of thyroid autoimmunity in type I diabetic patients may improve the diagnosis of thyroid disease in early stages. Yearly examination of anti-TPO antibodies allows identifying diabetic patients with thyroid autoimmunity.

  13. Iodine deficiency in children: A comparative study in two districts of south-interior Karnataka, India

    Mansoor Ahmed


    Full Text Available Introduction: Iodine is an essential component of the hormones produced by the thyroid gland that are essential for mammalian life. Although goiter is the most visible sequelae of iodine deficiency, the major impact of hypothyroidism as a result of iodine deficiency is impaired neurodevelopment, particularly early in life. According to the World Health Organization, it is the single most preventable cause of mental retardation and brain damage. The simplest, most effective and inexpensive preventive method is the consumption of iodized salt. Objectives: The objective of the following study is to estimate the prevalence of goiter in children in the rural areas of Mysore and Coorg districts in India and estimate iodine levels in salt samples. Materials and Methods: A cross-sectional study in the age group of 6-12 years, using population proportionate to size systematic sampling method. The total sample size was 10,082: out of which 5337 was from Mysore and the rest from Coorg district. Clinical examination of the thyroid gland was done and salt samples collected for the estimation of Iodine. Results: The total prevalence of goiter was 19.01% in children of 6-12 years in Coorg district and 8.77% in Mysore district and it was more in females than in males. Conclusions: It was observed that iodine deficiency disorders is endemic in both districts, with a prevalence of 19.01% in children aged 6-12 years in Coorg district and 8.77% in Mysore district. Analysis of salt samples suggested that most of the samples were inadequately iodised (73.92% in Coorg and 45.92% in Mysore.

  14. The Clinical Study on 39 Cases of Subclinical Hypothyroidism

    Yu, Cheol Jae; Ahn, Weon Jeon; Lee, Houn Young; Ro, Heung Kyu [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)


    Subclinical hypothyroidism can be defined as an asymptomatic state in which a reduction in thyroid activity has been compensated by an increased TSH output to maintain an euthyroid state. We analysed clinical features, laboratory data, and pathologic findings in 39 cases of subclinical hypothyroidism who were diagnosed at the Dept. of Internal Medicine, Chungnam National University Hospital from Aug. 1984 to June, 1985. 1) The age distribution was from sixteen to sixty-nine and mean age was 34.8. Peak incidence was in the 4th decade and 3rd, 5th, 6th decade in order. 2) The sex distribution showed female preponderance with a ratio of 18.5 to 1. 3) The major presenting manifestations were nonspecific ones such as fatigue, indigestion, and anorexia. 4) Physical examination revealed diffuse goiter in 47.6%. Major abnormalities were no gross abnormality (30.9%), nodular goiter and facial edema. 5) There was no significant difference of the basal serum T3 and T4 concentrations between subclinical hypothyroidism and normal controls (p>0.05). 6) The basal serum TSH concentration of subclinical hypothyroidism (32.61+-14.95 muU/ml) was significantly higher than that of normal controls (3.92+-1.05 muU/ml) (p<0.005). 7) Microsomal antibody was detected in 80.6% and thyroglobulin antibody was detected in 30%. 8) The pathologic findings in 26 cases revealed Hashimoto's thyroiditis in 76.9% (lymphocytic type, 34.6%; oxyphilic type, 26.9%; fibrotic type, 15.4%). The others were adenomatous goiter (15.4%), adenomatous carcinoma (3.8%) and subacute thyroiditis (3.8%).

  15. Fine Needle Aspiration Cytology of Pediatric Thyroid Nodules

    Ayper KAÇAR


    Full Text Available Objective: The objectives were to evaluate fine needle aspiration cytology results of 39 pediatric patients, and the pathologies that cause childhood thyroid nodules, and to review the literature on the subject.Material and Method: Thyroid fine needle aspiration cytology results of 39 pediatric patients were retrospectively reviewed. Associated diseases, thyroid functions, anti-thyroid antibody levels, ultrasonographic findings and number of nodules were also evaluated.Results: The vast majority of patients with thyroid nodules were cytopathologically diagnosed as benign (97.3%. Of these patients, 64.8% (24 patients were diagnosed as nodular goiter and 35.2% (13 patients as lymphocytic thyroiditis. Thyroid malignancy was found in two patients; one was diagnosed as follicular neoplasm/ minimal invasive follicular carcinoma on surgical evaluation while the other was a secondary tumor (Burkitt's lymphoma. The majority of our subjects were females (66.6%: the female/male ratio was 2:1 for nodular goiter and 3.3:1 for thyroiditis. Surgical resection was performed in 5 patients (4 cases of nodular goiter, 1 suspicious for malignancy and cytological diagnoses were confirmed by histology.Conclusion: Our study confirmed the utility of fine needle aspiration cytology in childhood thyroid disorders along with a possible higher incidence of nodular thyroiditis in childhood. Nodular autoimmune thyroiditis, focal thyroiditis and thyroid cancer in children are discussed and attention is drawn to some special subtypes of thyroid cancer and some benign lesions that can cause difficulty in interpreting fine needle aspiration cytology and frozen sections at this age.

  16. Radiogenic neoplasia in thyroid and mammary clonogens. Progress report, January 1, 1990--December 31, 1992

    Clifton, K.H.


    We have developed rat thyroid and mammary clonogen transplantation systems for the study of radiogenic cancer induction at the target cell level in vivo. The epithelial cell populations of both glands contain small subpopulations of cells which are capable of giving rise to monoclonal glandular structures when transplanted and stimulated with appropriate hormones. Previous results indicated that these clonogens are the precursor cells of radiogenic cancer, and that initiation, is common event at the clonegenic cell level. Detailed information on the physiologic control of clonogen proliferation, differentiation, and total numbers is thus essential to an understanding of the carcinogenic process. We report here studies on investigations on the relationships between grafted thyroid cell number and the rapidity and degree of reestablishment of the thyroid-hypothalamus-pituitary feedback axis in thyroidectomized rats maintained on a normal diet or an iodine deficient diet; studies of the persistence of, and the differentiation potential and functional characteristics of, the TSH-(thyrotropin-) responsive sub- population of clonogens during goitrogenesis, the plateau-phase of goiter growth, and goiter involution; studies of changes in the size of the clonogen sub-population during goitrogenesis, goiter involution and the response to goitrogen rechallenge; and a large carcinogenesis experiment on the nature of the grafted thyroid cell number-dependent suppression of promotion/progression to neoplasia in grafts of radiation-initiated thyroid cells. Data from these studies will be used in the design of future carcinogenesis experiments on neoplastic initiation by high and low LET radiations and on cell interactions during the neoplastic process.

  17. Radiogenic neoplasia in thyroid and mammary clonogens. Progress report, January 1, 1991--December 31, 1991

    Clifton, K.H.


    We have developed rat thyroid and mammary clonogen transplantation systems for the study of radiogenic cancer induction at the target cell level in vivo. The epithelial cell populations of both glands contain small subpopulations of cells which are capable of giving rise to monoclonal glandular structures when transplanted and stimulated with appropriate hormones. During the end of the last grant year and the first half of the current grant year, we have completed analyses and summarized for publication: investigations on the relationship between grafted thyroid cell number and the rapidity and degree of reestablishment of the thyroid-hypothalamicpituitary axis in thyroidectomized rats maintained on a normal diet or an iodine deficient diet; studies of the persistence of, and the differentiation potential and functional characteristics of, the TSH- (thyrotropin-) responsive sub-population of clonogens during goitrogenesis, the plateau-phase of goiter growth, and goiter involution; studies of changes in the size of the clonogen sub-population during goitrogenesis, goiter involution and the response to goitrogen rechallenge; and the results of the large carcinogenesis experiment on the nature of the grafted thyroid cell number-dependent suppression of promotion/progression to neoplasia in grafts of radiation-initiated thyroid cells. We are testing new techniques for the culture, cytofluorescent analysis and characterization mammary epithelial cells and of clonogens in a parallel project, and plan to apply similar technology to the thyroid epithelial cells and clonogen population. Data from these studies will be used in the design of future carcinogenesis experiments on neoplastic initiation by high and low LET radiations and on cells interactions during the neoplastic process.

  18. Radiogenic neoplasia in thyroid and mammary clonogens

    Clifton, K.H.


    We have developed rat thyroid and mammary clonogen transplantation systems for the study of radiogenic cancer induction at the target cell level in vivo. The epithelial cell populations of both glands contain small subpopulations of cells which are capable of giving rise to monoclonal glandular structures when transplanted and stimulated with appropriate hormones. Previous results indicated that these clonogens are the precursor cells of radiogenic cancer, and that initiation, is common event at the clonegenic cell level. Detailed information on the physiologic control of clonogen proliferation, differentiation, and total numbers is thus essential to an understanding of the carcinogenic process. We report here studies on investigations on the relationships between grafted thyroid cell number and the rapidity and degree of reestablishment of the thyroid-hypothalamus-pituitary feedback axis in thyroidectomized rats maintained on a normal diet or an iodine deficient diet; studies of the persistence of, and the differentiation potential and functional characteristics of, the TSH-(thyrotropin-) responsive sub- population of clonogens during goitrogenesis, the plateau-phase of goiter growth, and goiter involution; studies of changes in the size of the clonogen sub-population during goitrogenesis, goiter involution and the response to goitrogen rechallenge; and a large carcinogenesis experiment on the nature of the grafted thyroid cell number-dependent suppression of promotion/progression to neoplasia in grafts of radiation-initiated thyroid cells. Data from these studies will be used in the design of future carcinogenesis experiments on neoplastic initiation by high and low LET radiations and on cell interactions during the neoplastic process.

  19. Radiogenic neoplasia in thyroid and mammary clonogens

    Clifton, K.H.


    We have developed rat thyroid and mammary clonogen transplantation systems for the study of radiogenic cancer induction at the target cell level in vivo. The epithelial cell populations of both glands contain small subpopulations of cells which are capable of giving rise to monoclonal glandular structures when transplanted and stimulated with appropriate hormones. During the end of the last grant year and the first half of the current grant year, we have completed analyses and summarized for publication: investigations on the relationship between grafted thyroid cell number and the rapidity and degree of reestablishment of the thyroid-hypothalamicpituitary axis in thyroidectomized rats maintained on a normal diet or an iodine deficient diet; studies of the persistence of, and the differentiation potential and functional characteristics of, the TSH- (thyrotropin-) responsive sub-population of clonogens during goitrogenesis, the plateau-phase of goiter growth, and goiter involution; studies of changes in the size of the clonogen sub-population during goitrogenesis, goiter involution and the response to goitrogen rechallenge; and the results of the large carcinogenesis experiment on the nature of the grafted thyroid cell number-dependent suppression of promotion/progression to neoplasia in grafts of radiation-initiated thyroid cells. We are testing new techniques for the culture, cytofluorescent analysis and characterization mammary epithelial cells and of clonogens in a parallel project, and plan to apply similar technology to the thyroid epithelial cells and clonogen population. Data from these studies will be used in the design of future carcinogenesis experiments on neoplastic initiation by high and low LET radiations and on cells interactions during the neoplastic process.

  20. The structure of thyroid gland in its pathology

    Khayrullin R.M.


    Full Text Available Objective: to identify the microscopic features of the structure of the thyroid gland in different forms of its pathology. Materials and Methods. The study is based on the thyroid glands of 199 patients of both sexes aged 21 to 74 years. Results. At the micro-macrofollicular nontoxic goiter was found flattened thyroid epithelium with flattened normochromic nucleus, the small size of cells and nuclei, low nuclear-cytoplasmic index, intrafollicular moderate epithelial proliferation, homogeneous colloid and moderate diffuse lymphoid infiltration. At the micro-macrofollicular toxic goiter detected cubic epithelium with rounded normochromic kernel, smallest size of cells and nuclei, nuclear-cytoplasmic minimum index intrafollicular focal proliferation of the epithelium, colloid mesh boundary with severe vacuolization, focal lymphoid infiltration and hemorrhage. When diffuse toxic goiter detected cubic form cells of medium size with a fairly high nuclear-cytoplasmic index, rounded normochromic kernel, rare intrafollicular epithelial proliferation, homogeneous colloid with an edge vacuolization. With the prevalence of autoimmune thyroiditis was observed flattened epithelium with rounded normochromic nucleus, the small size of cells and nuclei, found the average nuclear-cytoplasmic index, homogeneous colloid and extensive lymphoid infiltration with light propagation centers. Adenoma of the thyroid gland epithelium was found with a cubic cell shape, round hyperchromatic nucleus, the large size of cells and nuclei, high nuclear-cytoplasmic index intrafollicular diffuse proliferation of epithelial and dense colloid. When thyroid cancer found the prevalence of papillary structures with short broad papillae formed polymorphic cells with round hyperchromatic nucleus, there is the largest size of cells and nuclei, nuclear-cytoplasmic maximum index expressed intrafollicular diffuse proliferation of the epithelium. Conclusions. Each form of thyroid disease

  1. Poorly differentiated (insular thyroid carcinoma arising in a long-standing colloid goitre: A cytological dilemma

    Hema Kini


    Full Text Available Poorly differentiated (insular thyroid carcinoma (PDITC is an uncommon thyroglobulin producing neoplasm intermediate in aggressiveness between well-differentiated carcinomas of follicular cell origin and undifferentiated anaplastic carcinoma. Its cytomorphological recognition is essential for planning surgery and subsequent management as it is known for its aggressive behavior, advanced stage at presentation, local recurrences and rapid dissemination. We report a case of PDITC arising in a long-standing goiter, in which presence of microfollicular structures and minimal necrosis resulted in difficulty in distinguishing it from a follicular neoplasm of thyroid.

  2. Use of recombinant human thyrotropin (rh TSH) as a method of preparation for radioiodine therapy in thyroid disorders; Utilisation de la thyreostimuline humaine recombinante dans la preparation au traitement par iode-131 des pathologies thyroidiennes

    Taieb, D.; Guillet, B.A.; Tessonnier, L.; Mundler, O. [Centre Hospitalo-Universitaire de la Timone, Service Central de Biophysique et de Medecine Nucleaire, 13 - Marseille (France)


    The introduction of recombinant human TSH (rh TSH) as a method of preparation for radioiodine therapy of follicular-derived thyroid tumors (benign and malignant) is a significant medical advance. Rh TSH has been approved for use in remnants ablation after total thyroidectomy for carcinoma. There are other potential uses for rh TSH that have not yet been licensed. The use of rh TSH allows to reduce administrated doses in goiters through an increase of iodine uptake and a more homogeneous distribution of radioiodine in the gland. Rh TSH also improves thyroid cancer patients quality of life by avoiding hypothyroidism. (authors)

  3. The Thyroid-Related Quality of Life Measure ThyPRO Has Good Responsiveness and Ability to Detect Relevant Treatment Effects

    Watt, Torquil; Cramon, Per; Hegedüs, Laszlo


    BACKGROUND AND PURPOSE: Patient-reported outcomes have become important endpoints in comparative effectiveness research and in patient-centered health care. Valid patient-reported outcome measures detect and respond to clinically relevant changes. The purpose of this study was to evaluate...... this measurement instrument as a patient-reported outcome in clinical studies and in clinical management....... nontoxic goiter treated with surgery or radioactive iodine and remaining euthyroid (n = 62). Changes in QoL were evaluated in terms of effect size and compared to the changes predicted by clinical experts. The responsiveness of equivalent scales from ThyPRO and SF-36 Health Survey were compared...

  4. Management of an unusual presentation of Ascher syndrome.

    de Figuerêdo, Adson Andrade; de Pochat, Victor Diniz; Barreto, Thaís Fagundes; Mendes, Rogério Silva; Alonso, Nivaldo; Meneses, José Valber


    Ascher syndrome is defined by the association between double lip, blepharochalasis, and nontoxic goiter. Because it is a rare disease, it is most often misdiagnosed, despite its implications for quality of life. We report a variation of an incomplete type of Ascher syndrome affecting the upper lip, upper eyelids, and lateral canthi of a young male patient. The surgical management, follow-up, and a brief overview of the syndrome are described. The results presented show an aesthetic and functional improvement of the facial deformities.

  5. Comparison of Infertility Causes Structure in Men and Women in Tashkent and Andijan Regions of Republic of Uzbekistan According to Screening Data

    S.I. Ismailov


    Full Text Available The structure of the causes of infertility has been studied in 100 couples (200 people with infertility in Tashkent and Tashkent region (50 families in each. It is found that among surveyed women in the genesis of infertility principal place takes hormonal dysfunction, as well as inflammatory diseases of the genitourinary system (diffuse goiter with subclinical hypothyroidism, ovarian failure with menstrual disorders, polycystic ovary syndrome, hyperandrogenism, luteal phase deficiency, impaired folliculogenesis, TORCH infections. Among surveyed men in the genesis of infertility principal place takes hormonal dysfunction (androgen deficiency associated with excess body weight, impaired spermatogenesis, hypergonadotrophic and hypogonadotropic hypogonadism.

  6. [Effect of preoperative administration of Lugol's solution on thyroid blood flow in hyperthyroidism].

    Rodier, J F; Janser, J C; Petit, H; Schneegans, O; Ott, G; Kaissling, A; Grob, J C; Velten, M


    A study of 50 patients with hyperthyroidism was conducted to evaluate the effect of preoperative administration of Lugol's iodine solution on thyroid blood flow. Highly significant reductions in diameter, time-averaged velocity, and volume flow of the superior thyroid artery were demonstrated after administration of Lugol's solution. The Duplex ultrasound scanning used in this study is a noninvasive, inexpensive, accurate, and reproducible technique suitable for analysis of thyroid blood flow in hyperthyroidism. On the basis of current ultrasonographic results and low postoperative morbidity in patients, Lugol's solution is well tolerated and may be recommended for use before thyroidectomy, especially for diffuse toxic goiters and Graves disease.

  7. Incidentally detected hydatid cyst of the adrenal gland: A case report.

    Akbulut, Sami


    Hydatid cysts are a zoonotic disease that can involve many organs and tissues in the human body but primarily involve the liver and lungs. Of the main organs, adrenal glands are those seldom affected by hydatid cysts. The purpose of this study was to present a case with an incidentally detected hydatid cyst of the right adrenal gland on computed tomography, and a positive echincoccus IgG enzyme-linked immunosorbent assay test on top of a toxic multinodular thyroid goiter for which thyroidectomy was indicated.

  8. Incidentally detected hydatid cyst of the adrenal gland: A case report

    Akbulut, Sami


    Hydatid cysts are a zoonotic disease that can involve many organs and tissues in the human body but primarily involve the liver and lungs. Of the main organs, adrenal glands are those seldom affected by hydatid cysts. The purpose of this study was to present a case with an incidentally detected hydatid cyst of the right adrenal gland on computed tomography, and a positive echincoccus IgG enzyme-linked immunosorbent assay test on top of a toxic multinodular thyroid goiter for which thyroidecto...

  9. Exosome-delivered microRNAs of “chromosome 19 microRNA cluster” as immunomodulators in pregnancy and tumorigenesis

    Bullerdiek Jörn; Flor Inga


    Abstract Background Structural rearrangements of chromosomal band 19q13 are a non-random cytogenetic abnormality in thyroid adenomas and adenomatous goiters and lead to an expression of miRNAs of the chromosome 19 microRNA cluster C19MC. Normally, expression of these miRNAs is silenced except for embryonic stem cells and the placenta where they represent the majority of miRNAs not only in the trophoblast but also in exosomes derived from it. Presentation of the hypothesis We have advanced the...

  10. Clinical diagnosis analysis of thyroid disease by B ultrasound%甲状腺疾病的B超临床诊断分析



    Objective:To explore the clinical value of B ultrasound in the diagnosis of thyroid disease.Methods:60 patients with thyroid disease were selected.They were given color ultrasonic device for diagnosis.The results were compared with thyroid puncture pathological results.Results:The results of B ultrasound diagnosis were 11 cases(18.3% ) of hypothyroidism,13 cases(21.7%) of thyroid goiter alone,22 cases(36.7%) of nodular thyroid,14 cases(23.3%) of diffuse goiter.The pathological results were 10 cases of hypothyroidism,11 cases of thyroid goiter alone,24 cases of nodular thyroid,15 cases of diffuse goiter.Both comparison had no statistical significance(P>0.05).Conclusion:B ultrasound in the diagnosis of thyroid disease has the advantages of fast,painless and high diagnosis coincidence rate,and it is an important method for diagnosing thyroid diseases.%目的:探讨B超诊断甲状腺疾病的临床价值。方法:收治甲状腺疾病患者60例,采用彩色超声诊断仪进行诊断,与甲状腺穿刺病理结果进行比较。结果:B超甲状腺功能减退11例(18.3%),单纯甲状腺肿13例(21.7%),结节性甲状腺22例(36.7%),弥漫性甲状腺肿14例(23.3%)。病理检查结果:甲状腺功能减退10例,单纯甲状腺肿11例,结节性甲状腺24例,弥漫性甲状腺肿15例,两者比较差异无统计学意义(P>0.05)。结论:B超诊断甲状腺疾病具有快速、无痛,诊断符合率高等优点,是诊断甲状腺疾病的重要方法。

  11. [A combination of diseases of the thyroid and asymptomatic adenoma of the parathyroid glands].

    Romanchishen, A F; Matveeva, Z S


    The authors have analyzed the cases of diagnosis of asymptomatic tumors of the parathyroid gland made during 8814 operations on the thyroid in the period from 1995 through 2004. The probability of detecting parathyroid incidentalomas in different forms of goiter was calculated which reaches 0.4%. A precision technique of operating allows the parathyroid tumors to be detected at the preclinical stage in all patients apart from a removal of the necessary volume of the thyroid tissue, guaranteed preservation of the laryngeal nerves and parathyroid glands.

  12. [Non-autoimmune thyroiditis].

    Rizzo, Leonardo F L; Mana, Daniela L; Bruno, Oscar D


    The term thyroiditis comprises a group of thyroid diseases characterized by the presence of inflammation, including autoimmune and non-autoimmune entities. It may manifest as an acute illness with severe thyroid pain (subacute thyroiditis and infectious thyroiditis), and conditions in which the inflammation is not clinically evident evolving without pain and presenting primarily thyroid dysfunction and/or goiter (drug-induced thyroiditis and Riedel thyroiditis). The aim of this review is to provide an updated approach on non-autoimmune thyroiditis and its clinical, diagnostic and therapeutic aspects.

  13. Primary tuberculosis of the thyroid gland:a case report

    Sant; Parkash; Kataria; Parul; Tanwar; Sneh; Singh; Sanjay; Kumar


    Tuberculosis of the thyroid gland is an uncommon disease and primary involvement of Uiyroid is even more rare.It is a rare disease even in countries in which tuberculosis is endemic.The diagnosis is often difficult as the clinical presentation has no distinct characteristics.Clinical course of the disease may resemble toxic goiter or acute thyroiditis or may follow a subacute or chronic growth pattern without specific symptomatology.Histologically presence of necrotizing epithelioid cell granulomas along with langhans type giant cells are the hallmark of thyroid tuberculosis.Demonstration of acid fast bacilli by ZN staining confirms the diagnosis,but this stain is frequently negative in tissue sections.

  14. Burkitts primary thyroid lymphoma coexistence with Hashimoto's thyroiditis; Linfoma Burkitt primario tiroideo. Coexistencia con tiroiditis de Hashimoto

    Higuera, A. [Hospital Alto Guadalquivir. Andujar Jaen (Spain); Vicente, J.; Lazaro, J. C. [Hospital Universitario Reina Sofia. Cordoba (Spain)


    Th primary thyroid lymphoma is a rare neoplasm, above all in children. We present a case of a child with Burkitt's thyroid lymphoma as the only manifestation of this disease, associated to lymphocytic thyroiditis. Clinically, it initiated as a rapidly growing goiter with compressive symptomatology. The X-ray findings are described: hypoechoic and hypodense multiple nodes that affect the right thyroid lobe and isthmus, with extraglandular extension to the vascular space and to the mediastinum. The differential diagnosis is considered with other more frequent thyroid pathologies in this age group. (Author) 14 refs.

  15. Thyroid disease in the pediatric patient: emphasizing imaging with sonography

    Babcock, Diane S. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)


    Thyroid disease does occur in the pediatric patient, and imaging plays an important role in its evaluation. A review is presented of normal development of the thyroid gland, the technique and indications for thyroid sonography, and key imaging features of congenital thyroid disorders (ectopic or absent thyroid, infantile goiter, thyroglossal duct remnants), benign thyroid masses (follicular adenoma, degenerative nodules, colloid and thyroid cysts), malignant masses (follicular, papillary and medullary carcinoma) and diffuse thyroid disease (acute bacterial thyroiditis, Hashimoto's thyroiditis, Grave's disease). (orig.)

  16. Expression of thyroid stimulating hormone receptor in differentiated thyroid carcinoma and its clinical significance



    Objective To explore the expression of thyroid stimulating hormone (TSH) receptor in differentiated thyroid carcinoma and its clinical significance.Methods Seventy-four patients with differentiated thyroid carcinoma treated in our department from January 2009 to January 2011were selected as the observation group,and 28 patients with nodular goiter were selected as the control group.Expression of TSH receptor in the two groups were detected by immunohistochemistry.Results The positive rate of TSH receptor expression in the observation group was55.4 (41/74) ,significantly lower than that of the control

  17. Association of tuberculous thyroiditis and papillary carcinoma of the thyroid: a rare coincidence.

    Errami, Noureddine; Benjellounb, Amine; Hemmaouia, Bouchaib; Nadoura, Karim; Benariba, Fouad


    We report the case of a 25 year-old patient with no medical history, admitted to our unit for nodular goiter of the right lobe without clinical or laboratory signs of hyperthyroidism. We carried out a right lobo-isthmectomy revealing the association of tuberculosis and thyroid papillary carcinoma. A left lobectomy has, therefore, been performed in a second stage. The patient underwent a six-month antituberculosis treatment with a good clinical outcome. We discuss this rare association and its best diagnostic and therapeutic support, with a review of the literature.

  18. Thyrotoxicosis and radioiodine therapy: Does the dose matter?

    Andrew Collier


    Full Text Available There are 3 treatment options for thyrotoxicosis: Antithyroid drugs, Surgery and radioiodine. The choice of treatment varies geographically. Radioiodine therapy is preferred in the United States. The aim of radioiodine is to destroy sufficient thyroid tissue to cure the hyperthyroidism. There is a lack of consensus towards what dose of radioiodine should be used. Several methods are used to determine the dose. In our practice we administer 400 MBq to patients with Graves and in patients with large multinodular goiter, we would administer 800 MBq.

  19. Lithium-associated hyperthyroidism.

    Siyam, Fadi F; Deshmukh, Sanaa; Garcia-Touza, Mariana


    Goiters and hypothyroidism are well-known patient complications of the use of lithium for treatment of bipolar disease. However, the occurrence of lithium-induced hyperthyroidism is a more rare event. Many times, the condition can be confused with a flare of mania. Monitoring through serial biochemical measurement of thyroid function is critical in patients taking lithium. Hyperthyroidism induced by lithium is a condition that generally can be controlled medically without the patient having to discontinue lithium therapy, although in some circumstances, discontinuation of lithium therapy may be indicated. We report on a patient case of lithium-associated hyperthyroidism that resolved after discontinuation of the medication.

  20. A Case Report of Post-Operative Jöd-Basedow Phenomennon Following Oral and IV Iodine Contrast Administration

    Maureen Higgs


    Full Text Available This is a case of thyrotoxicosis, due to the Jöd-Basedow phenomenon following administration of oral and IV iodinated contrast in a patient with history of gastrointestinal stromal tumor (GIST and small bowel obstruction. The patient developed atrial fibrillation and had an extended stay in the intensive care unit. Given the aging population with possible subclinical hyperthyroidism, multinodular goiter, and the rise in contrast administration for routine diagnostic studies, this case serves to raise awareness of the risks of “routine” tests administered to our aging patient population.

  1. Thyroid disorders in India: An epidemiological perspective

    Ambika Gopalakrishnan Unnikrishnan


    Full Text Available Thyroid diseases are common worldwide. In India too, there is a significant burden of thyroid diseases. According to a projection from various studies on thyroid disease, it has been estimated that about 42 million people in India suffer from thyroid diseases. This review will focus on the epidemiology of five common thyroid diseases in India: (1 hypothyroidism, (2 hyperthyroidism, (3 goiter and iodine deficiency disorders, (4 Hashimoto′s thyroiditis, and (5 thyroid cancer. This review will also briefly cover the exciting work that is in progress to ascertain the normal reference range of thyroid hormones in India, especially in pregnancy and children.

  2. Primary mucosa-associated lymphoid tissue thyroid lymphoma: a rare thyroid neoplasm of extrathyroid origin

    Dimitrios Hadjidakis


    Full Text Available Primary thyroid lymphoma is a rare malignancy, representing 2-8% of all thyroid malignancies and 1-2% of all extranodal lymphomas. The majority of cases concern non-Hodgkin`s lymphoma of B cell origin, following by Hodgkin’s disease, T cell lymphomas and rarely marginal zone B-cell mucosa-associated lymphoid tissue (MALT lymphomas. MALT lymphomas have been associated with long-standing autoimmune Hashimoto`s thyroiditis. We present the case of a 44-years-old woman with thyroid MALT lymphoma in the background of multinodular goiter of autoimmune origin.

  3. [Constant or break? On the relations between human genetics and eugenics in the Twentieth Century].

    Germann, Pascal


    The history of human genetics has been a neglected topic in history of science and medicine for a long time. Only recently, have medical historians begun to pay more attention to the history of human heredity. An important research question deals with the interconnections between human genetics and eugenics. This paper addresses this question: By focusing on a Swiss case study, the investigation of the heredity of goiter, I will argue that there existed close but also ambiguous relations between heredity research and eugenics in the twentieth century. Studies on human heredity often produced evidence that challenged eugenic aims and ideas. Concurrently, however, these studies fostered visions of genetic improvement of human populations.

  4. Bocio multinodular gigante deformante. Presentación de un caso sin síntomas obstructivos

    Paul Bogucki


    Full Text Available Se presenta el caso de un paciente masculino de 50 años, con una tumoración en la parte anterior de cuello de 25 años de evolución, sin síntomas de compresión. Al examen físico se aprecia una glándula tiroides de gran tamaño que deforma el cuello, de superficie lisa y nodular, de aproximadamente 16x12cm. Los estudios de imágenes y de laboratorio confirmaron el diagnóstico. Se practicó una tiroidectomía total, obteniéndose una glándula de 17x12cm. Se identificaron y preservaron ambos nervios laríngeos recurrentes y las glándulas paratiroides. No hubo complicaciones postoperatorias y el resultado estético fue satisfactorio. En conclusión el bocio es una patología común en las zonas con insuficiente aporte de Yodo, donde tiene una incidencia aproximada de 11%. Las estadísticas obtenidas en nuestro hospital se corresponden con lo publicado en la literatura internacional. La variedad gigante es infrecuente, constituyendo una causa de síntomas compresivos y disconformidad estética, por lo que la cirugía es la indicación terapéutica. Abstract Giant multinodular goiter. A case report with no obstructive symptoms In this report we show a 50 years male patient with a tumor in the anterior part of neck of 25 years of evolution, without symptoms of compression. Physical examination shows a large thyroid gland, which deforms the neck, smooth and nodular, painless to palpation, approximately 16x12cm. Imaging studies and laboratory-confirmed diagnosis of multinodular goiter. A total thyroidectomy was performed, with a gland 17x12cm. Were identified and preserved both recurrent laryngeal nerves and parathyroid glands. There were no postoperative complications and the aesthetic result was satisfactory. In conclusion the goiter is a condition common in areas with insufficient supply of iodine, which has an incidence of approximately 11%. The statistics obtained in our hospital are as published in the international literature to endemic

  5. Cervical Paraganglioma Mimicking Thyroid Nodule: A Rare Clinical Case

    Berna İmge Aydoğan


    Full Text Available Objective. Paraganglioma is a rare neuroendocrine tumor. When it is located in the neck, it is commonly misdiagnosed as other thyroid neoplasms. Case Report. We report a case of cervical paraganglioma in a 55-year-old female. Patient was admitted to our clinic with goiter and neck pain. Thyroid ultrasonography revealed a 20 mm solitary, heterogeneous nodule located in the upper pole of left thyroid lobe. Fine needle aspiration cytology was nondiagnostic. She underwent left lobectomy and histopathology showed paraganglioma. Discussion. Cervical paragangliomas should be considered in the differential diagnosis of thyroid nodules.

  6. Technetium 99m pertechnetate scans in congenital hypothyroidism

    Bauman, R.A.; Bode, H.H.; Hayek, A.; Crawford, J.D.


    Goiters are rarely palpable in infants with congenital hypothyroidism except in the case of maternal ingestion of iodide. The presence or absence of glandular tissue is, however, important for genetic and prognostic counseling and for acceleration of diagnosis in other affected siblings. The detection of thyroid tissue by /sup 99m/Tc pertechnetate scans in a significant number of our patients heretofore considered athyreotic establishes that physical findings and traditional laboratory data are not adequate to determine whether or not thyroid tissue is present.

  7. Biopsia aspirativa con aguja fina del tiroides

    Regino Piñeiro Lamas


    Full Text Available Se estudiaron 33 pacientes con afecciones tiroideas, procedentes de la consulta de Endocrinología Infantil del Hospital Pediátrico Docente "Juan Manuel Márquez", durante los años 1992 y 1993; 19 presentaron bocio difuso generalizado de tamaño II o III, 5 tenían bocio nodular, 4 bocio multinodular, 3 nódulos solitarios y 2 quiste de la glándula. A todos se les realizó biopsia aspirativa con aguja fina (BAF del tiroides, y fueron las conclusiones las siguientes: La BAF fue útil para el diagnóstico de la tiroiditis linfocítica crónica, pues se detectó en 16 pacientes (52 % de la serie; también fue útil en los 2 pacientes con quiste de la glándula. El proceder fue útil para la detección de lesiones malignas del tiroides, pues de 7 pacientes con nódulo único o bocio nodular, se detectó en 2 carcinoma papilar (estadio IV, en 1 se informó "sospechoso"(estadio III que corresponde a un nódulo coloide, el resto fue informado como benigno, para corresponder esto con las biopsias posquirúrgicas, para una sensibilidad del 100 % y especificidad del 80 %.33 patients with thyroid affections, coming from the Children's Endocrinology Department of the "Juan Manuel Márquez" Pediatric Teaching Hospital, were studied during 1992-1993. 19 presented size II or III generalized diffuse goiter; 5, nodular goiter; 4, multinodular goiter; 3, lone nodules; and 2, thyroid gland cyst. All of them underwent fine-needle aspiration biopsy (FAB of the thyroid. The conclusions reached were the following: FAB was useful for the diagnosis of chronic lymphocytic thyroiditis, since it was detected in 16 patients (52 % of the series; it was also useful in 2 patients with cyst of the thyroid gland. The procedure was of use for detecting malignant thyroid lesions as of 7 patients with lone nodule or nodular goiter, 2 papillary carcinomas were detected (stage IV, one was considered as "suspicious" (stage III, corresponding to a colloid nodule, and the rest was

  8. Primary tuberculosis of the thyroid gland:a case report

    Sant Parkash Kataria; Parul Tanwar; Sneh Singh; Sanjay Kumar


    Tuberculosis of the thyroid gland is an uncommon disease and primary involvement of thyroid is even more rare. It is a rare disease even in countries in which tuberculosis is endemic. The diagnosis is often difficult as the clinical presentation has no distinct characteristics. Clinical course of the disease may resemble toxic goiter or acute thyroiditis or may follow a subacute or chronic growth pattern without specific symptomatology. Histologically presence of necrotizing epithelioid cell granulomas along with langhans type giant cells are the hallmark of thyroid tuberculosis. Demonstration of acid fast bacilli by ZN staining confirms the diagnosis, but this stain is frequently negative in tissue sections.

  9. TSH unresponsiveness, a case report

    Aarseth, H.P.; Haug, E.; Raknerud, N.; Frey, H.M. (Aker Sykehus, Oslo (Norway))


    A patient with congenital primary hypothyroidism is presented. His thyroid gland had a normal uptake of radioiodine which was independent of endogenous or exogenous TSH, sympathetic B-receptor blockade or prostaglandin inhibition. Infusion of dibuturylcyclic AMP increased the uptake of radioiodine and stimulated release of protein bound /sup 131/I. He had no goiter even when he did not receive thyroxine, but thyroid histology showed evidence of active epithelium in the presence of adequate substitution with thyroxine. We assume that some unknown factor other than TSH stimulates part of the glandular function in this patient, without leading to adequate formation and release of thyroid hormone.

  10. Medical Surveillance Monthly Report (MSMR). Volume 16, Number 4, April 2009


    Periodontal disease 2,737 (94) 1,570 (84) 0 (130) Dental caries 1,096 (108) 963 (93) 19 (116) Diabetes mellitus Diabetes mellitus 17,652 (59) 5,072 (71...3.6 Endocrine, nutrition, immunity (240 - 279) 466 Diabetes mellitus 175 37.6 Disorders of fl uid, electrolyte and acid-base balance 108 23.2...base balance 28 14.1 Thyrotoxicosis with or without goiter 25 12.6 Diabetes mellitus 19 9.5 Hematologic disorders (280 - 289) 68 Iron defi ciency

  11. Double thyroid ectopia (with incidental papillary thyroid microcarcinoma) (2010: 8b)

    Borges, Alexandra [Instituto Portugues de Oncologia de Francisco Gentil-Centro de Lisboa, Department of Radiology, Lisbon (Portugal); Martins, Mariluz [Instituto Portugues de Oncologia de Francisco Gentil-Centro de Lisboa, Department of Head and Neck Surgery, Lisbon (Portugal); Andre, Saudade [Instituto Portugues de Oncologia de Francisco Gentil-Centro de Lisboa, Department of Pathology, Lisbon (Portugal)


    We present the case of a 45-year-old man with a long-standing history of a slow-growing left submandibular mass. Imaging was diagnostic as it disclosed an absent orthotopic thyroid gland and heterogeneous masses, with both solid and cystic components, as well as calcifications in the left sublingual/submandibular space and in the left paramedian aspect of the tongue base, consistent with double thyroid ectopia, originating from central and lateral thyroid anlages, respectively. Pathology confirmed an ectopic thyroid goiter in the left submandibular space with an incidental papillary microcarcinoma. Scintigraphy also demonstrated ectopic thyroid tissue in the left tongue base. (orig.)

  12. The Army Ambulatory Care Data Base (ACDB) Study: Implementation and Preliminary Data



  13. Radioiodine therapy in benign thyroid diseases

    Bonnema, Steen Joop; Hegedüs, Laszlo


    Radioiodine ((131)I) therapy of benign thyroid diseases was introduced 70 yr ago, and the patients treated since then are probably numbered in the millions. Fifty to 90% of hyperthyroid patients are cured within 1 yr after (131)I therapy. With longer follow-up, permanent hypothyroidism seems...... inevitable in Graves' disease, whereas this risk is much lower when treating toxic nodular goiter. The side effect causing most concern is the potential induction of ophthalmopathy in predisposed individuals. The response to (131)I therapy is to some extent related to the radiation dose. However, calculation...

  14. Thyroid disorders in mild iodine deficiency

    Laurberg, P; Nøhr, S B; Pedersen, K M


    in elderly subjects, especially women, with risk of cardiac arrhythmias, osteoporosis, and muscle wasting. The hyperthyroidism is caused by autonomous nodular growth and function of the thyroid gland and it is accompanied by a high frequency of goiter. Pregnant women and small children are not immediately......Comparative epidemiologic studies in areas with low and high iodine intake and controlled studies of iodine supplementation have demonstrated that the major consequence of mild-to-moderate iodine deficiency for the health of the population is an extraordinarily high occurrence of hyperthyroidism...

  15. Current Status Of Endemic Goitre Control Programme In India- Measures To Eradicate By 2000 A.D.

    Agarwal Dev K; Agarwal K.N


    Study of 5870 school children and 1664 general population showed that even in states covered by the iodized salt, the endemic goiter prevalence rates were 26.5 to 54.3% This may be partly due to inadequate supply of the iodized salt as well as loss of iodine during transport and storage. Unfortunately approximately 8000 metric tones/annum of rock salt is imported from Pakistan and mainly consumed in the Western sub-Himalayan endemic states (J&K, HP & Punjab). The measures effec...

  16. Lymphocytic interstitial pneumonia as a manifestation of SLE and secondary Sjogren's syndrome.

    Garcia, Daniel; Young, Lary


    A 47-year-old woman with systemic lupus erythematosus (SLE) diagnosed at age of 35 years was admitted for dyspnoea, substernal chest pain, dry mucosas and difficulty in swallowing. Physical examination revealed vesicular breath sounds bilaterally. Laboratory work showed antinuclear antibody (ANA) (speckled pattern, 1:40), positive anti-Sjogren's syndrome antigen (SSA) and antisingle side band (SSB) and negative double-strand DNA (dsDNA), with normal C3,C4,C50. A high-resolution chest CT scan demonstrated multiple bronchial cysts and diffuse interstitial infiltrates. Surgical lung biopsy revealed emphysematous changes and mild lymphocytic infiltrate around the bronchioles compatible with lymphocytic interstitial pneumonia diagnosis. This case illustrates a patient with primary SLE overlapped by initial manifestations of secondary Sjogren's syndrome (SS) presenting with associated autoimmune interstitial lung disease. Antibody markers, high-resolution chest CT scan and surgical lung biopsy were essential in evaluating this patient, confirming the interstitial lymphocytic infiltration of the lung. Primary SS (pSS) is the most commonly associated disease to lung interstitial pneumonia (LIP) (25%). High-resolution chest CT scan demonstrates areas of ground-glass attenuation, suggestive of interstitial disease. Surgical lung biopsy shows pathologic increase of mature lymphocyte cells and histiocytes. Most of the cases have a benign presentation and shortly relapse. Superimposed infection, pulmonary fibrosis and lymphoma develop in less than 20% of cases. Corticosteroids are the primary therapy. While pSS is commonly associated with interstitial lung involvement, secondary Sjogren's syndrome (sSS) is only rare. It has been described the initial sSS presentation by Sica symptoms development only, and our case is the first report of LIP presentation as initial manifestation of sSS. Our patient remained stable after corticosteroids and hydoxychloroquine therapy and no

  17. Ruling out coronary heart disease in primary care patients with chest pain: a clinical prediction score

    Burnand Bernard


    Full Text Available Abstract Background Chest pain raises concern for the possibility of coronary heart disease. Scoring methods have been developed to identify coronary heart disease in emergency settings, but not in primary care. Methods Data were collected from a multicenter Swiss clinical cohort study including 672 consecutive patients with chest pain, who had visited one of 59 family practitioners' offices. Using delayed diagnosis we derived a prediction rule to rule out coronary heart disease by means of a logistic regression model. Known cardiovascular risk factors, pain characteristics, and physical signs associated with coronary heart disease were explored to develop a clinical score. Patients diagnosed with angina or acute myocardial infarction within the year following their initial visit comprised the coronary heart disease group. Results The coronary heart disease score was derived from eight variables: age, gender, duration of chest pain from 1 to 60 minutes, substernal chest pain location, pain increasing with exertion, absence of tenderness point at palpation, cardiovascular risks factors, and personal history of cardiovascular disease. Area under the receiver operating characteristics curve was of 0.95 with a 95% confidence interval of 0.92; 0.97. From this score, 413 patients were considered as low risk for values of percentile 5 of the coronary heart disease patients. Internal validity was confirmed by bootstrapping. External validation using data from a German cohort (Marburg, n = 774 revealed a receiver operating characteristics curve of 0.75 (95% confidence interval, 0.72; 0.81 with a sensitivity of 85.6% and a specificity of 47.2%. Conclusions This score, based only on history and physical examination, is a complementary tool for ruling out coronary heart disease in primary care patients complaining of chest pain.

  18. Atypical presentations among Medicare beneficiaries with unstable angina pectoris.

    Canto, John G; Fincher, Contessa; Kiefe, Catarina I; Allison, Jeroan J; Li, Qing; Funkhouser, Ellen; Centor, Robert M; Selker, Harry P; Weissman, Norman W


    Chest pain is a hallmark symptom in patients with unstable angina pectoris (UAP). However, little is known regarding the prevalence of an atypical presentation among these patients and its relation to subsequent care. We examined the medical records of 4,167 randomly sampled Medicare patients hospitalized with unstable angina at 22 Alabama hospitals between 1993 and 1999. We defined typical presentation as (1) chest pain located substernally in the left or right chest, or (2) chest pain characterized as squeezing, tightness, aching, crushing, arm discomfort, dullness, fullness, heaviness, pressure, or pain aggravated by exercise or relieved with rest or nitroglycerin. Atypical presentation was defined as confirmed UAP without typical presentation. Among patients with confirmed UAP, 51.7% had atypical presentations. The most frequent symptoms associated with atypical presentation were dyspnea (69.4%), nausea (37.7%), diaphoresis (25.2%), syncope (10.6%), or pain in the arms (11.5%), epigastrium (8.1%), shoulder (7.4%), or neck (5.9%). Independent predictors of atypical presentation for patients with UAP were older age (odds ratio 1.09, 95% confidence interval 1.01 to 1.17/decade), history of dementia (odds ratio 1.49, 95% confidence interval 1.10 to 2.03), and absence of prior myocardial infarction, hypercholesterolemia, or family history of heart disease. Patients with atypical presentation received aspirin, heparin, and beta-blocker therapy less aggressively, but there was no difference in mortality. Thus, over half of Medicare patients with confirmed UAP had "atypical" presentations. National educational initiatives may need to redefine the classic presentation of UAP to include atypical presentations to ensure appropriate quality of care.

  19. Corrosive Injury of the Upper Gastrointestinal Tract: Review of Surgical Management and Outcome in 14 Adult Cases

    Mohammad Taghi Rajabi


    Full Text Available Introduction: Caustic ingestion is responsible for a spectrum of upper gastrointestinal tract injury from self-limited to perforation. This study conducted to evaluate clinical characteristics as well as surgical outcomes in patients with caustic ingestion.   Materials and Methods: Between Nov1993 to march 2011, 14 adults with a clinical evidence of corrosive ingestion were admitted into our institutions (Omid and Ghaem hospitals. Patients evaluated for etiology of erosion, location, type of surgery, morbidity and mortality after surgery.   Results: 14 patients (10men and 4 women with a age range between18-53 years were evaluated. In 6 patients, the injury was accidental and in 8 patients ingestion was a suicide attempt. Ingested agent included nitric acid in 4 patients, hydrochloric acid in 7 patients, sulfuric acid in 2 patients and strong alkali in one patient. The location and extent of lesion varied included esophagus in 13 cases, stomach in 7 cases and the pharynx in 3 cases. Acute abdomen was developed In 2 patients and a procedure of total gasterectomy and blunt esophagectomy was performed. In the remaining patients, substernal esophageal bypass in 2 patients, esophageal resection and replacement surgery in 9 patients and gastroenterostomy in one patient performed to relieve esophageal stricture. Two patients died of mediastinitis after esophageal replacement surgery. Postoperative strictures were developed in 2 survived patients with hypopharyngeal reconstruction that was managed by per oral bougienage in one patient and KTP Laser and stenting in the other patient.   Conclusion:  Esophageal resection with replacement was safe and good technique for severe corrosive esophageal stricture with low mortality and morbidity.

  20. Multicenter study of pectus excavatum, final report: complications, static/exercise pulmonary function, and anatomic outcomes.

    Kelly, Robert E; Mellins, Robert B; Shamberger, Robert C; Mitchell, Karen K; Lawson, M Louise; Oldham, Keith T; Azizkhan, Richard G; Hebra, Andre V; Nuss, Donald; Goretsky, Michael J; Sharp, Ronald J; Holcomb, George W; Shim, Walton K T; Megison, Stephen M; Moss, R Lawrence; Fecteau, Annie H; Colombani, Paul M; Cooper, Dan; Bagley, Traci; Quinn, Amy; Moskowitz, Alan B; Paulson, James F


    A multicenter study of pectus excavatum was described previously. This report presents our final results. Patients treated surgically at 11 centers were followed prospectively. Each underwent a preoperative evaluation with CT scan, pulmonary function tests, and body image survey. Data were collected about associated conditions, complications, and perioperative pain. One year after treatment, patients underwent repeat chest CT scan, pulmonary function tests, and body image survey. A subset of 50 underwent exercise pulmonary function testing. Of 327 patients, 284 underwent Nuss procedure and 43 underwent open procedure without mortality. Of 182 patients with complete follow-up (56%), 18% had late complications, similarly distributed, including substernal bar displacement in 7% and wound infection in 2%. Mean initial CT scan index of 4.4 improved to 3.0 post operation (severe >3.2, normal = 2.5). Computed tomography index improved at the deepest point (xiphoid) and also upper and middle sternum. Pulmonary function tests improved (forced vital capacity from 88% to 93%, forced expiratory volume in 1 second from 87% to 90%, and total lung capacity from 94% to 100% of predicted (p VO2 max during peak exercise increased by 10.1% (p = 0.015) and O2 pulse by 19% (p = 0.007) in 20 subjects who completed both pre- and postoperative exercise tests. There is significant improvement in lung function at rest and in VO2 max and O2 pulse after surgical correction of pectus excavatum, with CT index >3.2. Operative correction significantly reduces CT index and markedly improves the shape of the entire chest, and can be performed safely in a variety of centers. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Color-flow Doppler sonography in Graves disease: "thyroid inferno".

    Ralls, P W; Mayekawa, D S; Lee, K P; Colletti, P M; Radin, D R; Boswell, W D; Halls, J M


    Graves disease is a common diffuse abnormality of the thyroid gland usually characterized by thyrotoxicosis. We performed color-flow Doppler sonography in 16 patients with Graves disease and compared the results with those in 15 normal volunteers and 14 patients with other thyroid diseases (eight with multinodular goiter, four with focal masses, and two with papillary thyroid carcinoma). All 16 Graves disease patients exhibited a pulsatile pattern we call "thyroid inferno." This pattern consists of multiple small areas of intrathyroidal flow seen diffusely throughout the gland in both systole and diastole. In systole, both high-velocity flow (color coded white) and lower velocity flow (color coded red and blue) were noted. In diastole, fewer areas of flow and lower velocity flow were noted. Patients with Graves disease also exhibited color flow around the periphery of the gland. The inferno pattern did not occur in normal subjects or in patients with other thyroid diseases. On occasion, focal areas of intrathyroidal flow were detected in patients with multinodular goiter and focal thyroid masses. High-resolution gray-scale images did not show the small vascular channels from which the flow signal originated. Color-flow Doppler sonography shows promise as a cost-effective, noninvasive technique for diagnosing Graves disease.

  2. The clinician and the thyroid

    Biersack, H.J.; Hotze, A. (Bonn Univ. (Germany, F.R.). Inst. fuer Klinische und Experimentelle Nuklearmedizin)


    The goiter prevalence in iodine-deficient regions is up to 25%-54%. The most frequent disease in these endemic areas is non-toxic goiter, which is, however, oftentimes connected with autonomously functioning thyroid tissue leading to borderline or overt hyperthyroidism. Other thyroid diseases like cancer, thyroiditis and hypothyroidism play only a miner role in a thyroid clinic, while cases of Graves' disease may be observed more frequently. The most cost-effective tools to evaluate thyroid patients are the hand, ear and mouth of the thyroid clinician. The differential diagnosis of thyroid disorders may be evaluated by a battery of diagnostic tools like in-vitro tests and high performance imaging modalities. Once the diagnosis is established, the appropriate therapeutic procedures (drugs, radioiodine, surgery) have to be chosen. This review should be considered as a guideline for the diagnosis and treatment of thyroid diseases. In addition, special problems concerning elderly patients and pregnant women are discussed, including the differential diagnosis of thyroid diseases. (orig.).

  3. Iodine and thyroid gland with or without nuclear catastrophe

    Kovačev-Zavišić Branka


    Full Text Available Introduction. Iodine, as a trace element, is a necessary and limiting substrate for thyroid gland hormone synthesis. It is an essential element that enables the thyroid gland to produce thyroid hormones thyroxine (T4 and triiodothyronine (T3. Synthesis of Thyroid Hormones and Iodine Metabolism. Three iodine molecules are added to make triiodothyronine, and four for thyroxine - the two key hormones produced by the thyroid gland. Iodine deficiency. The proper daily amount of iodine is required for optimal thyroid function. Iodine deficiency can cause hypothyroidism, developmental brain disorders and goiter. Iodine deficiency is the single most common cause of preventable mental retardation and brain damage in the world. It also decreases child survival, causes goiters, and impairs growth and development. Iodine deficiency disorders in pregnant women cause miscarriages, stillbirths, and other complications. Children with iodine deficiency disorders can grow up stunted, apathetic, mentally retarded, and incapable of normal movements, speech or hearing. Excessive Iodine Intake. Excessive iodine intake, which can trigger autoimmune thyroid disease and dysfunction, is on the other side. Iodine use in Case of Nuclear Catastrophe. In addition to other severe consequences of radioactivity, high amount of radioactive iodine causes significant increase in incidence of thyroid gland carcinoma after some of the nuclear catastrophes (Hiroshima, Nagasaki, Chernobyl, Fukushima. The incidence of thyroid carcinoma was increased mostly in children. This paper was aimed at clarifying some of the possibilities of prevention according to the recommendations given by the World Health Organization.

  4. Clinical Aspects of Thyrotoxicosis in 592 Patients: A Single Center Experience from Turkey

    Serap Baydur Şahin


    Full Text Available Purpose: To determine the main causes of thyrotoxicosis and to compare the clinical and biochemical fetaures of the patients according to the underlying cause of thyrotoxicosis. Material and Method: Five hundred ninety-two patients, who were consecutively diagnosed with thyrotoxicosis, were retrospectively analysed. Symptoms of thyrotoxicosis, serum thyroid-stimulating hormone (TSH, free T3 and free T4 levels, anti-thyroglobulin autoantibody (TGAb, anti-thyroid peroxidase autoantibody (TPOAb and ultrasonographic features were recorded. To determine the cause of thyrotoxicosis, Tc-99m pertechnetate thyroid scintigraphy was performed in all patients except for pregnant women. The clinical and biochemical results were compared between the patients with different diagnosis of thyrotoxicosis. Results: 40.9% of patients were diagnosed with toxic multinodular goiter (TMNG. The other main causes of thyrotoxicosis were: Graves’ disease (GD (22%, thyroiditis (14.8%, gestational thyrotoxicosis (12.7%, and toxic adenoma (9.6%. The clinical presentation and severity of thyrotoxicosis varied according to the underlying cause. Weight loss was more frequently observed in patients with GD (p=0.0001, while cardiac arrhythmia dominated in patients with TMNG (p=0.0001. Moderate (27% or severe (23.9% thyrotoxicosis was more common in patients with GD than in patients with other forms of thyrotoxicosis (p=0.0001. Discussion: Toxic multinodular goiter is the most common cause of thyrotoxicosis in our region.

  5. Diagnosis and classification of Graves' disease.

    Menconi, Francesca; Marcocci, Claudio; Marinò, Michele


    Graves' disease (GD) is an autoimmune disorder involving the thyroid gland, typically characterized by the presence of circulating autoantibodies that bind to and stimulate the thyroid hormone receptor (TSHR), resulting in hyperthyroidism and goiter. Organs other than the thyroid can also be affected, leading to the extrathyroidal manifestations of GD, namely Graves' ophthalmopathy, which is observed in ~50% of patients, and Graves' dermopathy and acropachy, which are quite rare. Presumably, the extrathyroidal manifestations of GD are due to autoimmunity against antigens common to the thyroid and other affected organs. Although its exact etiology remains to be completely understood, GD is believed to result from a complex interaction between genetic susceptibility and environmental factors. Clinically, GD is characterized by the manifestations of thyrotoxicosis as well as by its extrathyroidal features when present, the latter making the diagnosis almost unmistakable. In the absence of ophthalmopathy, the diagnosis is generally based on the association of hyperthyroidism and usually diffuse goiter confirmed with serum anti-TSHR autoantibodies (TRAbs). Hyperthyroidism is generally treated with anti-thyroid drugs, but a common long term treatment strategy in patients relapsing after a course of anti-thyroid drugs (60-70%), implies the use of radioactive iodine or surgery.

  6. Comparison of MRI findings with traditional criteria in diagnosis of Pendred syndrome.

    Sharghi, Sasan; Haghpanah, Vahid; Heshmat, Ramin; Fard-Esfahani, Armaghan; Hadizadeh, Homayoun; Lashkari, Anahita; Tabatabaei, Ozra; Taheri, Eghbal; Motesaddi, Massoud; Mojtahedi, Alireza; Larijani, Bagher


    Pendred syndrome, defined as the constellation of goiter, sensori-neural hearing loss, and positive perchlorate discharge test, is the most frequent cause of congenital deafness. Newly introduced diagnostic approaches to the disease are rather expensive and complicated, therefore we evaluated the value of MRI as the sole, or adjunctive diagnostic approach, and compared it with the traditional ones. Presuming the classic triad as the gold standard, we compared MRI findings in six such defined patients with six cases having goiter, hearing loss, and normal perchlorate discharge test. Our results indicated that MRI was 83.6% sensitive and 66.7% specific in patients fulfilling all three criteria (complete), while in the 'partial' group the sensitivity and specificity were 66.7% and 100% respectively. In conclusion, MRI, although impressive as an adjunctive diagnostic tool, may not replace the holistic approach, and the latter may be more convenient, cheaper, and still more accurate. However in 'partial' cases with equivocal findings, and in relatives of the patients, MRI may be a valuable diagnostic adjunct.

  7. Lack of germline A339V mutation in thyroid transcription factor-1 (TITF-1/NKX2.1 gene in familial papillary thyroid cancer

    Cantara Silvia


    Full Text Available Abstract Thyroid cancer may have a familial predisposition but a specific germline alteration responsible for the disease has not been discovered yet. We have shown that familial papillary thyroid cancer (FPTC patients have an imbalance in telomere-telomerase complex with short telomeres and increased telomerase activity. A germline mutation (A339V in thyroid transcription factor-1 has been described in patients with multinodular goiter and papillary thyroid cancer. In this report, the presence of the A339V mutation and the telomere length has been studied in FPTC patients and unaffected family members. All samples analyzed displayed a pattern typical of the homozygous wild type revealing the absence of the A339V mutation. Shortening of telomeres was confirmed in all patients. We concluded that the A339V mutation in thyroid transcription factor-1 (TITF-1/NKX2.1 is not correlated with the familial form of PTC, even when the tumor was in the context of multinodular goiter.

  8. Evaluation of Thyroid Diseases by Hormonal Analysis in Pediatric Age Group

    Nayana A Shah


    Full Text Available Introduction: Among endocrine disorders commonly encountered in pediatric age group, thyroid diseases are more frequent. Congenital hypothyroidism is one of the major problems in this age with worldwide incidence of 1:3000-4000 live birth and in India it is 1:2500-2800. Objectives: The aim of this study is to know the prevalence of thyroid diseases in newborn and children by hormonal evaluation. Methodology: We have studied 50 children suspected of having signs and symptoms of thyroid diseases. Hormonal evaluation was done by the estimation of serum TSH, T3 and T4. Results: Out of total 50 children, 16 were detected with abnormal hormone level and diagnosed having thyroid diseases. Out of 16 affected children, 4 had congenital hypothyroidism (25%, 6 had subclinical or acquired hypothyroidism (37.5%, 3 had autoimmune thyroiditis (18.75% and 3 had goiter with graves disease (18.75%. Conclusion: Congenital hypothyroidism is one of the major preventable thyroid disease if diagnosed early. Other thyroid diseases commonly seen in pediatric age are subclinical hypothyroidism, autoimmune thyroiditis, goiter and rarely hyperthyroidism. [Natl J Med Res 2013; 3(4.000: 367-370

  9. Radio-contrast agent-induced hyperthyroidism: case report and review of the literature

    Iakovou, Ioannis, E-mail:, E-mail: [Nuclear Medicine Department, Papageorgiou Hospital, Thessaloniki (Greece); Zapandiotis, Apostolos; Mpalaris, Vassileios; Goulis, Dimitrios G. [Medical School, Aristotle University of Thessaloniki (Greece)


    A 66 year-old woman with a history of a euthyroid multinodular goiter underwent a head and neck computed tomography (CT) scan (total iodine load of 35 g) in order to evaluate the extent of retrosternal expansion. Less than 24 h after the iodine-based contrast media (ICM) administration, she presented with symptoms and laboratory findings typical of thyrotoxicosis. She was treated successfully with antithyroid medications. This is the shortest time reported in the literature and it is of clinical importance, as it may have an impact to the recommendations given by the attending physician. Given the fact that a large number of ICM examinations are performed in everyday practice, physicians should be aware of this possible thyroid-specific effect. Prophylactic drugs could be considered in high-risk populations, such as administration of perchlorate and a thionamide class drug to elderly patients with suppressed TSH and/or palpable goiter, started the day before and continued for two weeks after ICM administration. (author)

  10. Clark T. Sawin historical vignette: what do criminology, Harry Houdini, and King George V have in common with postpartum thyroid dysfunction?

    Smallridge, Robert C


    The history of postpartum thyroid dysfunction (PPTD) dates back almost two millennia, when Soranus of Ephesus, who practiced obstetrics and neonatology, observed swelling in the necks (presumably goiters) of women after pregnancy. The next reference to PPTD appeared in artwork more than 1000 years later, with many portraits illustrating women with goiter while holding infants. In the early to mid-19th century, Caleb Hillier Parry and Armand Trousseau described postpartum hyperthyroidism, while in the late 1800s, Sir Horatio Bryan Donkin reported the first patient with postpartum hypothyroidism. The modern era of PPTD began with the description in the late 1940s by H.E.W. Roberton of women after delivery reporting hypothyroid symptoms and responding to thyroid extract. The immunologic influence on PPTD was recognized initially by Parker and Beierwaltes in the early 1960s, and the clinical variability and natural history were carefully documented by numerous investigators in the 1970s-1980s. The past two decades have seen further refinements in understanding the prevalence, etiology, and treatment of PPTD. Yet to be determined is the role of screening as a cost-effective measure.

  11. Pathology of thyroid in acquired immunodeficiency syndrome

    Dhaneshwar Namdeorao Lanjewar


    Full Text Available Background: The course of human immunodeficiency virus infection and the acquired immunodeficiency syndrome can be complicated by a variety of endocrine abnormalities, including abnormalities of thyroid gland. Materials and Methods: This study was designed to understand the spectrum of pathology of thyroid in Indian patients with AIDS. The present study describes the findings of retrospective autopsy findings of 158 patients with AIDS which revealed infectious diseases from a time period before the use of highly active antiretroviral regimen. Results: A wide range of bacterial, fungal, and viral infections were observed. Tuberculosis was recorded in 14 (09% patients, Cryptococcus neoformans in 11 (7% patients and cytomegalovirus in 3 (2% patients. Hashimoto's thyroiditis and lymphocytic thyroiditis were seen in 02 (01% patients each. One patient had dual infection comprising of tuberculosis and cytomegalovirus infection. The other microscopic findings observed were goiter (2 patients, interstitial fibrosis in thyroid (7 patients, and calcification in thyroid (8 patients. Conclusions: Abnormalities of thyroid are uncommon findings in patients with HIV infection however several case reports of thyroid involvement by infectious agents and neoplasm are described in these patients; hence patients with HIV infection should be closely followed up for development of goiter or abnormalities of thyroid functions.

  12. Sonographic appearance of primary thyroid lymphoma-preliminary experience.

    Yu Xia

    Full Text Available OBJECTIVE: Primary thyroid lymphoma (PTL is an uncommon thyroid malignancy. Despite the rarity of PTL, it is important to recognize PTL promptly because its management differs from that of all the other thyroid neoplasms. This study was designed to investigate the sonographic features of PTL. METHODS: Twenty-seven pathologically confirmed PTLs were categorized into diffuse and non-diffuse type. Sonographic features including thyroid size, thyroid background echotexture, lesion size, echogenecity, calcification, vascularity, cervical lymphadenopathy of each type were retrospectively analyzed. RESULTS: All 27 PTLs were diffuse large B-cell lymphomas and were accompanied by diffuse Hashimoto's thyroiditis. Ten were diffuse type and seventeen were non-diffuse type sonographically. The observations in diffuse group included goiter (10/10, 100.0%, marked echogenesity (10/10, 100.0%, heterogeneous echotexture (10/10, 100.0%, and cervical lymphadenopathy (4/10, 40.0%. The observations in non-diffuse group included marked hypoechogenicity (17/17, 100.0%, heterogeneous background thyroid gland (17/17, 100.0%, goiter (15/17, 88.2%, increased vascularity (8/13, 61.5%, mulifocality (10/17, 58.8%, and cervical lymphadenopathy (7/17, 41.2%. CONCLUSIONS: Although some common features were found, the sonographic appearance of PTL is unspecific, especially for the diffuse type. Therefore, interventional diagnostic procedures should be warranted in the clinical settings when PTL is suspected.

  13. Additional effective dose by patients undergoing NAI-131 capsules therapy

    Orlic, M.; Jovanovic, M.; Spasic Jokic, V.; Cuknic, O.; Ilic, Z.; Vranjes Djuric, S. [VINCA - Institute of Nuclear Sciences, Belgrade, Serbia and Montenegro (Yugoslavia)


    Capsules or solutions containing Na{sup 131}I are indicated for the therapy of some thyroid carcinomas such as functioning metastatic papillary or follicular carcinoma of the thyroid; and for the treatment of hyperthyroidism (diffuse toxic goiter and single or multiple toxic nodular goiter). The recommended dosage ranges of Na{sup 131}I capsules or solution for the therapy of the average patient (70 kg) are: (3.7-5.55) GBq for ablation of normal thyroid tissue; (3.7-7.4) GBq for subsequent treatments; a (148-370) MBq for hyperthyroidism. The purpose of this paper is to calculate effective dose as a result of iodine-131 capsules remaining in stomach before absorption starts. This result can determine the disadvantage of capsule versus solution containing sodium iodine-131 (Na{sup 131}I) in radionuclide therapy application from radiation protection point of view. The Monte Carlo code MCNP4b was used to model transport of gamma and beta particles emitted by radionuclide {sup 131}I treated as a point source at the bottom of stomach. Absorbed energy per unit transformation in stomach and surrounding organs has been calculated. (authors)

  14. Role of AgNORs in thyroid lesions on fine needle aspiration cytology smears

    Asotra Sarita


    Full Text Available Background: Fine needle aspiration has an important role in diagnosis of thyroid neoplasm. However, it is difficult to differentiate between follicular adenoma and follicular carcinoma by cytology alone. Recently, silver staining has been performed for nucleolar organizer regions (AgNORs to differentiate various tumors. Aims: The present study was undertaken to see if the AgNOR technique could distinguish between benign and malignant lesions, particularly, follicular neoplasm. Materials and Methods: One hundred forty cases of thyroid lesions were examined, which included colloid goiter (n = 36, multinodular goiter (n = 38, subacute thyroiditis (n = 6, Hashimoto′s thyroiditis (n = 17, lymphocytic thyroiditis (n = 3, follicular neoplasm (n = 18, Hurthle cell neoplasm (n = 3, papillary carcinoma (n = 16, and medullary carcinoma (n = 3. Diagnosis was confirmed by histopathology in 80 cases. The usual one-step silver colloidal reaction was performed at room temperature for 35 minutes and intranuclear dots of silver deposits were counted in 100 cells. Results: AgNOR counts of benign and malignant lesions were compared and were found to be statistically significant (P < 0.001. The mean AgNOR counts were higher in neoplastic lesions. Conclusions: AgNOR counting in fine needle aspiration smears is a simple, sensitive, and cost-effective method for differentiating benign from malignant thyroid follicular neoplasms.

  15. Mutation spectrum and genotype-phenotype correlation of hearing loss patients caused by SLC26A4 mutations in the Japanese: a large cohort study.

    Miyagawa, Maiko; Nishio, Shin-Ya; Usami, Shin-Ichi


    Mutations in SLC26A4 cause a broad phenotypic spectrum, from typical Pendred syndrome to nonsyndromic hearing loss associated with enlarged vestibular aqueduct. Identification of these mutations is important for accurate diagnosis, proper medical management and appropriate genetic counseling and requires updated information regarding spectrum, clinical characteristics and genotype-phenotype correlations, based on a large cohort. In 100 patients with bilateral enlarged vestibular aqueduct among 1511 Japanese hearing loss probands registered in our gene bank, goiter data were available for 79, of whom 15 had Pendred syndrome and 64 had nonsyndromic hearing loss. We clarified the mutation spectrum for the SLC26A4 mutations and also summarized hearing levels, progression, fluctuation and existence of genotype-phenotype correlation. SLC26A4 mutations were identified in 82 of the 100 patients (82.0%). Of the Pendred syndrome patients, 93% (14/15) were carriers, as were 77% (49/64) of the nonsyndromic hearing loss patients. Clinical characteristics of patients with SLC26A4 mutations were congenital, fluctuating and progressive hearing loss usually associated with vertigo and/or goiter. We found no genotype-phenotype correlations, indicating that, unlike in the case of GJB2 mutations, the phenotype cannot be predicted from the genotype. Our mutation analysis confirmed the importance of mutations in the SLC26A4 gene among hearing loss patients with enlarged vestibular aqueduct and revealed the mutation spectrum, essential information when performing genetic testing.


    Ramya Ranganathan


    Full Text Available Hashimoto thyroditis is an organ specific autoim-mune disorder. Initially described Hakaru Hash-imotoa century ago is now the most common cause of hypothyroidism in iodine sufficient are-as of the world. But still the pathogenesis is not fully understood. With higher incidence among female population HT develops as a result of in-teraction between the genetic factors and envi-ronmental factors in susceptible individuals. HT is associated with other autoimmune disorders. Now many variants of HT have been identified: classical form, fibrous variant, IgG4 variant, juve-nile form, hashitoxicosis and silent thyroiditis (sporadic or postpartum. All variants of HT are characterized by lympho-cytic infiltration, destruction and atropy of thyroid gland ultimately thyroid failure though each entity has specific other features. Clinically HT can also present as euthyroid or even hyperthyroid state with or without goiter. Diagnosis is based on the clinical features, demonstration of antibodies against thyroid antigen, sonography and cytological findings. Treatment is mainly supplementing Levothyroixin for correction of hypothyroidism. Surgery is reserved for patients with large goiter causing mechanical compression of cervical structures, painful HT and suspicion of malignancy.

  17. Hashimoto thyroiditis: clinical and diagnostic criteria.

    Caturegli, P; De Remigis, A; Rose, N R


    Hashimoto thyroiditis (HT), now considered the most common autoimmune disease, was described over a century ago as a pronounced lymphoid goiter affecting predominantly women. In addition to this classic form, several other clinico-pathologic entities are now included under the term HT: fibrous variant, IgG4-related variant, juvenile form, Hashitoxicosis, and painless thyroiditis (sporadic or post-partum). All forms are characterized pathologically by the infiltration of hematopoietic mononuclear cells, mainly lymphocytes, in the interstitium among the thyroid follicles, although specific features can be recognized in each variant. Thyroid cells undergo atrophy or transform into a bolder type of follicular cell rich in mitochondria called Hürthle cell. Most HT forms ultimately evolve into hypothyroidism, although at presentation patients can be euthyroid or even hyperthyroid. The diagnosis of HT relies on the demonstration of circulating antibodies to thyroid antigens (mainly thyroperoxidase and thyroglobulin) and reduced echogenicity on thyroid sonogram in a patient with proper clinical features. The treatment remains symptomatic and based on the administration of synthetic thyroid hormones to correct the hypothyroidism as needed. Surgery is performed when the goiter is large enough to cause significant compression of the surrounding cervical structures, or when some areas of the thyroid gland mimic the features of a nodule whose cytology cannot be ascertained as benign. HT remains a complex and ever expanding disease of unknown pathogenesis that awaits prevention or novel forms of treatment.

  18. PRDM1 expression via human parvovirus B19 infection plays a role in the pathogenesis of Hashimoto thyroiditis.

    Wang, Lu; Zhang, Wei-Ping; Yao, Li; Zhang, Wei; Zhu, Jin; Zhang, Wei-Chen; Zhang, Yue-Hua; Wang, Zhe; Yan, Qing-Guo; Guo, Ying; Fan, Lin-Ni; Liu, Yi-Xiong; Huang, Gao-Sheng


    Ectopic lymphoid follicle infiltration is a key event in Hashimoto thyroiditis (HT). Positive regulatory domain zinc finger protein 1 (PRDM1), which is induced by antigen stimulation, can regulate all lymphocyte lineages. Several groups independently demonstrated that human parvovirus B19 (PVB19) is closely associated with HT. Hence, we determined whether PRDM1 is expressed in HT thyroid tissue and whether there is any correlation between PRDM1 expression and PVB19 in the pathogenesis of HT. We detected PRDM1 expression in HT (n = 86), normal thyroid tissue (n = 30), and nontoxic nodular goiter (n = 20) samples using immunohistochemistry. We also detected PVB19 protein in HT samples in a double-blind manner and analyzed the correlation between the 2 proteins using immunofluorescence confocal detection and coimmunoprecipitation. Furthermore, we detected changes of the expression levels of PRDM1 and PVB19 in transfected primary thyroid follicular epithelial cells using real-time quantitative polymerase chain reaction. We found that PRDM1 protein is significantly highly expressed in the injured follicular epithelial cells in HT (83/86 cases) than in normal thyroid cells (0/30 cases) or in nontoxic nodular goiter cells (0/20 cases) (P thyroid epithelial cells also showed PRDM1 up-regulation after PVB19 NS1 transfection. Our findings suggest a previously unrecognized role of PRDM1 and PVB19 in the pathogenesis of HT.

  19. Clinical diagnostic potentials of thyroid ultrasonography and scintigraphy; An evaluation

    Torizuka, Tatsuo; Kasagi, Kanji; Hatabu, Hiroto; Misaki, Takashi; Iida, Yasuhiro; Konishi, Junji (Kyoto Univ. (Japan). Hospital); Endo, Keigo


    This prospective study was designed to evaluate the potential contributions of high resolution ultrasonography (US) and Tc-99m scintigraphy in the routine diagnosis of thyroid disease. The diagnostic impacts of US and Tc-99m scintigraphy results in 177 patients visiting our thyroid clinic were assessed and scored according to the following criteria: when the information provided by either test supported, confirmed or changed the initial clinical diagnosis, they received scores of 2, 3 and 4 respectively, while score 1 was given when the test itself was useless for the differential diagnosis. US identified focal lesions that both palpation and scintigraphy had failed to detect in 14 (12.1%) of 116 patients with diffuse thyroid diseases, suggesting the necessity of Hashimoto's thyroiditis, adenoma, adenocarcinoma and adenomatous goiter, and vice versa in the diagnosis of hyperthyroid and euthyroid Graves's diseases. Thus, the advantages of US over scintigraphy for morphological evaluation were confirmed. US was particularly useful for the differential diagnosis of adenomatous goiter from Hashimoto's thyroiditis or a single nodular disease. In contrast, scintigraphy gave functional images, being especially helpful for the differential diagnosis of thyrotoxicosis. (author).

  20. Assessment of iodine nutrition in populations: past, present, and future.

    Zimmermann, Michael B; Andersson, Maria


    Iodine status has been historically assessed by palpation of the thyroid and reported as goiter rates. Goiter is a functional biomarker that can be applied to both individuals and populations, but it is subjective. Iodine status is now assessed using an objective biomarker of exposure, i.e., urinary iodine concentrations (UICs) in spot samples and comparison of the median UIC to UIC cut-offs to categorize population status. This has improved standardization, but inappropriate use of the crude proportion of UICs below the cut-off level of 100 µg/L to estimate the number of iodine-deficient children has led to an overestimation of the prevalence of iodine deficiency. In this review, a new approach is proposed in which UIC data are extrapolated to iodine intakes, adjusted for intraindividual variation, and then interpreted using the estimated average requirement cut-point model. This may allow national programs to define the prevalence of iodine deficiency in the population and to quantify the necessary increase in iodine intakes to ensure sufficiency. In addition, thyroglobulin can be measured on dried blood spots to provide an additional sensitive functional biomarker of iodine status.

  1. Improvement of Metabolic Parameters Resulted from Levothyroxine Therapy in Hypothyroid Type 2 Diabetes Mellitus Patient

    Dante S Harbuwono


    Full Text Available This is a case of 51 year-old woman with uncontrolled type 2 diabetes mellitus which was diagnosed 1.5 year earlier, obesity with body mass index 32.2 kg/m2, waist circumference of 113 cm, diffuse goiter with neck circumference 40 cm, and hypertension with blood pressure >140/90 mmHg. Since 6 months ago, she often seemed like having less concentration or daydreaming, chronic fatigue, depression, and low food intake. Her body weight had been increasing over time. Her hypothyroidism clinical scoring Billewicz and Zulewski criterias were 17 and 8 respectively, showing that she tended to experience hypothyroidism. From laboratory examination, fasting blood glucose was 216 mg/dL and 2-hour postprandial blood glucose was 320 mg/dL with level of HbA1c was 9.9%, triglyceride level was 486 mg/dL, HDL cholesterol 46 mg/dL, LDL cholesterol 157 mg/dL, and total cholesterol was 269 mg/dL. Thyroid ultrasound showed a diffuse goiter in both lobes of her thyroid gland.

  2. Iodine intake in Somalia is excessive and associated with the source of household drinking water.

    Kassim, Ismail A R; Moloney, Grainne; Busili, Ahono; Nur, Abukar Yusuf; Paron, Paolo; Jooste, Pieter; Gadain, Hussein; Seal, Andrew J


    Few data on iodine status in Somalia are available, but it is assumed that deficiency is a public health problem due to the limited access to iodized salt. We aimed to describe the iodine status of the population of Somalia and to investigate possible determinants of iodine status. A national 2-stage, stratified household cluster survey was conducted in 2009 in the Northwest, Northeast, and South Central Zones of Somalia. Urinary iodine concentration (UIC) was determined in samples from women (aged 15-45 y) and children (aged 6-11 y), and examination for visible goiter was performed in the Northwest and South Central strata. A 24-h household food-frequency questionnaire was conducted, and salt samples were tested for iodization. The median UICs for nonpregnant women and children were 329 and 416 μg/L, respectively, indicating excessive iodine intake (>300 μg/L). The prevalence of visible goiter was Somalia is among the highest in the world and excessive according to WHO criteria. Further work is required to investigate the geochemistry and safety of groundwater sources in Somalia and the impact on human nutrition and health.

  3. Population Survey of Iodine Deficiency and Environmental Disruptors of Thyroid Function in Young Children in Haiti.

    von Oettingen, Julia E; Brathwaite, Tesha D; Carpenter, Christopher; Bonnell, Ric; He, Xuemei; Braverman, Lewis E; Pearce, Elizabeth N; Larco, Philippe; Larco, Nancy Charles; Jean-Baptiste, Eddy; Brown, Rosalind S


    Iodine deficiency is the leading cause of preventable neurodevelopmental delay in children worldwide and a possible public health concern in Haiti. To determine the prevalence of iodine deficiency in Haitian young children and its influence by environmental factors. Cross-sectional study, March through June 2015. Community churches in 3 geographical regions in Haiti. 299 healthy Haitian children aged 9 months to 6 years; one-third each enrolled in a coastal, mountainous, and urban region. Urinary iodide, serum thyrotropin (TSH), goiter assessment, and urinary perchlorate and thiocyanate. Mean age was 3.3±1.6 years, with 51% female, median family income USD 30/week, and 16% malnutrition. Median urinary iodide levels were normal in coastal (145 μg/L, interquartile range [IQR] 97 to 241) and urban regions (187 μg/L, IQR 92 to 316), but revealed mild iodine deficiency in a mountainous region (89 μg/L, IQR 56 to 129), P < 0.0001. Grade 1 goiters were palpated in 2 children, but TSH values were normal. Urinary thiocyanate and perchlorate concentrations were not elevated. Predictors of higher urinary iodide included higher urinary thiocyanate and perchlorate, breastfeeding, and not living in a mountainous region. Areas of mild iodine deficiency persist in Haiti's mountainous regions. Exposure to two well-understood environmental thyroid function disruptors is limited.

  4. Effects of Imbalance in Trace Element on Thyroid Gland from Moroccan Children.

    El-Fadeli, Sana; Bouhouch, Sabir; Skalny, Anatoly V; Barkouch, Yassir; Pineau, Alain; Cherkaoui, Mohamed; Sedki, Azeddine


    The major environmental factor that determines goiter prevalence is iodine status. However, other trace elements like selenium and zinc can influence the thyroid function. Hair samples (n = 68) were collected from goitrous and non-goitrous children aged 8-12 years living in the area of Al Haouz Marrakech-(Morocco). Trace element concentrations (Cr, Fe, Mg, Zn, Se, I) in hair were measured using flame atomic absorption spectroscopy, graphite furnace atomic absorption spectroscopy, and inductively coupled plasma mass spectrometry. Difference in the mean concentration of each trace element between groups was determined by ANOVA test. The mean concentration levels of I, Se, and Zn for goitrous children were lower and were similar to the mean concentrations reported in the literature for subjects with goiter. The regression results gave us a better model that revealed significant positive relations between thyroid volume and Zn contents and significant negative relation with I and Se. The overall findings of the present study revealed that the actual factors of thyroid gland volume increase are I and Se deficiency. This work could shed some light on the effects of trace elements-other than iodine-on the thyroid disorders.

  5. Expressions of miRNAs in papillary thyroid carcinoma and their associations with the clinical characteristics of PTC.

    Hu, Jianxia; Li, Chengqian; Liu, Chongkai; Zhao, Shihua; Wang, Yangang; Fu, Zhengju


    The sensitivity and specificity of biomarkers which have been used in clinical practice for diagnosis of papillary thyroid carcinoma (PTC) are low, it is essential to develop novel diagnostic and prognostic biomarkers for PTC. To explore the expressions of miR-940, miR-15a, miR-16 and IL-23 in PTC tissues and plasma and their associations with the clinical characteristics of PTC. We investigated the expressions of miR-940, miR-15a, miR-16 and IL-23 in plasma and thyroid tissues of PTC, nodular goiter and healthy people with qRT-PCR, and further analyzed the associations between their levels and the clinical characteristics of PTC. Level of IL-23 expression was higher while levels of miR-940, miR-15a and miR-16 expression in the PTC tissues were lower compared with the nodular goiter tissues and perineoplastic thyroid tissues. And the levels of miR-940, miR-15a, miR-16 and IL-23 expression in the PTC tissues were associated with some clinical characteristics of PTC, including bilateral tumor, multicentricity, extrallyroidal invasion, cervical lymph node metastasis, distant metastasis and clinical advanced stages (III/IV). Expressions of miR-940, miR-15a, miR-16 and IL-23 in PTC tissues might be useful biomarkers and promising targets in the diagnosis of papillary thyroid carcinoma.

  6. Interactive MR-guided biopsies of the thyroid gland: validation of a new method

    Kacl, G.M. [Department of Medical Radiology, University Hospital Zurich (Switzerland)]|[Division of Nuclear Medicine, University Hospital Zurich (Switzerland); Bicik, I.; Schulthess, G.K. von [Division of Nuclear Medicine, University Hospital Zurich (Switzerland); Schoenenberger, A.W.; Steiner, P.; Romanowski, B.; Debatin, J.F. [Department of Medical Radiology, University Hospital Zurich (Switzerland)


    The aim of this study was to demonstrate the clinical feasibility and utility of an interactive MR-guidance system to target and biopsy thyroid lesions, and to compare resolution between ultrasound and interventional MR imaging in the evaluation of thyroid lesions. Twenty thyroid lesions of 18 patients were interactively biopsied using a 0.5-T superconducting open magnet system. Stereotactic localization of the needle and imaging was accomplished using T1-weighted gradient-recalled-echo (GRE) images. Representative cytological material was retrieved in 16 of 20 lesions (benign cystic or colloid goiter: n = 14; one de Quervain`s thyroiditis and one follicular neoplasia). Lesions smaller than 1.5 cm detected by ultrasound could not be visualized adequately on GRE images. Lesions smaller than 1.5 cm were successfully biopsied by ultrasound (three colloid and haemorrhagic goiters and one adenoma). Magnetic-resonance-guided interactive biopsies and positioning of non-ferromagnetic needles in the thyroid gland are technically feasible and safe. Compared with high-resolution ultrasound, lesions larger than 1.5 cm can be adequately visualized and biopsied. Magnetic-resonance-guided placement of non-ferromagnetic needles is no substitute for high-resolution ultrasound in clinical work-up of thyroid lesions. (orig.) With 8 figs., 1 tab., 18 refs.

  7. Determination of Thyroid Volume by Ultrasonography among Schoolchildren in Philippines

    Bu Kyung Kim


    Full Text Available Objective. Iodine deficiency is defined by the goiter and the urinary iodine concentration. However, a lack of local thyroid volume reference data resulted in the vague definition of goiter, especially in school-aged children. The aim of this paper was to determine the thyroid volumes by ultrasonography in schoolchildren aged 6 to 12 years living in Cagayan areas in Philippine. Methods. Cross-sectional thyroid ultrasonographic data of 158 schoolchildren aged 6–12 years from Tuguegarao and Lagum in Cagayan valley, Philippine were used. Thyroid volumes were compared based on logistic issue and urban and rural area and compared with other previously reported data. Results. The mean values of thyroid volume in Tuguerago and Lagum were 2.99±1.34 mL and 2.42±0.92 mL. The thyroid size was significantly in association with age (P<0.00, weight (P<0.00, height (P<0.00, and BSA (P<0.00 by Pearson’s correlation. The median thyroid volumes of schoolchildren investigated in this study were generally low compared to international reference data by age group but not by BSA. Conclusions. We propose for the first time local reference ultrasound values for thyroid volumes in 6–12 aged schoolchildren that should be used for monitoring iodine deficiency disorders.

  8. Potential risk factors in systemic hypoplasia and dental caries at odontogenesis stage

    Kovach I.V.


    Full Text Available Lesion of hard dental tissue with caries process and lesions not connected with caries present overwhelming majority of dental diseases. Causes leading to damage of enamel integrity and dentin with progressing demineralization are known; they allow to choose justified method of primary prophylaxis. Along with it, etiology and pathogenesis of enamel lesions with demineralization signs remains unexplored. Epidemiologic study of prevalence, incidence and severity of lesion of hard dental tissues in 330 pupils, who constantly live on endemic iodine-defficient territory, of three zones – mountain zone, foothill and valley. For comparison, schoolchildren migrated to this territory 2-3 years after birth, and children – residents of favorable as for iodine level in drinking water were examined, 30 children in each group. It was established, that overwhelming number of schoolchildren of endemic zone suffer from endemic goiter of various severity, which sufficiently impacts on protein-mineral ratio of the organism, bone skeleton and teeth including. It was also established, that residents of three various levels of iodine consumption are prone to development of multiple dental caries and systemic enamel hypoplasia. Children, residents of mountain zone suffer the most, with simultaneous lesion of thyroid gland. The role of endemic goiter in systemic dental enamel hypoplasia and multiple caries, which changes protein matrix, negatively impacts on odontogenesis and mineralization degree is underlined.

  9. Cobalt Cardiomyopathy: A Critical Reappraisal in Light of a Recent Resurgence.

    Packer, Milton


    Cobalt can cause a distinctive, rapidly progressive and reversible depression of cardiac systolic function, which is readily distinguished from other causes of cardiomyopathy. Patients present with the subacute onset of severe heart failure, which is accompanied by hypotension and cyanosis, pericardial effusion, low voltage on the electrocardiogram, marked elevation of serum enzymes, and lactic acidosis. They typically have a history of lethargy, anorexia, and weight loss in the months preceding the illness and exhibit other evidence of cobalt's effects on the body (eg, polycythemia and goiter). The course of cobalt-related cardiomyopathy may be progressive and fatal, but those who survive and cease exposure generally demonstrate complete resolution of symptoms and recovery of cardiac function. Patients presenting with rapid onset of cardiomyopathy, who also exhibit polycythemia, pericardial effusion, or goiter should be evaluated for cobalt exposure. Exposure can be confirmed by the measurement of cobalt in the serum, but serum levels of the ion are not reliably predictive of clinical cardiotoxicity. The clinical emergence of cobalt cardiomyopathy seems to require the coexistence of one or more cofactors, particularly a low-protein diet, thiamine deficiency, alcoholism, and hypothyroidism. As the medicinal use of cobalt has waned and measures to reduce industrial exposure have been implemented, subacute cobalt-related cardiomyopathy had become rare. However, reports describing classical features of the disease have recently surged among patients with a malfunctioning cobalt-alloy hip prosthesis. © 2016 American Heart Association, Inc.

  10. Antenatal management of recurrent fetal goitrous hyperthyroidism associated with fetal cardiac failure in a pregnant woman with persistent high levels of thyroid-stimulating hormone receptor antibody after ablative therapy.

    Matsumoto, Tadashi; Miyakoshi, Kei; Saisho, Yoshifumi; Ishii, Tomohiro; Ikenoue, Satoru; Kasuga, Yoshifumi; Kadohira, Ikuko; Sato, Seiji; Momotani, Naoko; Minegishi, Kazuhiro; Yoshimura, Yasunori


    High titer of maternal thyroid-stimulating hormone receptor antibody (TRAb) in patients with Graves' disease could cause fetal hyperthyroidism during pregnancy. Clinical features of fetal hyperthyroidism include tachycardia, goiter, growth restriction, advanced bone maturation, cardiomegaly, and fetal death. The recognition and treatment of fetal hyperthyroidism are believed to be important to optimize growth and intellectual development in affected fetuses. We herein report a case of fetal treatment in two successive siblings showing in utero hyperthyroid status in a woman with a history of ablative treatment for Graves' disease. The fetuses were considered in hyperthyroid status based on high levels of maternal TRAb, a goiter, and persistent tachycardia. In particular, cardiac failure was observed in the second fetus. With intrauterine treatment using potassium iodine and propylthiouracil, fetal cardiac function improved. A high level of TRAb was detected in the both neonates. To the best of our knowledge, this is the first report on the changes of fetal cardiac function in response to fetal treatment in two siblings showing in utero hyperthyroid status. This case report illustrates the impact of prenatal medication via the maternal circulation for fetal hyperthyroidism and cardiac failure.

  11. Prevalence of goitre and autoimmune thyroiditis in schoolchildren in Delhi, India, after two decades of salt iodisation.

    Gopalakrishnan, Sripathy; Singh, S P; Prasad, Walia Ram; Jain, Sushil Kumar; Ambardar, Vinod Kumar; Sankar, Rajan


    Delhi lies in the sub-Himalayan plains and the existence of iodine deficiency is well established. Iodised salt was introduced in Delhi nearly two decades ago. The aim of the present study was to determine the status of iodine nutrition in school-aged children and the prevalence of autoimmune thyroiditis. A total of 4,320 schoolchildren (2,218 [51.3%] boys) aged 10-16 years were studied. Goitre was detected in 396 children, an overall goitre prevalence of 9.2%. Of the 396 children with goitre, 112 (28.3%) had evidence of autoimmune thyroiditis (AIT). The median urinary iodine (UI) excretion in the study population as a whole was 14.6 microg/dl. The median UI in the group of children with goiter was 13.3 microg/dl, whereas UI in children with goiter and evidence of AIT was 16.6 microg/dl (p <0.01). Of the 112 children with AIT, 77 (68.7%) were euthyroid, 23 (20.5%) had subclinical hypothyroidism, eight (7.2%) had hypothyroidism and the remaining four (3.6%) had hyperthyroidism. UI was high in goitrous children with AIT, and in children with thyroid dysfunction. Further studies are needed to clarify whether the higher UI in goitrous children with AIT is causally related to AIT or is due to the inability of the diseased thyroid to trap available iodine efficiently.

  12. Caracterización clínica y funcional en pacientes con diagnóstico inicial de tiroiditis de Hashimoto en el año 2007. Clinical and functional characterization in patients with initial diagnosis of Hashimoto's thyroiditis in 2007.

    Marelys Yanes Quesada


    Full Text Available INTRODUCCIÓN: la tiroiditis de Hashimoto constituye una afección tiroidea autoinmune de lenta evolución, y es la primera causa de hipotiroidismo con bocio en zonas con adecuada ingesta de yodo. OBJETIVO: identificar las características clínicas (edad, sexo, antecedentes patológicos familiares de enfermedad tiroidea y presencia de bocio, así como el estado de función tiroideo en el momento del diagnóstico de la tiroiditis de Hashimoto. MÉTODOS: se realizó un estudio descriptivo y transversal con 41 pacientes con diagnóstico inicial de tiroiditis de Hashimoto durante el año 2007, a los cuales se les llenó un modelo de encuesta, y se les hizo examen físico del tiroides, así como dosificación de hormona estimulante del tiroides y tiroxina total. Los datos se analizaron utilizando el método porcentual y se expusieron en tablas. RESULTADOS: se obtuvo un predominio del sexo femenino con un 78 %, y según edad y sexo el grupo más frecuente ocurrió en las mujeres de 50 a 59 años con un 29,26 %. El 60,97 de los pacientes presentó antecedentes patológicos familiares de enfermedad tiroidea. Todos los pacientes presentaron bocio, y fue el más frecuente el grado 2, con un 60,97 %. El 58,53 de los pacientes estaba funcionalmente eutiroideo. CONCLUSIONES: la tiroiditis de Hashimoto fue más frecuente en el sexo femenino y en la quinta década de la vida, la presencia de antecedentes patológicos personales fue muy frecuente, y todos los pacientes presentaron bocio en el momento del diagnóstico, más frecuente de grado 2. La mayoría de los casos tuvo una función tiroidea normal.INTRODUCTION: Hashimoto's thyroiditis is an autoimmune thyroid affection of slow evolution and it is the first cause of hypothyroidism with goiter in zones with an adequate ingestion of iodine. OBJECTIVE: to identify the clinical characteristics (age, sex, family pathological history of thyroid disease and presence of goiter, as well as the state of thyroid

  13. 2008年浙江省舟山市海岛地区甲状腺疾病流行病学调查%Epidemic investigation of thyroid diseases related to iodized salt intake in Zhoushan Archipelago

    胡晓斐; 竺王玉; 周世权; 王晔恺; 郑笑娟; 赵臣银; 袁惠萍; 刘晓光; 张永奎


    目的 调查浙江省舟山市海岛地区食用非加碘盐的居民患甲状腺疾病状况及致甲状腺疾病的相关影响因素.方法 2008年在浙江省舟山市岱山县对737名食用非加碘盐的居民进行流行病学问卷调查、甲状腺B超检查、甲状腺功能及尿碘测定;同时抽查了183名8~10岁儿童(均为食用非加碘盐居民的子女)的尿碘.结果 舟山市岱山县食用非加碘盐的居民尿碘中位数(MUI)为122.2 μg/L,8~10岁儿童MUI为123.7μg/L;甲状腺肿、甲状腺癌、甲状腺功能亢进(简称甲亢)、亚临床甲状腺功能亢进(简称亚临床甲亢)和亚临床甲状腺功能减退(简称亚临床甲减)的患病率分别为39.9%、0.4%、0.4%、0.7%和0.8%.logistic回归分析显示,甲状腺肿患病率无性别差异(P>0.05),而年龄是甲状腺肿发生的危险因素(P0.05).结论 舟山市海岛地区食用非碘盐居民碘摄入适量,但甲状腺肿和甲亢患病率较高.%Objective To investigate the healthy status of thyroid in the residents of Zhoushan Archipelago who hadn't taken iodized salt and to analyze the relative influeneing factors of thyroid disease. Methods Seven hundred and thirty-seven residents who hadn't eaten iodized salt in Zhoushan Archipelago were surveyed by questionnaire, their thyroid conditions were detected by B ultrasound, and their thyroid function was also determined. And at the same time, the levels of urinary iodine were analysed in those people and 183 children of 8-10 years old. Results The urinary iodine median of the residents and the children in Daishan County was 122.2,123.7 μg/L, respectively. The prevalence rates of goiter, thyroid carcinoma, hyperthyreosis, subclinical hyperthyreosis, and subclinical hyperthyroidism were 39.9% ,0.4% ,0.4% ,0.7% and 0.8%, respectively. The prevalence rate of thyroid goiter in female was the same as that in male (P > 0.05). Age was a risk factor for thyroid goiter. Thyroid goiter, hyperthyreosis and

  14. Estudo da prevalência das doenças tireoidianas em pacientes tireoidectomizados no Hospital da Santa Casa de Goiânia Prevalence of thyroid diseases in patients submitted to thyroidectomy at the Santa Casa de Goiânia Hospital

    Alexandre Roberti


    Full Text Available OBJETIVO: O Estado de Goiás deixou de ser oficialmente considerado como região endêmica de bócio em 1995. O objetivo deste estudo é verificar a correspondência entre os diagnósticos das doenças tireoidianas (bócio endêmico, tireoidites e câncer, observados nos laudos anátomo-patológicos e nas observações dos inquéritos epidemiológicos. MÉTODO: Estudo retrospectivo de 1399 pacientes submetidos a tireoidectomias na Santa Casa de Misericórdia de Goiânia de 1993 a 2003, e que resultaram em 1610 diagnósticos anátomo-patológicos. RESULTADOS: Os resultados dos exames anátomo-patológicos dos pacientes revelaram: a adenoma folicular 155 (9,63%; b outros adenomas 29 (1,8%; c bócio adenomatoso 87 (5,4%; d bócio colóide 981 (60,9%; e carcinoma folicular 36 (2,24%; f carcinoma indiferenciado 3 (0,19%; g carcinoma papilífero 93 (5,78%; h cistos 9 (0,56%; i bócio difuso tóxico 75 (4,66%; j outras tireoidites 12 (0,75%; l outras neoplasias malignas 6 (0,38% e m tireoidite linfocítica 124 (7,71%. CONCLUSÕES: O perfil observado com uma prevalência alta de tireoidite linfocítica e carcinoma papilífero se correlaciona realmente com região não endêmica.BACKGROUND: The State of Goiás has left the position of an endemic goiter region in 1995. Our objective is to study the correlation between histological diagnosis of thyroid diseases (endemic goiter, thyroiditis and cancer and results of epidemiological enquiries. METHODS: Retrospective analysis of 1399 patient files, who underwent thyroid surgery from 1993 to 2003 at the Santa Casa de Misericórdia de Goiânia. RESULTS: We detected 1610 histological diagnosis: follicular adenoma in 155 (9.63%, others adenomas in 29 (1.80%, adenomatous goiter in 87 (5.40%, colloid goiter in 981 (60.9%, follicular carcinoma in 36 (2.24%, anaplastic carcinoma in 3 (0.19%, papillary carcinoma in 93 (5.78%, cysts in 9 (0.56%, toxic diffuse goiter in 75 (4.66%, others thyroiditis in 12 (0.75%, others

  15. 试论碘缺乏与甲状腺病的预防%Prevention of Iodine Deficiency and Thyroid Disease



    目的:预防碘缺乏是消除甲状腺肿地方病的主要措施,因碘摄入越少时甲状腺肿的患病率越高。方法近年来国家规定了在缺碘地区售食盐必须是加碘的食盐和食用天然富有含碘食品的海产品,并对加碘保健品进行了大量的开发和研制性工作,目前采取了综合性措施,这是预防缺碘性甲状腺肿行之有效的措施。结果我国采取食用含碘食品,虽然经过了若干年的努力后已基本消除了碘缺乏病,但要保持持续消除碘缺乏病,还需要一个长期的战略目标。结论预防甲状腺肿的地方病,对提高全民族的健康水平、实现消灭碘缺乏病的目标将有着十分重要的意义。%Objective To prevent iodine deficiency is a major measure to eliminate endemic goiter,the higher the iodine intake is low due to the prevalence of goiter. Methods In recent years the state of the salt in iodine-deficient areas sale must be iodized salt and consumption of natural foods rich in iodine seafood,and iodized health products a lot of research and development work is currently taking a comprehensive measures which is the prevention of iodine deficiency goitre ef ective measures. Results iodine edible to take in our country. Even after several years of diligence has been basical y eliminated iodine deficiency disorders,but sustained elimination of iodine deficiency disorders,also requires a long-term strategic objectives. Conclusion The goal of the endemic goiter,to improve the health of the whole nation,to achieve the eradication of iodine deficiency diseases wil have great significance.

  16. Effectiveness of radioiodine therapy in treatment of hyperthyroidism.

    Alam, M N; Chakrabarty, R K; Akhter, M; Nahar, N; Swapan, M K; Alam, M M; Nahar, R; Sultana, N; Hallaz, M M; Alam, M M; Uddin, M M; Hossain, M A; Yasmin, S; Islam, M R


    The present non randomized clinical trial was conducted in the Center for Nuclear Medicine and Ultrasound, Mymensingh, Bangladesh for duration of one year. Total 30 patients with hyperthyroidism diagnosed by clinical and biochemical profile were included in the study. All patients received radioiodine treatment and regular follow up at 1st month, 3rd month, 6th month & 9th month were done to evaluate clinical and biochemical status and complications. Data were analyzed by computer with SPSS programme using 't' test and chi-square test. In the present study, out of 30 respondents more than three fourth of the respondents (76.6%) were in the age group of 31-50 years followed by less than 30 years are group (16.7%) and rest of respondents were in the age group of more than 50 years (06.7%). Mean±SD and range of age of the respondents were 39.80±10.02 years and 17-65 years respectively. Among the 30 respondents 11(36.7%) were male and 19(63.3%) were female. Male to female ratio was 1:1.73. Out of 30 patients 26(86.7%) presented with goiter and among them 21(80.8%) has diffused goiter and five (19.2%) had nodular goiter. Baseline mean±SD, median, range of serum T₃ level were 5.24±3.62, 4.34, 1.48-14.65nmol/L respectively. Base line mean±SD, median range of serum T₄ level were 192.25±99.17, 201.77, 1.75-336.25nmol/L respectively. Baseline mean±SD, median range of serum TSH level were 6.33±23.93, 0.15-0.07, 130.46nmol/L respectively. In the present study serum T₃, T₄ level among the respondents sharply decrease from baseline to 2nd follow up then gradually decrease from 2nd to 4th follow up. Serum TSH level gradually increases from baseline to 3rd follow up and then gradually decreases from 3rd to 4th follow up. The result showed radioiodine is an effective option for the treatment of thyrotoxicosis.

  17. Estrogen receptors (alpha and beta) and 17beta-hydroxysteroid dehydrogenase type 1 and 2 in thyroid disorders: possible in situ estrogen synthesis and actions.

    Kawabata, Wakako; Suzuki, Takashi; Moriya, Takuya; Fujimori, Keisei; Naganuma, Hiroshi; Inoue, Satoshi; Kinouchi, Yositaka; Kameyama, Kaori; Takami, Hiroshi; Shimosegawa, Tooru; Sasano, Hironobu


    Both epidemiological and experimental findings suggest the possible roles of sex steroids in the pathogenesis and/or development of various human thyroid disorders. In this study, we evaluated the expression of estrogen receptors (ER) alpha and beta in normal thyroid glands (N = 25; female: n = 13, male: n = 10, unknown: n = 2) ranging in age from fetus to adult. Furthermore, using immunohistochemistry, we investigated the expression of ERalpha and beta in 206 cases of thyroid disorders, including 24 adenomatous goiters, 23 follicular adenomas, and 159 thyroid carcinomas. In addition, we also studied the mRNA expression of ERalpha and beta and 17beta-hydroxysteroid dehydrogenase Type 1 and 2, enzymes involved in the interconversion between estrone and estradiol, using reverse transcription polymerase chain reaction (RT-PCR), in 48 of these 206 cases (10 adenomatous goiters, 10 follicular adenomas, and 28 papillary thyroid carcinomas) in which fresh frozen tissues were available for examination to further elucidate the possible involvement of intracrine estrogen metabolism and/or actions in thyroid disorders. ERalpha labeling index, or percentage of cells immunopositive for ERalpha, was significantly higher in adenomatous goiter (14.2 +/- 6.4), follicular adenoma (13.4 +/- 5.1), and thyroid carcinoma (16.4 +/- 2.1) than in normal thyroid gland (0; P thyroid glands. In papillary carcinoma, ERalpha labeling index was significantly higher in premenopausal women (28.1 +/- 4.5) than in postmenopausal women (14.2 +/- 2.9) and in men of various ages (7.6 +/- 2.7; P thyroid carcinoma, no significant correlations were detected. ERbeta immunoreactivity was detected in both follicular and C-cells of normal thyroid glands, including those in developing fetal thyroid glands. In addition, ERbeta immunoreactivity was detected in the nuclei of various thyroid lesions. But no significant correlations were detected between ERbeta labeling index and clinicopathological findings

  18. 甲状腺结节的超声诊断分析%Diagnosis Analysis of Thyroid Nodules in Ultrasound



    目的:探讨超声对甲状腺结节鉴别诊断的价值。方法对85例超声检查并经手术及病理证实的甲状腺结节超声表现进行回顾性分析。结果病理证实结节性甲状腺肿59例(结节性甲状腺肿并腺瘤结节7例),甲状腺瘤8例,结节性桥本氏甲状腺炎12例,甲状腺癌6例。术前超声诊断结节性甲状腺肿66例,腺瘤6例,结节性桥本氏甲状腺炎7例,甲状腺癌3例,结节性质待定3例。结论超声诊断是甲状腺结节术前检查不可缺少的手段,对甲状腺疾病临床诊断和鉴别诊断具有重要价值。%Objective To evaluate the value of ultrasound in dif erential diagnosis of thyroid nodules .Methods Eighty five cases of ultrasound probe on the preoperative examination, surgical and pathological examination of the thyroid nodules were retrospectively analyzed. Results Pathology confirmed fivety nine cases of nodular goiter ( nodular goiter and seven cases of nodular adenoma), thyroid adenoma in eighty cases, Hashimoto's thyroiditis in twelve cases,six cases of thyroid cancer. Preoperative ultrasound diagnosis of sixty six cases of nodular goiter, Adenoma in 6 cases, Hashimoto's thyroiditis in seven cases,three cases of Thyroid carcinoma,unsure nodules in three cases .Conclusion The high-frequency ultrasound to determine the nature of thyroid nodules Have a higher value, but easy to mistakenly missed, especial y in the smal er thyroid microcarcinoma easily missed.

  19. Expression and significance of STK15 gene in parpillary thyroid carcinoma%丝氨酸/苏氨酸激酶15在甲状腺乳头状癌诊治中的意义

    孙淑明; 杨秀珣; 陈耿芝; 卢晓峰; 林豪雨; 梁伟全; 陈春发


    Objective To explore the expression of serine/threonine kinase 15 (STK15) gene and its significance for papillary thyroid carcinoma. Methods SP immunohistochemical method was used to detect the expression of STK15 gene in 71 cases of papillary thyroid carcinoma and 45 cases nodular goiter tissue. Results The positive expression rates of STK15 gene in 71 cases of papillary thyroid carcinoma were 100%, and the adjacent of papillary thyroid carcinoma expressions of STK15 gene 8.5%, nodular goiter tissue of STK15 gene expression rates 24.4%. The expression of STK15 gene was positively correlated with that of STK15 gene in papillary thyroid carcinoma (P < 0.01). Conclusion High expression of STK15 gene is confirmed in papillary thyroid carcinoma. The detection of STK15 gene can provide valuable evidence for diagnosis of papillary thyroid carcinoma and evaluation of the malignant potential of nodular goiter.%目的:探讨甲状腺乳头状癌组织中丝氨酸/苏氨酸激酶15(STK15)的表达及其作用。方法:采用免疫组织化学法检测71例甲状腺乳头状癌组织及其癌旁组织和45例结节性甲状腺肿组织中STK15基因的表达。结果:71例甲状腺乳头状癌组织中STK15基因的阳性表达率均为100.0%,癌旁组织STK15阳性表达率8.45%,结节性甲状腺肿组织中STK15阳性表达率为24.4%。在甲状腺乳头状癌组织中STK15的表达具有相关性(P <0.01)。结论:STK15基因在甲状腺乳头状癌组织中均为高表达,通过检测STK15可提高甲状腺乳头状癌的诊断率,对发现具有恶性潜能的结节性甲状腺肿有重要意义。

  20. Evaluation with low-dose dual-phase helical computed tomography of patients with thyroid lesions

    Li Lin; Wang Yong; Zhao Yanfeng; Zou Shuangmei; Lin Meng; Yu Xiaoduo; Tang Wei


    Background The incidence of thyroid cancer has been increasing.Our aim was to evaluate the efficacy of low-dose dualphase helical computed tomography (CT) in the characterization of thyroid lesions,and to discuss the relationship between image characteristics and their pathology.Methods One hundred and six patients with thyroid lesions underwent low-dose dual-phase helical CT after the injection of contrast material.CT scans were obtained at arterial and venous phase with delays of 25 and 65 seconds,and tube current of 60 and 120 mA,respectively.The attenuation change in the lesion between the arterial and venous phase was analyzed and categorized as "increased," "decreased," "mixed" or "no change." Results Histopathologic diagnosis was obtained by surgery in 106 patients (115 lesions).Of the 106 patients,45 had nodular goiter,5 thyroid adenoma,6 thyroiditis,and 50 papillary thyroid carcinoma (PTC) (59 lesions).The attenuation value showed a significant difference (P <0.05) between the arterial and venous phase for the high attenuation area.There was statistical significant difference in terms of attenuation value in high attenuation areas at both phases and in low attenuation areas on arterial phase between nodular goiter and PTC (P <0.05).However,there was no significant difference in attenuation value between adenoma and PTC.Twenty-nine cases (76.3%) of goiter manifested mixed type,3 cases (3/5) of adenoma showed decreased type,6 cases (6/6) of thyroiditis showed increased type,and 55 cases (93.2%) of PTC showed decreased type attenuation.The sensitivity,specificity for thyroid carcinoma by dual-phase CT were 94.9% and 80.4% respectively.The overall diagnostic accuracy for thyroid lesions by dual-phase CT was 87.8%.Conclusions The performance of dual-phase helical CT is related to the pathological structure of the lesions.The analysis of enhancement patterns by using dual-phase helical CT will be helpful in the differential diagnosis of thyroid

  1. MSCT Diagnosis of Chronic Lymphocytic Thyroiditis%慢性淋巴细胞性甲状腺炎的MSCT诊断

    顾立军; 韩本谊; 冀星华


    目的:探讨慢性淋巴细胞性甲状腺炎(CLT)的MSCT表现及其诊断与鉴别诊断.方法:回顾性分析经手术病理证实的CLT患者56例,其中伴有结节性甲状腺肿17例、甲状腺腺瘤15例和甲状腺癌9例.全部病例均行CT平扫,42例同时增强扫描.结果:CT平扫甲状腺增大49例,腺体密度均匀减低30例,不均匀减低16例;伴有结节或团块37例,其中单发结节24例,多发结节10例,弥漫小结节3例;出现钙化10例、囊变4例.增强扫描病变呈速升缓降型,60sCT值达峰值,然后缓慢下降,强化均匀或不均匀.结论:CLT常合并结节性甲状腺肿、腺瘤和甲状腺癌,MSCT表现有一定特点,帮助诊断及鉴别诊断.%Purpose: To explore the MSCT manifestation, diagnosis and differential diagnosis of chronic lymphocytic thyroiditis (CLT). Methods: Fifty-six cases of CLT confirmed by operation and pathological result were reviewed, including 17 cases of nodular goiter, 15 cases of thyroid adenoma and 9 cases of thyroid carcinoma. All the cases received plain CT scan, and 42 of them accepted contrast-enhanced scan. Results: Plain CT scan: 49 cases were shown with thyroid goiter, 30 of them were with homogeneous low densities in the thyroid, and 16 cases with non-uniform low densities; 37 cases were shown with nodules or lumps, which included 24 cases with solitary nodule, 10 cases with multiple nodules, and 3 case with diffuse nodules; Calcification was found in 10, and cystoid degeneration in 4. Contrast-enhanced CT scans: CLT was shown with quick ascent and slow decent time-density curve, the CT value of the lesion was increased to maximum at 60' s, then was decreased slowly; The enhancement was homogeneous or heterogeneous. Conclusion: CLT often accompanies with nodular goiter, thyroid adenoma and thyroid carcinoma. It has some common features on MSCT, which can be used for diagnosis and differential diagnosis of CLT.

  2. Thyroid lesions diagnosis by Fourier transformed infrared absorption spectroscopy (FTIR); Diagnostico de lesoes da tireoide pela espectroscopia de absorcao no infravermelho por transformada de Fourier - FTIR

    Albero, Felipe Guimaraes


    Thyroid nodules are a common disorder, with 4-7% of incidence in the Brazilian population. Although the fine needle aspiration (FNA) is an accurate method for thyroid tumors diagnosis, the discrimination between benign and malignant neoplasm is currently not possible in some cases with high incidence of false negative diagnosis, leading to a surgical intervention due to the risk of carcinomas. The aim of this study was to verify if the Fourier Transform infrared spectroscopy (FTIR) can contribute to the diagnosis of thyroid carcinomas and goiters, using samples of tissue and aspirates. Samples of FNA, homogenates and tissues of thyroid nodules with histopathological diagnosis were obtained and prepared for FTIR spectroscopy analysis. The FNA and homogenates samples were measured by {mu}-FTIR (between 950 . 1750 cm{sup -1}), at a nominal resolution of 4 cm{sup -1} and 120 scans). Tissue samples were analyzed directly by ATR-FTIR technique, at a resolution 2 cm{sup -1}, with 60 scans in the same region. All spectra were corrected by the baseline and normalized by amides area (1550-1640 cm{sup -1}) in order to minimize variations of sample homogeneity. Then, spectra were converted into second derivatives using the Savitzk-Golay algorithm with a 13 points window. The Ward's minimum variance algorithm and Euclidean distances among the points were used for cluster analysis. Some FNA samples showed complex spectral pattern. All samples showed some cell pellets and large amount of hormone, represented by the bands of 1545 and 1655 cm{sup -1}. Bands in 1409, 1412, 1414, 1578 and 1579 cm{sup -1} were also found, indicating possible presence of sugar, DNA, citric acid or metabolic products. In this study, it was obtained an excellent separation between goiter and malign lesion for the samples of tissues, with 100% of specificity in specific cluster and 67% sensibility and 50 of specificity. In homogenate and FNA samples this sensibility and specificity were lower

  3. Obstructive Sleep Syndrom in Patient with Plonjon Guatr: Case Report

    Haldun sevketbeyoglu


    Full Text Available A large number of predisposing factors (obesity, nasal obstruction, adenoid hypertrophy, macroglossia, etc. are reported to be associated with obstructive sleep apnea syndrome (OUAS. In addition to these factors, the large goiter and hypothyroidism were reported to be associated with OSAS as well. However, this relationship could not yet be fully demonstrated. In our case related to plonjon goiter, we wanted to show the effect of hyroidectomy to OSAS and #8211;if there is- and the relationship between pressure and OSAS. Two years ago, a 72-year-old female with BMI: 26.8 kg/m2 patient was admitted to our clinic with complaints of respiratory standstill during sleep, snoring, morning headaches and drowsiness during daylight. In the chest X-ray, chest computed tomography and ultrasonography applied to the patient, it was detected that the trachea was deviated to the left due to euthyroid plonjon goiter and severe OSAS and polisomnografisi (PSG was diagnosed for the patient. The patients apnea-hypopnea index (AHI was measured 63.1/h. With the aim of treatment, in 7cm H2O pressure, nasal continuous positive airway pressure (nCPAP was applied to the patient and AHI decreased to the level of 11.4/h. Thyroidectomy was performed one month after the diagnosis. AHI was found 34.8 /h on the PSG applied for the purpose of 8 week-postoperative control. There were recovery on the levels of total sleep time, AHI, obstructive apnea index, hypopnea index, average desaturation index, stage 3 and REM as 16%, 44.8%, 84.7%, 19%, 38.3%, 52.4% and 28% respectively when compared the preoperative term with and postoperative term. It was demonstrated that there was no change of the in the degree of OSAS after thyroidectomy but only some partial improvement in the OSAS. The conclusion that there may be some improvements in nCPAP pressures after thyroidectomy and nCPAP treatment should not be stopped was reached. Also, it should be kept in mind that patients who apply to

  4. Diffuse lipomatosis of the thyroid gland: A pathologic curiosity

    Gupta Ruchika


    Full Text Available We report the case of a 45-year-old man who presented with a 4-year history of midline neck swelling associated with recent onset respiratory distress. Local examination showed a lobulated diffuse thyroid enlargement. A subtotal thyroidectomy was performed. The right lobe weighed 225 g and the left lobe weighed 130 g. Multiple sections from both the lobes revealed diffuse infiltration of the stroma by mature adipose tissue. There was no evidence of amyloid deposits or papillary carcinoma. A final diagnosis of diffuse lipomatosis of the thyroid gland was rendered. Lipomatosis or adenolipomatosis of the thyroid gland is an extremely rare entity. The various differential diagnoses of fat in the thyroid include benign entities like amyloid goiter, adenolipoma, lymphocytic thyroiditis, intrathyroid thymic or parathyroid lipoma and malignant tumors like liposarcoma and encapsulated papillary carcinoma. Adequate clinical details and a thorough histopathological examination are mandatory for diagnosis.

  5. Phrenic Nerve Palsy as Initial Presentation of Large Retrosternal Goitre.

    Hakeem, Arsheed Hussain; Hakeem, Imtiyaz Hussain; Wani, Fozia Jeelani


    Unilateral phrenic nerve palsy as initial presentation of the retrosternal goitre is extremely rare event. This is a case report of a 57-year-old woman with history of cough and breathlessness of 3 months duration, unaware of the thyroid mass. She had large cervico-mediastinal goiter and chest radiograph revealed raised left sided hemidiaphragm. Chest CT scan did not reveal any lung parenchymal or mediastinal pathology. The patient underwent a total thyroidectomy through a cervical approach. The final pathology was in favor of multinodular goitre. Even after 1 year of follow up, phrenic nerve palsy did not improve indicating permanent damage. Phrenic nerve palsy as initial presentation of the retrosternal goitre is unusual event. This case is reported not only because of the rare nature of presentation, but also to make clinicians aware of the entity so that early intervention may prevent attendant morbidity.

  6. Monitoring of iodine intake and thyroid status of pregnant women in Saratov region from 1999 till 2008

    Naumova Yu.V.


    Full Text Available The article presents the results of monitoring of iodine intake and thyroid status in pregnant women in Saratov region according to the two cross-sectional studies in 1999 and 2008. The study involved 229 pregnant women. It has been established that there is a decrease in frequency of endemic goiter in pregnant women from 52,8 to 23,6% and increase in median urinary ioduria from 33,0 to 115,5 ug/l. However, iodine intake in pregnancy remains insufficient, as currently the median urinary ioduria is 150-249 ug/l (WHO, 2007. The frequency of maternal hypothyroxinemia, the most significant iodine deficiency disorders in pregnant women, has not changed in a 10-year period (1999 - 46,3%; in 2008 - 55,7%; p>0,1. The research has not obtained significant differences in the frequency of interrelated with pregnancy and delivery complications within two groups of patients

  7. Onset of Graves' disease during pregnancy in a woman with established hypothyroidism.

    Alberiche, María; Sánchez-Hernández, Rosa María; López Mérida, Xabier; Wägner, Ana María


    Pregnancy strongly influences the thyroid gland and its function. Thyroid guidelines recommend a 30 to 50% increase of the preconceptional levothyroxine dose in women with hypothyroidism, when pregnancy is diagnosed. A 33 year-old, 8-week pregnant woman with hypothyroidism, presents with a 2-week history of palpitations, sweating, nervousness and fatigue. Physical examination shows tachycardia (108 bpm), distal tremors and diffuse goiter. After biochemical confirmation of hyperthyroidism, her levothyroxine dose is reduced and finally interrupted. Propylthiouracil is started and maintained until after the delivery of a healthy baby at week 40. Two weeks postpartum, hyperthyroidism worsens and propylthiouracil is replaced by methimazole. Eighteen months after delivery 7.5 mCi 131Iodine was given. Two months later, hypothyroidism developed and levothyroxine was initiated. Although conversion of Hashimoto's hypothyroidism into Graves' disease is exceptional in pregnancy, pregnant women with autoimmune hypothyroidism should ideally have their TSH concentrations measured before empirically increasing their levothyroxine dose.

  8. Thyroid functions of neonates with Down syndrome

    Sarici Dilek


    Full Text Available Abstract Background We aimed to evaluate thyroid functions and volumes and detect abnormalities in 80 neonates with Down syndrome. Methods Data about free triiodothyronine, free thyroxine, thyroid stimulating hormone, thyroglobulin and urinary iodine levels, and ultrasonographic thyroid volume were collected. Results Abnormal thyroid function tests were detected in 53.8% of the patients (n = 50 and these were hyperthyrotropinemia, hypothyroidism, iodine deficiency and iodine overload in 32, 2, 12 and 4 patients, respectively. Thyroid volumes were assessed in 36 patients and a total of 17 abnormalities were detected (7 hypoplasia, 3 agenesis and 7 goiter. In patients with hyperthyrotropinemia mean thyroid volume was significantly greater and mean TSH was significantly higher when compared to the patients without hyperthyrotropinemia. Conclusion Neonatal screening by thyroid function tests in Down syndrome should be performed to prevent further intellectual deterioration and improve overall development. In the neonatal period, the risk of hyperthyrotropinemia should be kept in mind.


    Vatseba, T S


    The aim of the study was to investigate the levels of adiponectin and indexes of insulin resistance in patients with primary hypothyroidism. In this article published data and personal data about the role of adiponectin in formation insulin resistance in patients with primary hypothyroidism are shown. The study involved 72 patients with primary hypothyroidism. arising on the background of endemic goiter, including 42 women and 30 men. A direct linear correlation between indexes HOMA IR and TSH was established. We found significantly lower levels of adiponectin in all patients with manifest and subclinical hypothyroidism compared with the control group. Low levels of adiponectin may be an independent factor in the development of insulin resistance in hypothyroidism, cardiovascular diseases and can be considered to be the marker of hypothyroidism with components of metabolic syndrome.

  10. Iniencephaly clausus: A case report with review of literature

    Padmaja R Kulkarni


    Full Text Available Iniencephaly is a rare neural tube defect characterized by extreme retroflexion of the head with the absence of neck due to spinal deformities. The important features that help us to diagnose a case of iniencephaly are occipital bone deficit leading to enlarged foramen magnum, fusion of malformed cervical and thoracic vertebrae, and upward turned face with chin continuous with chest because of the absence of neck. The differential diagnoses include anencephaly with spinal retroflexion, Klippel-Fiel syndrome, nuchal tumors such as teratoma, goiter, and lymphangioma and Jarcho-Levin syndrome. Previously many case reports on radiological features of iniencephaly are published, but there are very few articles on necropsy findings and differential diagnosis. In the present case we have discussed in detail the necropsy findings of iniencephaly clausus with special reference to differential diagnosis.


    Aleksandar Karanikolić


    Full Text Available Tracheobronchial injury (TBI is a rare complication occurring after endotracheal intubation. Treatment can be conservative for small lesions and when the patient’s condition is stable, or surgical for bigger lesions and when pneumomediastinum and/or subcutaneous emphysema threaten the patient’s life. Total thyroidectomy was performed in a 60-year-old woman with multinodular goiter. Ten hours after surgery, subcutaneous emphysema of the face and neck developed. A cervical and thoracic multislice computed tomography (MSCT confirmed subcutaneous emphysema, pneumomediastinum, and posterior wall tracheal rupture 2cm in size. The patient was treated conservatively. The MSCT imaging can be a useful method for diagnosing the location and form of tracheal injury in hemodynamically stable patients.

  12. Volcanoes and carcinoma of the thyroid: a possible association.

    Kung, T M; Ng, W L; Gibson, J B


    Environmental factors contributing to incidences of thyroid carcinoma are re-evaluated and emphasized in this study. Thyroid cancers appear to occur independent of endemic goiter, based on epidemiologic and histologic evidence. While environmental factors appear to be important, the specific etiologic agent has not yet been identified or suggested. The number of thyroid cancer incidences available from cancer registries are analyzed in an attempt to identify a specific environmental carcinogenic agent. The presence of active volcanoes that produce abundant lava is found to be the common denominator of Iceland and Hawaii, where the incidence of thyroid cancer is outstandingly high. Comparison with other areas with active volcanoes is made. The presence of a carcinogenic agent in the lava is postulated and its possible mode of action on humans through fish products is hypothesized.

  13. Metastatic Renal Cell Carcinoma to the Thyroid Gland: A Case Report and Brief Review of the Literature

    Georgios Kyriakos


    Full Text Available Thyroid metastases are rarely seen in clinical practice but should be considered particularly in patients with a history of non-thyroidal malignancies. Renal cell carcinoma (RCC is the most common tumor to metastasize to the thyroid gland and may present many years after a nephrectomy. Thus, patients require a long-term follow-up and, physicians should have a high index of suspicion particularly in patients with benign disorders of the thyroid gland. Fine needle aspiration cytology (FNAC and thyroglobulin immunohistochemical staining are considered the most effective methods for diagnosis. Surgical treatment of solitary thyroid metastases is recommended and prolongs survival. Adjuvant medical treatment may also be useful in specific situations. We present the unusual case of a relative young patient with goiter who presented with an intrathyroidal metastasis of RCC. Turk Jem 2014; 2: 58-60

  14. Weight Gain and Serum TSH Increase within the Reference Range after Hemithyroidectomy Indicate Lowered Thyroid Function

    Toft Kristensen, Tina; Larsen, Jacob; Pedersen, Palle Lyngsie;


    -up period. Results. Two years after hemithyroidectomy, median serum TSH was increased over preoperative levels (1.23 versus 2.08 mIU/L, P weight (75.0 versus 77.3 kg, P = 0.02). Matched healthy controls had unchanged median serum TSH (1.70 versus 1.60 mIU/L, P = 0......Background. Weight gain is frequently reported after hemithyroidectomy but the significance is recently discussed. Therefore, the aim of the study was to examine changes in body weight of hemithyroidectomized patients and to evaluate if TSH increase within the reference range could be related...... to weight gain. Methods. In a controlled follow-up study, two years after hemithyroidectomy for benign euthyroid goiter, postoperative TSH and body weight of 28 patients were compared to preoperative values and further compared to the results in 47 matched control persons, after a comparable follow...

  15. Evaluating autoimmunity markers (TPO Ab, Tg Ab and TM Ab in hypothyroid patients of Bushehr province

    Iraj Nabipour


    Full Text Available Background: Chronic autoimmune thyroiditis (Hashimoto's Thyroiditis is the common cause of primary hypothyroidism in iodine sufficient countries. Iran is named an iodine sufficient country, in this century. Methods: A total of 88 hypothyroid patients, on suppressing dose of levothyroxine who were followed in a university endocrine disorder clinic were evaluated for serum thyroid autoimmunity markers: thyroid peroxidase antibody (TPO Ab, thyroglobulin antibody (Tg Ab and thyroid microsomal antibody (TM Ab using ELISA method. Results: The prevalence of TPO Ab, Tg Ab and TM Ab were 73.9%, 45.5% and 71.6%, respectively. Among the patients with high level of TPO Ab (> 75 u/ml, 45.3% had grade 1 or 2 of goiter (P< 0.05. Conclusion: Autoimmune thyroid disease (Hashimoto's thyroiditis is the most common cause of hypothyroidism in Bushehr province.

  16. Ex vivo imaging of human thyroid pathology using integrated optical coherence tomography and optical coherence microscopy

    Zhou, Chao; Wang, Yihong; Aguirre, Aaron D.; Tsai, Tsung-Han; Cohen, David W.; Connolly, James L.; Fujimoto, James G.


    We evaluate the feasibility of optical coherence tomography (OCT) and optical coherence microscopy (OCM) for imaging of benign and malignant thyroid lesions ex vivo using intrinsic optical contrast. 34 thyroid gland specimens are imaged from 17 patients, covering a spectrum of pathology ranging from normal thyroid to benign disease/neoplasms (multinodular colloid goiter, Hashimoto's thyroiditis, and follicular adenoma) and malignant thyroid tumors (papillary carcinoma and medullary carcinoma). Imaging is performed using an integrated OCT and OCM system, with sections. Characteristic features that suggest malignant lesions, such as complex papillary architecture, microfollicules, psammomatous calcifications, or replacement of normal follicular architecture with sheets/nests of tumor cells, can be identified from OCT and OCM images and are clearly differentiable from normal or benign thyroid tissues. With further development of needle-based imaging probes, OCT and OCM could be promising techniques to use for the screening of thyroid nodules and to improve the diagnostic specificity of fine needle aspiration evaluation.

  17. Renal, gastric and thyroidal amyloidosis due to familial Mediterranean fever.

    Kavukçu, S; Türkmen, M; Eroğlu, Y; Canda, T; Yörükoğlu, K; Iğci, E; Büyükgebiz, A


    Chronic renal failure developed in a 10-year-old girl due to renal amyloidosis secondary to familial Mediterranean fever (FMF). During management of the chronic renal failure by hemodialysis and of FMF with colchicine, goiter and hypothroidism were observed. Thyroid fine-needle aspiration and gastric endoscopical biopsies, performed when recurrent abdominal pain could not be controlled, revealed amyloid deposits in both thyroid and gastric tissues. After 6 months' therapy with colchicine and levothyroxine, there was no significant change in the thyroid volume. This is the first case in which gastric amyloidosis secondary to FMF in childhood has been demonstrated. Patients with amyloidosis secondary to FMF who have thyroid enlargement and unexplained gastrointestinal symptoms despite adequate therapy should be evaluated with imaging studies and biopsy examinations.

  18. Respiratory Syncytial Virus Infection as a Precipitant of Thyroid Storm in a Previously Undiagnosed Case of Graves' Disease in a Prepubertal Girl

    Charlton RWilliam


    Full Text Available Graves' disease is less common in prepubertal than pubertal children, and initial presentation with thyroid storm is rare. We report an 11-year-old prepubertal Hispanic girl who presented with a one-day history of respiratory distress, fever, and dysphagia. She had exophthalmos, a diffuse bilateral goiter and was agitated, tachycardic, and hypertensive. Nasal swab was positive for respiratory syncytial virus (RSV. She was diagnosed with thyroid storm and admitted to the pediatric intensive care unit. While infection is a known precipitant of thyroid storm and RSV is a common pediatric infection, to the best of our knowledge, this is the first reported case of RSV infection apparently precipitating thyroid storm in a prepubertal child.

  19. Italian Association of Clinical Endocrinologists (AME) & Italian Association of Clinical Diabetologists (AMD) Position Statement : Diabetes mellitus and thyroid disorders: recommendations for clinical practice.

    Guastamacchia, Edoardo; Triggiani, Vincenzo; Aglialoro, Alberto; Aiello, Antimo; Ianni, Lucia; Maccario, Mauro; Zini, Michele; Giorda, Carlo; Guglielmi, Rinaldo; Betterle, Corrado; Attanasio, Roberto; Borretta, Giorgio; Garofalo, Piernicola; Papini, Enrico; Castello, Roberto; Ceriello, Antonio


    Thyroid disease and diabetes mellitus, the most common disorders in endocrine practice, are not infrequently associated in the same subject. An altered thyroid function may affect glucose tolerance and worsen metabolic control in patients with diabetes. Thyrotoxicosis increases the risk of hyperglycemic emergencies, while a clinically relevant hypothyroidism may have a detrimental effect on glycemic control in diabetic patients. The association of alterations in thyroid function with diabetes mellitus may adversely affect the risk of cardiovascular and microvascular complications resulting from diabetes. Moreover, the treatments used for both diabetes and thyroid disease, respectively, can impact one other. Finally, multinodular goiter, but not thyroid carcinoma, was shown to be more prevalent in type 2 diabetes mellitus. Aim of the present Position Statement is to focus on the evidence concerning the association of thyroid disease and diabetes mellitus and to provide some practical suggestions for an updated clinical management.

  20. Contribution of ultrasonography and scintillography to the evaluation of parothyroid glands; Contribuicao da ultra-sonografia na avaliacao das glandulas paratireoideas

    Craide, Rosany Helena [Sao Paulo Univ., SP (Brazil). Hospital das Clinicas. Servico de Ultra-som; Cerri, Giovanni Guido [Instituto do Coracao, Sao Paulo, SP (Brazil). Dept. de Diagnostico por Imagem; Custodio, Melani Ribeiro; Jorgetti, Vanda [Sao Paulo Univ., SP (Brazil). Hospital das Clinicas. Servico de Nefrologia; Oliveira, Ilka Regina S. [Sao Paulo Univ., SP (Brazil). Hospital das Clinicas. Inst. de Radiologia; Vermelho, Marli B.F. [Sao Paulo Univ., SP (Brazil). Hospital das Clinicas. Servico de Ultra-sonografia


    Sonography and scintilography are good methods for imaging the parathyroid adenomas and hyperplasias. The diagnostic methods were correlated in order to determine the sensitivity of sonographic evaluation with that of scintigraphy in the preoperative examinations for hyperparathyroidism suspected on clinical groups. Scintigraphic examinations were obtained using technetium-9 9 m and technetium-99m-sestamibi as radionuclide agents. A group of 36 patients was evaluated with sonography 19 being correlated with sestamibi. Our results suggest that sonography yields a sensitivity of 77 and 78.5%in comparison with scintigraphy with technetium-99m and with technetium-99m-sestamibi, respectively. The sonographic limitations are ectopic glands, enlarged thyroid goiter and posteriorly displaced adenomas. (author)