Anaplastic Carcinoma and Toxic Multinodular Goiter: An Unusual Presentation

Science.gov (United States)

Marcelino, Mafalda; Marques, Pedro; Lopes, Luis; Leite, Valeriano; de Castro, João Jácome

2014-01-01

A 70-year-old male was referred with hyperthyroidism and multinodular goiter (MNG). Thyroid ultrasonography showed 2 nodules, one in the isthmus and the other in the left lobe, 51 and 38 mm in diameter, respectively. Neck CT showed a large MNG, thyroid scintigraphy showed increased uptake in the nodule in the left lobe, and fine-needle aspiration biopsy showed a benign cytology of the nodule in the isthmus. The patient declined surgery and was treated with methimazole. After being lost to follow-up for 3 years, the patient returned with complaints of dyspnea, dysphagia, and hoarseness; he was still hyperthyroid. Cervical CT showed a large mass in the isthmus and left lobe with invasion of surrounding tissues, the trachea, the esophagus, and the recurrent laryngeal nerve. Bronchoscopy showed extensive infiltration and compression of the trachea to 20% of its caliber. A tracheal biopsy revealed an anaplastic thyroid carcinoma. The tumor was considered unresectable, and radiotherapy was given. One month later, the patient died. The association between a toxic thyroid nodule and anaplastic thyroid carcinoma has apparently not been reported so far. PMID:25759806

STRUCTURE OF THE NODULAR GOITER IN CHILDREN

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O. S. Rogova

2015-01-01

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

Mutations in the thyrotropin receptor signal transduction pathway in the hyperfunctioning thyroid nodules from multinodular goiters: a study in the Turkish population.

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Gozu, Hulya; Avsar, Melike; Bircan, Rifat; Sahin, Serap; Deyneli, Oguzhan; Cirakoglu, Beyazit; Akalin, Sema

2005-10-01

Many studies have been carried out to determine G(s) alpha and TSHR mutations in autonomously functioning thyroid nodules. Variable prevalences for somatic constitutively activating TSHR mutations in hot nodules have been reported. Moreover, the increased prevalence of toxic multinodular goiters in iodine-deficient regions is well known. In Turkey, a country with high incidence rates of goiter due to iodine deficiency, the frequency of mutations in the thyrotropin receptor signal transduction pathway has not been evaluated up to now. In the present study, a part of the genes of the TSHR, G(s)alpha and the catalytic subunit of the PKA were checked for activating mutations. Thirty-five patients who underwent thyroidectomy for multinodular goiters were examined. Genomic DNAs were extracted from 58 hyperactive nodular specimens and surrounding normal thyroid tissues. Mutation screening was done by single-strand conformational polymorphism (SSCP) analysis. In those cases where a mutation was detected, the localization of the mutation was determined by automatic DNA sequencing. No G(s)alpha or PKA mutations were detected, whereas ten mutations (17%) were identified in the TSHR gene. All mutations were somatic and heterozygotic. In conclusion, the frequency of mutations in the cAMP signal transduction pathway was found to be lower than expected in the Turkish population most likely because of the use of SSCP as a screening method and sequencing only a part of TSHR exon 10.

Thiamazole Pretreatment Lowers the (131)I Activity Needed to Cure Hyperthyroidism in Patients With Nodular Goiter.

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Kyrilli, Aglaia; Tang, Bich-Ngoc-Thanh; Huyge, Valérie; Blocklet, Didier; Goldman, Serge; Corvilain, Bernard; Moreno-Reyes, Rodrigo

2015-06-01

Relatively low radioiodine uptake (RAIU) represents a common obstacle for radioiodine ((131)I) therapy in patients with multinodular goiter complicated by hyperthyroidism. To evaluate whether thiamazole (MTZ) pretreatment can increase (131)I therapeutic efficacy. Twenty-two patients with multinodular goiter, subclinical hyperthyroidism, and RAIU effective option than LID.

Congenital thyroid hemiagenesis with multinodular goiter

International Nuclear Information System (INIS)

Bhartiya, SK; Verma, A; Basu, S; Shukla, VK

2014-01-01

Thyroid hemiagenesis is a rare form of thyroid dysgenesis characterized by an absence of half of the thyroid gland. Developmental hemi-thyroid anomalies can result from either an abnormal descent or an agenesis of one lobe of the thyroid gland. We report a case of a 40-year-old woman with history of a longstanding gradually progressive thyroid swelling without any complication. An ultrasonographic examination diagnosed the absence of the left thyroid lobe and enlargement of the right lobe, which was confirmed on a computed tomography (CT) angiogram and a radionuclide scan of the neck. A cytological examination showed nodular goiter with cystic degeneration. Right subtotal thyroidectomy was performed and histopathological examination confirmed adenomatous goiter with degenerative changes. We report the rarity of the condition and emphasize the role of a comprehensive radiological, cytological, and radionuclide algorithm for an accurate preoperative diagnosis and subsequent management

A study of goiter among female adolescents referred to centre for nuclear medicine, Lahore

International Nuclear Information System (INIS)

Elahi, S; Hassan, M.; Syed, Z.; Hyder, S.W.; Nazeer, L.; Nagra, S.A.

2005-01-01

Objective: To study goiter and thyroid dysfunction in female adolescents residing in Lahore referred to Centre for Nuclear Medicine (CENUM), Mayo Hospital for thyroid scanning and thyroid function tests. Design: Retrospective study of thyroid size, thyroid scan patterns and serum FT/sub 4/ and TSH levels. Setting: Centre for Nuclear Medicine (CENUM), Mayo Hospital, Lahore. Patients: 350 female adolescent referred during September 2002 to April 2003. Main outcome measures: adolescent goiter, thyroid nodules, hyperthyroidism, hypothyroidism, Graves' disease, toxic multi nodular goiter. Results: Among 350 adolescents 212(60.6%) had goiter of various grades mostly visible. Among goiterous patients 136(64.2%) had diffuse and 76 (35.8%) had nodular presentation. The number of patients with solitary nodular goiter (20.7%) was more than multi nodular goiter (15.1%) and number of patients with solitary cold nodule (16.5%) was more than functioning nodule (4.2%). The incidence of biochemical thyroid dysfunction, both overt and subclinical, was detected in 42(19.8%) patients and was significantly more frequent in patients with nodular than diffuse presentation (29% VS 14.7%; p<0.001) and in multinodular than solitary nodular goiter (p<0.005). More than 80% of the patients with solitary nodular goiter were euthyroid. Simple goiter was detected in 116(54.7%), Graves' disease in 5(2.4%) and toxic multinodular goiter in 4(1.9%) patients. Overall incidence of hypothyroidism was more than double as compared to hyperthyroidism. Incidence of nodularity and hypothyroidism was more in large goiter but duration of goiter was not significant in promoting nodularity. Conclusion: Goiterous adolescents need urgent attention because they don't have just diffuse hypertrophy with normal thyroid function. Many are afflicted with dysfunction and nodularity, particularly solitary cold nodule bearing risk of thyroid malignancy. (author)

Harmonic scalpel in multinodular goiter surgery: impact on surgery and cost analysis.

Science.gov (United States)

Sebag, Frederic; Fortanier, Cécile; Ippolito, Guiseppe; Lagier, Aude; Auquier, Pascal; Henry, Jean-Francois

2009-04-01

The aim of this study was to evaluate the potential advantages and the general operative cost of the Harmonic Scalpel (HS) in surgery for multinodular goiter (MNG). Patients undergoing total thyroidectomy (TT) for MNG were prospectively allocated in a conventional tie-and-clip (TC) group (n = 50) and an HS group (n = 50). All pre- and postoperative data were recorded. The economic evaluation was based on a microcost measurement and aimed to consider all the resources consumed for each patient during the surgical procedure. To compare the results, we used the nonparametric unpaired two-tailed Mann-Whitney test. There were 81 women and 19 men (mean age, 55 +/- 15 years). Mean preoperative TSH level was 1.2 (SD, 1.1) (TC) and 1.3 (SD, 2) (HS) (P = NS). Mean body mass index was 24.72 (SD, 8) (TC) and 25.6 (SD, 8) (HS) (P = NS). Four patients experienced a transient hypocalcemia (2 in each group). One patient had a postoperative hematoma requiring surgical evacuation (HS). One patient experienced a transient recurrent nerve palsy (TC). Mean length of surgery was 104 (SD, 32) (TC) and 84 minutes (SD, 17) (HS) (P = .0001). Mean length of hospitalization was 2 days in both groups (SD, 1) (P = NS). Mean operative cost per patient was 990 euro (SD, 191) in the TC group and 1,024 euro (SD, 143) in the HS group (P = NS). Safety and efficiency of the HS is comparable to the tie-and-clip technique in thyroid surgery. The use of the HS in MNG surgery allows for a significant reduction in the length of the procedure with a comparable cost.

Radioiodine therapy in toxic multinodular goiter- the influence of carbimazole therapy and dietary iodine on relapse rates

International Nuclear Information System (INIS)

Mitra, S.; Muthu, G.S.

2007-01-01

Full text: The relapse rate of radioiodine therapy in toxic multinodular goiter (TMNG) is reported to be around 34% at one year. The effect of antithyroid drugs on the response rate is controversial with studies reporting a higher relapse rate in patients pretreated with antithyroid drugs. Other studies report no influence of pretreatment with antithyroid drugs. The thyroid clinic at Tata Main Hospital is a referral center for thyroid disorders in Jamshedpur. 63 patients of TMNG (Group A) were treated with Radioiodine between 1995-2003. The demographic profile of these patients was as follows: M/F- 38%: 62%, 76% of patients were above 40 years, 85% had been on anti-thyroid drugs for more than 18 months. Fixed dose radioiodine in an oral dose varying from 5-10 mCi was given in all patients of Group A. 32.4 % of patients continued to be toxic or relapsed after a period of euthyroid status within 1 year of Radioiodine therapy. A change in protocol for radioiodine therapy was introduced in 2003. This included withdrawal of antithyroid drugs for one month before radioiodine therapy and the use of noniodized salt and abstinence from seafood in diet during this period. 33 TMN Goiter patients (Group B) followed this protocol before receiving Radioiodine. The dose of Radioiodine remained 5-10 mCi. The age and sex profile of Group A and B were comparable. However, Group B patients had been on antithyroid drugs for a shorter period (p< 0.001). The dose of Radioiodine in 94% of Group B patients was between 7-10mCi, whereas this was 63.4% in Group A. The rest of the patients had received a dose between 5-7 mCi. The relapse rate in Group B was 9.1% compared to 32.4% in Group A. Improvement in response rates with increase in Radioiodine dose remains controversial.P PThe better response rate in Group B patients may be attributed to the withdrawal of antithyroid drugs for one month before therapy and the reduction in dietary intake of Iodine for a month before therapy. However, a

A Giant Euthyroid Endemic Multinodular Goiter with No Obstructive or Compressive Symptoms

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Ahmed Nada

2011-01-01

Full Text Available Diffusely enlarged thyroid glands (goitres are becoming increasingly infrequent. However, in some geographical areas they are still relatively common and can cause compressive symptoms involving the trachea, oesophagus, and recurrent laryngeal nerve. Surgical treatment of diffusely enlarged thyroid glands requires a high level of expertise and may lead to severe complications. Here we present a case report of surgical treatment of an extremely enlarged thyroid gland, found in a 61-year-old female patient. The patient underwent surgery, and a thyroidectomy was performed. The resulting specimen weighed 4.7 kg (10.4 lbs. Histopathological examination revealed a multinodular goitre with multiple cysts and areas of haemorrhage and necrosis. Surgical excision can immediately resolve local symptoms and is often recommended when substernal extension is evident. To the best of our knowledge, this is the largest thyroid gland ever reported in the literature. Only experienced surgeons should treat large thyroid goitres. Ideally, large thyroid goitres should be treated before they reach a substernal component, otherwise any sudden growth in gland size could seriously compromise respiration.

Thyroid growth immunoglobulins in large multinodular endemic goiters: effect of iodized oil.

Science.gov (United States)

Medeiros-Neto, G A; Halpern, A; Cozzi, Z S; Lima, N; Kohn, L D

1986-09-01

-promoting activity and serum Tg concentrations (r = 0.58; P less than 0.001), but no significant correlation was found with other parameters (TSH, T4, and T3). We conclude that growth-promoting IgGs lacking ability to stimulate cAMP production may play a role in the large multinodular goiters due to chronic iodine deficiency.

Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: a quality improvement project

International Nuclear Information System (INIS)

Mitra, Sujata; Muthu, Sonai G.

2012-01-01

Radioiodine ( 131 I) therapy is the definitive treatment of toxic multinodular goiter (TMNG). Treatment failure may result in relapse after 131 I therapy. The present study was undertaken to reduce treatment failure rate of 131 I therapy in TMNG patients. Multiple causes may have lead to treatment failure of 131 I in TMNG patients making it difficult to establish a direct cause-effect relationship and take corrective action. Therefore, the JURAN methodology of quality improvement was applied. The treatment failure rate in 80 TMNG patients treated with 131 I in the period 2003-06 was 29%. The root cause analysis identified delay in decision to radioablate and concomitant antithyroid drugs (ATD) with 131 I therapy as factors leading to relapse. In 2007, a change in management was introduced with decision to radioablate all TMNG patients not remitting at 1 year of ATD and to withdraw ATD for 2 weeks prior to 131 I therapy. A total of 63 patients of TMNG followed the changed protocol between 2007 and 2009. Further analysis showed that one of the factors identified in the initial brainstorming (high iodide pool in the patient) had not been addressed in the protocol currently followed. The protocol was modified to include patient preparation and implemented after standardization. The post- 131 I relapse rate in patients treated after implementation of the new protocol from 2007 to 2009 was 18% which further reduced to 16% in 2011 after modification of the protocol. The failure rate of 131 I therapy in TMNG reduced from 29% to 16% through standardization of the treatment procedure achieved by the use of Juran Methodology that helped to identify process-related defects. (author)

Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: a quality improvement project

Energy Technology Data Exchange (ETDEWEB)

Mitra, Sujata; Muthu, Sonai G., E-mail: sujatamitra@tatasteel.com [Department of Nuclear Medicine, Tata Main Hospital, Jamshedpur (India)

2012-01-15

Radioiodine ({sup 131}I) therapy is the definitive treatment of toxic multinodular goiter (TMNG). Treatment failure may result in relapse after {sup 131}I therapy. The present study was undertaken to reduce treatment failure rate of {sup 131}I therapy in TMNG patients. Multiple causes may have lead to treatment failure of {sup 131}I in TMNG patients making it difficult to establish a direct cause-effect relationship and take corrective action. Therefore, the JURAN methodology of quality improvement was applied. The treatment failure rate in 80 TMNG patients treated with {sup 131}I in the period 2003-06 was 29%. The root cause analysis identified delay in decision to radioablate and concomitant antithyroid drugs (ATD) with {sup 131}I therapy as factors leading to relapse. In 2007, a change in management was introduced with decision to radioablate all TMNG patients not remitting at 1 year of ATD and to withdraw ATD for 2 weeks prior to {sup 131}I therapy. A total of 63 patients of TMNG followed the changed protocol between 2007 and 2009. Further analysis showed that one of the factors identified in the initial brainstorming (high iodide pool in the patient) had not been addressed in the protocol currently followed. The protocol was modified to include patient preparation and implemented after standardization. The post-{sup 131}I relapse rate in patients treated after implementation of the new protocol from 2007 to 2009 was 18% which further reduced to 16% in 2011 after modification of the protocol. The failure rate of {sup 131}I therapy in TMNG reduced from 29% to 16% through standardization of the treatment procedure achieved by the use of Juran Methodology that helped to identify process-related defects. (author)

A Clinical Study on 125IT3 Resin Uptake Rate and Serum Thyroxin(T4) in Hyperthyroidism

International Nuclear Information System (INIS)

MooN, Ern Soo; Park, Yoh Han; Cho, Chang Ho; Park, In Soo; Lee, Chong Suk; Lee, Hak Choong

1978-01-01

Hyperthyroidism may be defined as those clinical conditions which result from an increase in the circulating levels of one or both thyroid hormones. Hyperthyroidism in broad sense could be classified with toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter on the basis of the circulating thyroid hormone levels. For this study, the subject included 94 cases with hyperthyroidism were presented in 77 with toxic diffuse goiter, 8 with toxic adenomatous goiter, and 9 with toxic multinodular goiter on the levels of 125 IT 3 resin uptake rate and serum thyroxine (T 4 ). The observed results were as follows: 1) In the cases of hyperthyroidism including toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter, 20.21% of the patients were male and 79.79% female. The majority of the patients were in 2nd to 4th decades of their lives. 2) There were objective signs clearly manifested in hyperthyroidism including toxic diffuse goiter and toxic adenomatous goiter which were rare in the multinodular goiter. The clinical signs in toxic diffuse and toxic adenomatous goiter included wide pulse pressure, tachycardia, systolic murmur, exophthalmos, tremor and warm skin etc. 3) The most frequent complaints of the patients with hyperthyroidism were palpitation, weight loss, increased appetite, perspiration, heat intolerance, nervousness, exertional dyspnea, and menstrual disturbance etc. There was no clear difference in the incidence of symptoms between toxic diffuse goiter and toxic adenomatous goiter, but there was clear difference between toxic multinodular goiter. 4) Considering of results of 125 IT 3 resin uptake rate and serum T 4 level in toxic diffuse goiter, toxic adenomatous goiter and toxic multinodular goiter, 125 IT 3 resin uptake rate was 49.15±9.94% (mean) and serum T 4 21.29±7.04 ug/dl (mean) in toxic diffuse goiter. In toxic multinodular goiter, 125 I T 3 resin uptake rate was 32.47±6.74% (mean) and serum T 4 level 11.03�

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

Energy Technology Data Exchange (ETDEWEB)

Albino, C.C., E-mail: ccalbino@uol.com.b [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

2006-03-15

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)

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

International Nuclear Information System (INIS)

Albino, C.C.; Graf, H.; Paz-Filho, G.; Olandoski, M.; Sabbag, A.; Buchpiguel, C.

2006-01-01

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 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 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 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 131 I (author)

Total thyroidectomy as primary elective procedure in multinodular thyroid disease

International Nuclear Information System (INIS)

Sheikh, I.A.; Haider, I.Z.; Haroon, A.; Ashfaq, M.

2009-01-01

Multinodular goitre is one of the commonest thyroid diseases encountered in the practice of surgery. The most common surgery being performed for multinodular goitre is subtotal thyroidectomy. Total thyroidectomy is designed to remove all of the thyroid tissue. The objective of this study was to evaluate total thyroidectomy as a primary elective procedure for treatment of multinodular thyroid disease. This descriptive study was carried out at Combined Military Hospital Rawalpindi from June 2003 to September 2006. 88 patients of multinodular thyroid disease were included. Patients having evidence of recurrent laryngeal nerve damage, recurrent goitre, evidence of altered parathyroid functions or evidence of malignancy were excluded. All patients underwent total thyroidectomy by the same team of surgeons and the patients were closely followed up for postoperative complications especially in terms of recurrent laryngeal nerve damage and hypocalcaemic tetany. No major postoperative complication was noted. Only 1 patient (1.14%) developed unilateral recurrent laryngeal nerve damage and 2 patients (2.27%) developed transient hypocalcaemia that recovered quickly. Total thyroidectomy as a primary elective procedure in multinodular thyroid disease is a safe option and it removes the disease process completely, lowers local recurrence rates and avoids the substantial risks of re operative surgery. (author)

A Clinical Study on {sup 125}IT{sub 3} Resin Uptake Rate and Serum Thyroxin(T{sub 4}) in Hyperthyroidism

Energy Technology Data Exchange (ETDEWEB)

MooN, Ern Soo; Park, Yoh Han; Cho, Chang Ho; Park, In Soo; Lee, Chong Suk; Lee, Hak Choong [National Medical Center, Seoul (Korea, Republic of)

1978-09-15

Hyperthyroidism may be defined as those clinical conditions which result from an increase in the circulating levels of one or both thyroid hormones. Hyperthyroidism in broad sense could be classified with toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter on the basis of the circulating thyroid hormone levels. For this study, the subject included 94 cases with hyperthyroidism were presented in 77 with toxic diffuse goiter, 8 with toxic adenomatous goiter, and 9 with toxic multinodular goiter on the levels of {sup 125}IT{sub 3} resin uptake rate and serum thyroxine (T{sub 4}). The observed results were as follows: 1) In the cases of hyperthyroidism including toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter, 20.21% of the patients were male and 79.79% female. The majority of the patients were in 2nd to 4th decades of their lives. 2) There were objective signs clearly manifested in hyperthyroidism including toxic diffuse goiter and toxic adenomatous goiter which were rare in the multinodular goiter. The clinical signs in toxic diffuse and toxic adenomatous goiter included wide pulse pressure, tachycardia, systolic murmur, exophthalmos, tremor and warm skin etc. 3) The most frequent complaints of the patients with hyperthyroidism were palpitation, weight loss, increased appetite, perspiration, heat intolerance, nervousness, exertional dyspnea, and menstrual disturbance etc. There was no clear difference in the incidence of symptoms between toxic diffuse goiter and toxic adenomatous goiter, but there was clear difference between toxic multinodular goiter. 4) Considering of results of {sup 125}IT{sub 3} resin uptake rate and serum T{sub 4} level in toxic diffuse goiter, toxic adenomatous goiter and toxic multinodular goiter, {sup 125}IT{sub 3} resin uptake rate was 49.15+-9.94% (mean) and serum T{sub 4} 21.29+-7.04 ug/dl (mean) in toxic diffuse goiter. In toxic multinodular goiter, {sup 125}I T{sub 3} resin uptake

Obstructive sleep apnoea syndrome in a patient with retrosternal goiter: a case report

International Nuclear Information System (INIS)

Sevketbeyoglu, H.; Kara, K.; Ince, M.; Karaagac, H.

2012-01-01

Full text: Introduction: Obstructive sleep apnoea syndrome (OSAS) is associated with a large number of predisposing factors (obesity, nasal obstruction, adenoid hypertrophy, macroglossia etc.). In addition to these factors goiter and hypothyroidism have been reported to be associated with OSAS. Objectives and tasks: In our case with retrosternal goiter, values of OSAS before and after thyroidectomy were shown. Materials and methods: Seventy-two years old, BMI: 26,8 kg/m 2 , female patient was admitted our hospital because of complaints to stop breathing during sleep, snoring, morning headache and daytime drowsiness. Results: Thorax CT and ultrasonography of thyroid shown retrosternal goiter and left tracheal deviation. Severe OSAS was diagnosed by polysomnography (PSG). Thyroid function tests were normal. Apneahypopnea index (AHI) was 63,1/h. Patients was performed 7 cm H 2 O nasal continuous positive airway pressure (gvrnCPAP). AHI was 11,4/h under nCPAP. One month after OSAS diagnosis the patient underwent thyroidectomy operation. Pathological examination was reported as multinodular GOITER. In postoperative period CPAP treatment couldn't continue, because patient was not compliant. In postoperative 8-th weeks, PSG was performed; AHI was 34,8/h. The patient's weight and BMI didn't change. Conclusion: In our case, despite absence of continued CPAP treatment after thyroidectomy, symptoms and PSG values improved partially. As a result of these findings, especially, compression of upper airway and deterioration of venous circulation of patients with large goiter may lead to an increase in OSAS symptoms. During patients with OSAS are treated with CPAP, goiter needs to be investigated

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

DEFF Research Database (Denmark)

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

2012-01-01

goiter volume reduction with rhTSH-augmented (131)I therapy improves the long-term reduction in goiter-related symptoms and reduces the need for additional therapy compared with plain (131)I therapy. Overall patient satisfaction is benefited, despite a higher rate of permanent hypothyroidism....

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

Energy Technology Data Exchange (ETDEWEB)

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)

2007-12-15

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)

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

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G.J. Paz-Filho

2007-12-01

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.

Diagnosis of thyroid multinodular goiter using diffraction-enhanced imaging

International Nuclear Information System (INIS)

Rocha, H.S.; Lopes, R.T.; Valiante, P.M.; Tirao, G.; Mazzaro, I.; Hoennicke, M.G.; Cusatis, C.; Giles, C.

2005-01-01

Diffraction-enhanced images (DEI) have been obtained using two silicon crystals. A first channel-cut silicon crystal using the Si(3 3 3) reflection is employed to reduce the divergence of the pre-monochromated Si(1 1 1) beam of the light line to 60 microradian (12 arcsec). A second channel-cut Si(3 3 3) crystal was used as a Bragg analyzer to obtain bright and dark field images by changing its angular position. This technique is ideally suited for soft-tissue imaging or objects with the same absorption coefficient interfaces. DEI was developed at the XRD-2 beamline at the Brazilian Synchrotron (LNLS) in Campinas-Brazil. Feasibility tests on acquired images, which allow the diagnosis of thyroid nodular goiter, were performed. This disease is ordinary. The tissue developed on the cervical area causes compression of the nearby structures and undesirable aesthetic deformities with worldwide distribution. DEI of the tissues were taken to observe their morphology and to compare with the microscopic analysis (histopathological). This technique allows cutting sections a hundred times thicker than conventional histological techniques allowing a complete vision of the disease morphology. DEI show details not clearly seen with conventional techniques

Bocio multinodular gigante deformante. Presentación de un caso sin síntomas obstructivos

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Paul Bogucki

2014-04-01

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

Effect of 131I in the treatment of hyperthyroidism at Hospital San Juan de Dios for the period from January 1, 2005 to December 31, 2007

International Nuclear Information System (INIS)

Badilla Barboza, Oscar Yuran

2011-01-01

Radioactive iodine 131 ( 131 I) is used for the treatment of hyperthyroidism at Hospital San Juan de Dios. The most common causes of hyperthyroidism have been Graves disease or diffuse goiter, toxic multinodular goiter and toxic nodular goiter, among others; but, the results are unknown and factors that have influenced the treatment with 131 I. The study has included only patients with these causes, and have been administered radioactive iodine 131 as treatment. 180 cases have been treated with radioactive iodine, 75.0% have presented diffuse goiter, 22.2% multinodular goiter and 2.8% nodular goiter, where were been 144 female patients (80%) and 36 male patients (20%). Women have had predominance in the three groups that were analyzed pathologies, according to medical literature, an approximate incidence of 0.4 cases has existed per thousand women to year. A proportional relationship between clinical size of goiter and failure of therapy with 131 I has been in diffuse goiter for the handling of hyperthyroidism. Likewise, male sex has been risk factor in the failure of such therapy. Multinodular goiter and nodular goiter have not had difference between the results according to sex and size of goiter. Most hyperthyroid patients with diffuse goiter, nodular and multinodular have received 131 I as treatment, and previously this, they have received propylthiouracil; treatment outcome was unaffected. Treatment with 131 I in hyperthyroid patients has managed to be effective for reduction in size of the thyroid gland in diffuse goiter, nodular goiter and multinodular [es

Scintigraphy and fine-needle aspiration biopsy in the evaluation of nodular goiter. Pt. 2

International Nuclear Information System (INIS)

Kempken, K.; Droese, M.; Bayer-Pietsch, E.; Hoer, G.; Pabst, H.W.; Technische Univ. Muenchen

1978-01-01

The results of scintigphic and cytological investigations in 548 patients with goiter are presented: In 402 goiters 470 nodes were detected, 385 of which were scintigraphically 'cold'. 276 solitary nodules were found, 109 in cases of multinodular goiter. Solitary nodules were preferentially located in the right lobe. The cytological diagnosis was confirmed histologically in 88 cases. Out of 24 malignant tumors, 21 were diagnosed correctly by means of cytology. The positive smears and the histological findings were in agreement in 14 of 15 cases. The accuracy of cytological diagnosis in the detection of thyroid malignancies was 87.5%. 12.5% of the smears were false negatives, 1.6% false positives and 10.9% false suspicious. The relative high percentage of false suspicious smears is caused by difficulties in cytologic differentiation of thyroid lesions due to microfollicular structures which are usually only classified as 'folicular neoplasia'. This cytologic term necessitates an obligatory histologic examination since cytology does not allow to differentiate between follicular adenomas and carcinomas. 5.5% of the histologically ascertained cold nodules were malignant, in 19% of the cases with cold nodes thyroid punction revealed cystic lesions. (orig.) [de

Airway management of a difficult airway due to prolonged enlarged goiter using loco-sedative technique

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Divya Srivastava

2013-01-01

Full Text Available Appropriate airway management is an essential part of anesthesiologist′s role. Huge goiters can lead to distorted airway and difficulty in endotracheal intubation. In this report, we present a case of a 67-year-old woman with a huge toxic multinodular thyroid swelling, gradually increasing in size for last 20 years, where trachea was successfully intubated. She had a history of deferred surgery in June 2007 due to inability to intubate, despite 5-6 attempts using different laryngoscopes, bougie, and stylet. Patient was re-admitted in December 2011 for the surgery and was successfully intubated this time with help of fiberoptic intubation using loco-sedative technique. Patient was electively kept intubated postoperatively in view of chances of tracheomalacia due to prolonged large goiter. She was extubated successfully on post-op day 2 after demonstration of leak around trachea following tracheal tube cuff deflation. The different techniques of managing the difficult airway in these patients are discussed.

[Short-term results of treatment with 131I in patients with multinodular goiter: effect of the associated degree of hyperthyroidism and other variables].

Science.gov (United States)

Boj Carceller, D; Liévano Segundo, P; Navarro Beltrán, P; Sanz París, A; de Castro Hernández, P; Monreal Villanueva, M; Abós Olivares, D

2011-01-01

To assess the effectiveness of radioactive iodine (RAI) therapy and the incidence of hypothyroidism post RAI in patients with subclinical hyperthyroidism or clinical hyperthyroidism with Multinodular Goiter (MNG). A retrospective study of 69 consecutive patients treated with (131)I for MNG during the year 2008 observed for six months. All patients received a single fixed dose of 16 mCi (592 MBq) weighted by the gland size. They were categorized into two groups: subclinical hyperthyroidism or clinical hyperthyroidism. We compared the success rate and the incidence of hypothyroidism. The thyroid dysfunction was corrected in 82.09% of the patients. Success rate was 100% in the clinical hyperthyroidism group and 78.13% in the subclinical hyperthyroidism group (P=0.105). The overall incidence of hypothyroidism was 16.42%; 25.00% of patients with clinical hyperthyroidism and 14.55% with subclinical hyperthyroidism developed this secondary effect (P=0.400). No statistically significant differences were found in the success rate in the incidence of hypothyroidism when the results were analyzed according to the thyrotropin decrease in patients with subclinical hyperthyroidism. Seven patients had positive anti-thyroid peroxidase antibodies (anti-TPO) before therapy. The incidence of hypothyroidism was significantly higher in them (57.14% vs 11.67%; P=0.011). Cardiac arrhythmias were four times more frequent in patients with clinical hyperthyroidism. Previous treatment with thiamazol positively affected the outcome. A single fixed weighted dose of (131)I is highly effective and safe for the control of clinical and subclinical hyperthyroidism due to MNG. Patients with anti-TPO antibodies may have a high risk of developing post-iodine hypothyroidism. Copyright © 2010 Elsevier España, S.L. y SEMNIM. All rights reserved.

Coexistence of hyperthyroidism and thyroid cancer

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Fatih Taşkesen

2014-06-01

Full Text Available Objective: Thyroid cancer can be associated with thyrotoxicosis caused by Graves' disease, toxic multinodular goiter, or toxic nodular goiter. The aim of this study was considered to be endemic in our region have received the diagnosis of hyperthyroidism, thyroid cancer is detected thyroidectomy performed and patients were retrospectively evaluate. Methods: We retrospectively studied 69 patients assessed for hyperthyroidism between 2006 and 2012. Clinical hyperthyroidism was diagnosed by elevated tri-iodothyronine/thyroxine (T3/T4 ratios and low thyroid-stimulating hormone (TSH levels, with clinical signs and symptoms. The criteria for surgery were cytological evidence of malignancy, a goiter causing symptoms of tracheal or esophageal compression, side effects of antithyroid drug therapy, or Graves’ disease with multiple relapses after therapy withdrawal or responsiveness to antithyroid drugs. Results: Totally 69 patients were included. In 20 (28.9% patients there was toxic multinodular goiter, in 28 (40.6% Graves’s disease, and in 21 (30.5% patients there was toxic nodular goiter. Of these patients, 12 (17.4% had thyroid cancer. Conclusions: As a result; low likelihood of malignancy in patients with hyperthyroidism, though suspicious lesions detected in the lymph nodes and neck adenopathies be examined in detail.

Goiter and deaf mutism.

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Thieme, E T

1975-08-01

The occurrence of deaf-mutism and goiter unassocaited with creatinism or mental retardation in euthyroid patients is known as Pendred's Syndrome. It is considered due to a single mutant recessive gene responsible for both the goiter and deafness. The penetrance is high, the intenseness of expressivity may vary within the same family and only one generation is affected. The extremely atypical hyperplasia seen in such goiters has been considered malignant. In 1956 the author reported a family in which 4 of 6 sibilings demonstrated Pendred's Syndrome. Three of the 4 had undergone thyroidectomy, two were considered to have carcinoma. Nineteen years later the family is again reported. The fourth sibling has recently undergone thyroidectomy. This thyroid demonstrated the same atypical hyperplasia as seen in the elder two siblings. The 19 year followup of this family has shown no evidence of recurrence or metastases, indicating that the atypical hyperplasia is probably not malignant. Pendred's Syndrome is described and certain suggestions are made for the counseling of the parents and the treatment and counseling of those children so afflicted.

Rapid resolution of fetal goiter associated with maternal Grave's disease: a case report.

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Friedland, D R; Rothschild, M A

2000-08-11

The incidence of abnormal fetal thyroid function with maternal Grave's disease is about 2-12%. The development of larger fetal goiters can complicate labor and precipitate life-threatening airway obstruction at delivery. A case is presented of a large stable goiter confirmed by sonography, which unexpectedly resolved by the time of parturition. A 3 x 6 cm fetal goiter was detected at 34 weeks gestation in a mother treated with propylthiouracil for Grave's disease. A repeat sonogram at 36 weeks showed no change in goiter size. Umbilical blood sampling showed the fetus to be markedly hyperthyroid. Planned Cesarean section took place 11 days after the final sonogram. A multi-disciplinary operative team was present including the Otolaryngology service with equipment for emergency intubation, bronchoscopy and tracheotomy. Upon delivery, the infant had no evidence of goiter and no airway compromise. Fetal goiter is a rare entity, and recent advances in the field of maternal-fetal medicine have enabled intra-uterine diagnosis and treatment of such conditions. A review of published case reports demonstrates two trends in treated fetuses: preterm progressive resolution of the goiter, or delivery with gross evidence of goiter. This reported case is unique, as a persistent goiter resolved completely in less than 2 weeks. Otolaryngologic response to and management of potential congenital airway compromise is discussed.

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

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Bapat R

1993-10-01

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.

Follicular carcinoma of the thyroid with hyperthyroidism. A case report.

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Sharma, Prashant; Kumar, Neeta; Gupta, Ruchika; Jain, Shyama

2004-01-01

Follicular carcinoma of the thyroid in association with hyperthyroidism is rare. The malignant lesion may remain occult for a long time. Certain clinical and cytologic features may be helpful in raising the alarm. An elderly male with a history of occupational exposure to X rays, long-standing toxic multinodular goiter and clinical hyperthyroidism presented with a rapidly enlarging mass in the neck. Cytologic smears showed a prominent microfollicular pattern, scanty colloid, anisonucleosis and nuclear overlapping. The noteworthy feature was the presence of marginal vacuoles. The cytologic diagnosis of follicular neoplasm with highly suggestive malignancy was made. Subsequently, multiple pulmonary nodules provided radiologic evidence of possible metastatic spread. This case report demonstrates the rare association of follicular carcinoma of the thyroid with hyperthyroidism and analyzes certain high-risk clinical and cytologic features to be considered in the follow-up of long-standing hyperfunctioning multinodular goiter.

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

Energy Technology Data Exchange (ETDEWEB)

Albino, Claudio Cordeiro

2009-07-01

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

Treatment of hyperthyroidism with radioactive iodine

International Nuclear Information System (INIS)

Bell, R.L.

1974-01-01

While radioactive iodine is clearly the therapy of choice for Graves' disease (even in younger patients) the use of radioactive iodine for therapy of the toxic multinodular or uninodular goiter presents an entirely different problem. Although these two entities can be treated with radioactive iodine provided there is some suppression of the tissue that is not autonomous, transient release of thyroid hormone may induce symptoms of thyroid storm in the very large multinodular toxic goiter treated with radioiodine therapy. These toxic nodules generally require much larger doses of radioiodine than is commonly used for classical Graves' disease and may either require fractional administration of radioisotopes or concomitant use of antithyroid drugs and iodides. In general, surgery remains the treatment of choice for large toxic multinodular goiters, after proper preparation by medical means including radioactive iodine. Radioactive iodine therapy for hyperthyroidism is contraindicated in pregnancy and generally is not used in children below five years of age. (U.S.)

A clinical study on 125I T3 resin uptake rate and serum thyroxin (T4) in hyperthyroidism

International Nuclear Information System (INIS)

Moon, E.S.; Park, Y.H.; Cho, C.H.; Park, I.S.; Lee, C.S.; Lee, H.C.

1978-01-01

Total of 94 cases of hyperthyroidism were classified as toxic diffuse goiter (77 case) as toxic adematous goiter (8 case) and as toxic multinodular goiter (9 case) on the levels of T 3 - 125 I resin uptake rate and the measurement of serum T 4 levels. Various clinical symptoms and diagnostic characteristics were discussed. (author)

TSH test

Science.gov (United States)

... an underactive thyroid gland ( hypothyroidism ). There are many causes of this problem. A lower-than-normal level may be due to an overactive thyroid gland, which can be caused by: Graves disease Toxic nodular goiter or multinodular goiter Too much ...

Radioiodine therapy in non-toxic multinodular goitre

International Nuclear Information System (INIS)

Miah, S.R.; Rahman, H.

2007-01-01

Full text: The effect of radioiodine in the treatment of non-toxic multinodular goitre has not been adequately evaluated. The aim of the study was to see the effect of radioiodine on thyroid size and function in patients with non-toxic multinodular goitre. We prospectively studied 55 non-toxic multinodular goitre patients treated with radioiodine of which 15 were males and 40 were females with age ranged from 25 years to 60 years (mean ± SD 40.45 ± 10.70 years) for a minimum of 12 months. Patients who were selected were those with local compression symptoms or for cosmetic reasons and the treatment was chosen because of a high operative risk or refusal to be operated on. Thyroid volume and T3, T4, TSH of all patients were determined before treatment and 6 months interval after treatment. Radioiodine was given in the dose ranged from 333 MBq (9 mCi) to 555 MBq (15 mCi) (mean ± SD 11.45 ± 2.04 mCi). The mean thyroid volume was reduced from 44.75 ± 37.44 ml to 28.76 ± 27.25 ml at 12 months (p < 0.001) i.e., reduced by 35.73%. Thyroid volume reduction at 6 months was 21.07%. Hypothyroidism occurred in 9.1% of the patients at 12 months. Side effects were few. Three cases developed radiation thyroiditis and two cases developed hyperthyroidism that was managed conservatively. It has been concluded that radioiodine is effective and well tolerated in the treatment of non-toxic multinodular goitre and may be the treatment of choice in elderly patients, in patients in whom surgery is contraindicated and in patients who are unwilling to undergo surgery. (author)

Surgical management of hyperthyroidism.

Science.gov (United States)

Quérat, C; Germain, N; Dumollard, J-M; Estour, B; Peoc'h, M; Prades, J-M

2015-04-01

Hyperthyroidism includes several clinical and histopathological situations. Surgery is commonly indicated after failure of medical treatment. The aim of this study was to analyze the indications and complications of surgery as well as endocrine results. Patients operated on for hyperthyroidism between 2004 and 2012 were included in a retrospective study. Total thyroidectomy was performed for Graves' disease, toxic multinodular goiter and amiodarone-associated thyrotoxicosis; patients with toxic nodule underwent hemithyroidectomy. Pathologic analysis assessed surgical specimens; postoperative complications and resolution of hyperthyroidism were noted. Two hundred patients from 15 to 83 years old were included. One hundred and eighty-eight underwent primary surgery and 12 were re-operated for recurrent goiter (6 with subtotal thyroidectomy for multinodular goiter 25 years previously; 6 with hemithyroidectomy for solitary nodule 15 years previously). Eighty-two patients suffered from toxic multinodular goiter, 78 from Graves' disease, 35 from solitary toxic nodules and 5 from amiodarone-associated thyrotoxicosis. Fourteen papillary carcinomas (including 11 papillary microcarcinomas) and 34 healthy parathyroid glands (17%) were identified in the pathological specimens. Postoperative complications comprised 4% permanent recurrent laryngeal nerve palsy (1 year follow-up), 9% hematoma requiring surgical revision, and 3% definitive hypocalcemia. Normalization of thyroid hormone levels was observed in 198 patients. Two recurrences occurred due to incomplete resection (1 case of Graves' disease and 1 intrathoracic toxic goiter that occurred respectively 18 and 5 months after resection). Postoperative complications were more frequent in multinodular goiter (23%) than in Graves' disease (13%) (ns: P>0.05). Surgical management of hyperthyroidism enables good endocrinal control if surgery is complete. Patients need to be fully informed of all possible postoperative complications

Influence of diffuse goiter on tracheal width

International Nuclear Information System (INIS)

Baik, Sung Mo; Shon, Hyung Sun; Kim, Choon Yul; Bahk, Yong Whee

1980-01-01

The radioisotopic scanning of the thyroid gland is well established method of demonstrating morphology of the thyroid gland and is used to measure the size, area and weight of thyroid gland. The purpose of this investigation is to observe the various effects of goiter to the regional trachea. Both radioisotopic scanning and roentgenogram were taken at the same time to evaluate size, area and weight of the thyroid glands, as well as to measure the width of soft tissue structure of the neck and the regional trachea in normal and goitrous patients. The clinical materials consisted of normal thyroid group for control (46 cases), diffuse simple goiter group (76 cases) and Graves' disease group (59 cases). The results were as follows; 1. The goiter causes some narrowing of the regional trachea to various degree which is not necessarily reflective of the size of goiter. 2. The goiter may increase the width of retrotracheal soft tissue space. 3. The lateral roentgenogram of the neck appear very useful in estimating the thyroid gland three dimensionally and the effect of goiter to the regional trachea

Diagnosing diseases of the thyroid gland by means of scintiscanning and puncture cytology taking into consideration the nodular goitre

International Nuclear Information System (INIS)

Eitel, M.

1981-01-01

This paper contains the results of scintigraphical and puncture-cytological examinations carried out during an observation period of appr. 3 years on 548 patients with goiters from the Upper-Bavarien endemis region. In total, we had 484 thyroid gland scintigrams which showed 335 uninodular, 71 multinodular, and 78 diffuse goiters. The 335 solitary nodular goiters were allocated 278 cold, 36 warm, and 18 hot nodes; in three cases, the scintigram could not be assessed due to exogenous iodine contamination. In the 71 multinodular goiters, we found 118 cold, 28 warm, and 9 hot nodes. Cytological findings were established in 548 patients. In 484 cases, the findings were negative, in 19 cases suspicious, and in 17 cases positive. The efficiency of cytological diagnosis of malignant tumours can be stated to be 87.5%. The rate of falsely negative smears was 12.5%; cytologically, in 10.9% of the preparations falsely suspicious diagnoses were established, and in 1.6% the diagnoses were falsely positive. (orig./MG) [de

Surgery: Is it any good for goiter?

DEFF Research Database (Denmark)

Sørensen, Jesper Roed; Watt, Torquil; Døssing, Helle

Background: Using the thoroughly validated ThyPRO-questionnaire, we aimed at investigating changes in disease-specific quality of life (QoL) following surgical treatment in patients with benign non-toxic nodular goiter. Method: Patients with goiter scheduled for thyroid surgery (n=106) and indivi......-toxic nodular goiter. Our study may contribute important information for the patient as well as for the physician in guidance of choice of treatment, and what effects to expect as for various aspects of QoL.......Background: Using the thoroughly validated ThyPRO-questionnaire, we aimed at investigating changes in disease-specific quality of life (QoL) following surgical treatment in patients with benign non-toxic nodular goiter. Method: Patients with goiter scheduled for thyroid surgery (n=106...... ((ES: 1.26, pL (ES: 0.56, pL (ES: 0.74, p

C-cells in colloid goiter

Directory of Open Access Journals (Sweden)

Lima Marcus A.

2003-01-01

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.

Simple goiter in children and juveniles

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Wiebel, J

1983-10-31

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.

A case of methimazole-induced hypothyroidism in a patient with endemic goiter: effects of endogenous TSH hyperstimulation after discontinuation of the drug.

Science.gov (United States)

Messina, M; Manieri, C; Spagnuolo, F; Sardi, E; Allegramente, L; Monaco, A; Ciccarelli, E

1989-04-01

Serum thyroid hormone and TSH concentrations were monitored in a patient with multinodular endemic goiter and severe methimazole (MMI) induced hypothyrodism up to 190 days after drug withdrawal. Serum concentrations of TT3, TT4 and TSH returned to normal values at the 6th., the 140th, and the 120th. day respectively. Within the first 20 days after MMI withdrawal the increase of serum T3 levels was correlated with the observed decrease of serum TSH concentrations. Successively T3 values decreased and T4 levels progressively increased. Six months after MMI withdrawal basal serum TSH concentration was normal while an exaggerated response to TRH was observed. We think that this peculiar hormone pattern is due to iodine depletion. In this case TSH hyperstimulation increases predominantly T3 secretion demonstrating the reduced thyroidal ability to produce T4 when hyperstimulated.

Cardiovascular involvement in patients with different causes of hyperthyroidism.

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Biondi, Bernadette; Kahaly, George J

2010-08-01

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.

Amyloid Goiter Secondary to Ulcerative Colitis

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Bunyamin Aydin

2016-01-01

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.

The yield of adequate and conclusive fine-needle aspiration results in thyroid nodules is uniform across functional and goiter types.

Science.gov (United States)

Liel, Y

1999-01-01

Relatively little is known about the cytological characteristics of hyperfunctioning (hot) thyroid nodules. Concern has been expressed that fine-needle aspiration (FNA) identifies hot nodules as follicular tumors or indeterminate, and as a consequence patients could be unnecessarily referred for surgery. Between 1979 and 1996, thyroid FNA was performed on 829 patients. Result of thyroid scan was available in 326; 69 (21%) patients had hot, and 257 (79%) had warm or cold thyroid nodules. Nodules in each of these major groups were divided into 2 subgroups: clinically solitary nodules and dominant nodules in multinodular goiters (MNG). The frequencies of adequate versus inadequate FNA samples, and of conclusive versus indeterminate FNA results were determined separately for each of the groups and subgroups. In addition, patients with hot nodules and overt hyperthyroidism were identified and evaluated separately. Bivariate analyses were performed for the frequency of adequate versus inadequate smears and conclusive versus indeterminate results between hot, toxic, and cold-warm nodules, and between solitary nodules and MNG. The frequency of adequate aspirations and conclusive results in the various groups and subgroups was found to be statistically indistinguishable. In conclusion, the yield of adequate samples and the rate of conclusive results of FNA in thyroid nodules is similar, irrespective of the functional state or of goiter presentation. Hot thyroid nodules do not seem to produce an increase in the rate of inadequate or indeterminate FNA results, and therefore, do not affect the overall performance of thyroid FNA.

Risk factors for goiter and thyroid nodules

DEFF Research Database (Denmark)

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

2002-01-01

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...... and drinking water. Less focus has been on individual environmental factors and the interplay between factors. The goiter prevalence is higher in certain groups in the population. The variation in goiter prevalence between the genders is well known with a higher occurrence among women. The association with age...

Iodine Status and Goiter Prevalence in Nizhegorodsky Region

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Yu I Tarasov

2005-03-01

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.

Pathogenesis of nodular goiter and its implications for surgical management

International Nuclear Information System (INIS)

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

1988-01-01

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. 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 3 H-thymidine did not parallel the distribution of functionally active tissue labelled by 131 I. Thyroxine treatment did not completely inhibit 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

Plexiform (multinodular) schwannoma of soft palate. Report of a case.

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Kapetanakis, Stylianos; Vasileiadis, Ioannis; Petousis, Aristotelis; Fiska, Aliki; Stavrianaki, Anna

2012-01-01

Plexiform schwannoma is a rare benign neoplasm of the neural sheath characterized by a multinodular plexiform growth pattern. Only 5% of schwannomas have a plexiform or multinodular growth pattern. Schwannoma apparently derives from the Schwann cells. Extracranially, 25% of all schwannomas are located in the head and neck region, but only 1% show an intraoral origin. The intraoral lesions show a predilection for the tongue, followed by the palate, buccal mucosa, lip and gingival. Microscopic examination is necessary to confirm the diagnosis. Characteristic histological signs are the palisading of the spindle-shaped Schwann cells around the central acellular area, so called Verocay bodies. We report a case of a 21-year-old woman with a smooth mass of the soft palate that was gradually increasing. Surgical excision of the mass was done and the histopathology and immunohistochemistry study of the excised lesion revealed a multinodular plexiform schwannoma of the soft palate. The patient is under regular clinical control, with no signs of recurrence after 17 months. Plexiform schwannomas of the soft palate are mentioned very rarely in the English literature. This rare benign tumor is worthy of recognition because it can be misdiagnosed as plexiform neurofibroma.

Myopericytoma proliferating in an unusual anastomosing multinodular fashion.

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Inoue, Takuya; Misago, Noriyuki; Asami, Akihiko; Tokunaga, Osamu; Narisawa, Yutaka

2016-05-01

We herein describe a case of myopericytoma that proliferated in an unusual fashion. Myopericytoma is described as a group of rare, benign, dermal or subcutaneous tumors that are characterized histologically by a striking, concentric, perivascular proliferation of spindle cells and showing apparent differentiation towards perivascular myoid cells. Myopericytoma forms a morphological continuum with myofibroma/myofibromatosis, glomus tumor and angioleiomyoma. The patient was a 64-year-old woman who demonstrated a recurrent ulcer on an atrophic plaque on her left shin. A histopathological examination of the plaque demonstrated that tumor cells proliferated in an anastomosing multinodular fashion along the vessels in the dermis and subcutaneous tissue. In those nodules, there were numerous, small, concentric proliferations of myoid-appearing spindle cells around small vascular lumina. The present case is an unusual example of myopericytoma, manifesting in a characteristic anastomosing, multinodular, infiltrating fashion. © 2015 Japanese Dermatological Association.

Congenital goiter due to maternal ingestion of iodide

International Nuclear Information System (INIS)

Iancu, T.; Boyanower, Y.; Laurian, N.

1974-01-01

A newborn infant with large bilateral cervical masses developed respiratory difficulties three days after birth. A congenital goiter was suspected and a biopsy was performed. Later information pointed to the ingestion of large amounts of inorganic iodine, during the pregnancy, by the asthmatic mother. Further investigation proved the goiter to be due to transient depression of peroxidase activity by the exogenous iodine. Within several days after birth, the infant's thyroid regained its full activity, the goiter disappeared, and the few signs of hypothyroidism subsided. (U.S.)

Nodular goiter after occupational accidental exposure to radiation

Energy Technology Data Exchange (ETDEWEB)

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)

2012-07-01

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

Thyroid status and urinary iodine levels in women of endemic goiter area

International Nuclear Information System (INIS)

Bashir, S.; Shabbir, I.; Hussain, R.; Islam, M.U.; Aasim, M.

2012-01-01

Background: To determine the thyroid function tests and urinary iodine levels in women belonging to goiter endemic area. Study type and settings: Descriptive study conducted in women of goiter endemic area in Saggian Lahore. Subjects and Methods: Saggian Lahore is a goiter endemic area. A total of 293 women between the ages of 18-45 years residing in the area were clinically screened for goiter. Of them 73 women having goiter were recruited for the study. Information regarding demographic profile clinical presentation and physical examination of the goiter was recorded on a questionnaire. The goiter size was graded according to WHO, UNICEF and the International Council for the Control of Iodine Deficiency Disorder. About 5ml of blood sample was drawn from each women and run for thyroid function tests i.e. T3 T4 and TSH using Elisa kits (Human scientific Co. Germany). Urinary iodine was checked by chemical method. Results: Mean age of 73 women was 28.5 years. Marital status showed that 48(65.7%) were married and 25(34.3%) were unmarried. Visible diffuse goiter was seen in 56(77%) cases. Pressure symptoms as cough and shortness of breath was seen in 30(41%) and 31(42.5%) women respectively. Among the 73 women 24.6% (18 cases) took treatment for goiter. Adverse pregnancy outcome secondary to goiter was seen in 58% (28 cases) out of 48 married women. Thyroid function tests result showed that 72% (53 cases) were euthyroid, 18% (13 cases) were hypothyroid, and 10% (7 cases) were hyperthyroid. Urinary iodine levels showed that 99% women were iodine deficient. Conclusions: Thyroid functions do not indicate iodine deficiency in all cases of goiter, therefore, Urinary iodine levels need be estimated while investigating goiter cases. Policy message: Iodine deficiency should be diagnosed and treated on priority basis. (author)

Long term effect of radioactive iodine treatment in nontoxic multinodular goitre

International Nuclear Information System (INIS)

Nygaard, B.; Hegedues, L.; Gervil, M.; Hjalgrim Jensen, H.; Soee-Jensen, P.; Moelholm hansen, J.E.

1994-01-01

The aim of this study was to investigate the long term effect of 131 I treatment on thyroid function and size in patients with non-toxic multinodular goitre. The subjects were 69 consecutive patients with multinodular non-toxic goitre selected for 131 I treatment and followed for a minimum of 12 months. Outcome measures were standard thyroid function variable and ultrasonically determined thyroid volume before and after treatment. Fifty-nine patients were treated with a single dose of 131 I, 12 with tow doses, and one with four doses. In 45 patients treated with one dose who remained euthyroid the median thyroid volume was reduced from 73 (interquartile range 50-106) ml to 29 (interquartile range 23-48) ml at 24 months. The median reuction was 40 (22-48) ml, half of which occurred within three months. Patients treated with two doses as well as those developing hypo- or hyper-thyroidism also had a significant reduction in thyroid volume. Eleven patients develeoped hypothyroidism (cumulative five year risk 22%). Side effects were few. In conclusion we find that 131 I treatment of multinodular non-toxic goitre is an attractive alternative to surgery. (au) (19 refs.)

Tubercular thyroiditis with multinodular goitre with adenomatous hyperplasia: a rare coexistence.

Science.gov (United States)

Chaurasia, Jai Kumar; Garg, Cheena; Agarwal, Arjun; Naim, Mohammed

2013-09-25

A 32-year-old Indian woman presented with swelling in the anterior part of the neck for the last 3 years. Clinical and radiological examination and fine needle aspiration cytology suggested the diagnosis of multinodular goitre. A subtotal thyroidectomy was performed by the surgeon and the specimen was submitted for the final diagnosis. Histological examination of the specimen revealed multiple caseating tubercular granulomas coexistent with multinodular goitre and adenomatous hyperplasia. The sections demonstrated acid-fast tubercle bacteria, confirming the diagnosis of tubercular thyroiditis. This case emphasises that tubercular thyroiditis should always be considered in patients with thyroid swelling or nodule, in countries where the prevalence of tuberculosis is high.

Efficiency of radioiodine therapy in Graves disease and adenoma toxicum and incidence of hypothyroidism

International Nuclear Information System (INIS)

Petrovski, Z.P.

2002-01-01

The aim of the this study was to evaluate different states in hyperthyroid patients and incidence of hypothyroidism after I-131 therapy.We observed a total of 184 hyperthyroid pts, from which 108(58,7%)pts with Graves' disease,65(35,3%)pts with single toxicum nodule and 11(6%)pts with toxicum multinodular goitre,treated with radioiodine therapy during the period 1986-2001.Dose of I-131 orally administered ranged 150-1100MBq and was calculated according to the 'MBq/gram' method.The radioiodine-131 therapy was performed once in 69,5%(128/184)pts,twice in 21,2%(39/184)pts and in 9,3%(17/184)pts more than two doses. Completely cured of hyperthyroidism occurred in 61%(66/108)pts with Graves' disease,81,8%(9/11)pts with toxic multinodular goiter and 90,7%(59/65)pts with single toxic nodule. The patients in our study were evaluated 6 months to 15 years after received J-131 therapy. Incidence of early hypothyroidism within one year was 23,1%(25/108) in Graves' disease,9%(1/11) in toxic multinodular goiter and 4,6%(3/65) with single toxicum nodule.Overall incidence of hypothyroidism within one year was 17,6% and had cumulative increase of Graves' disease every following year approximately for 3%,while for adenoma toxicum there was no any significant changes. We concluded that radioiodine therapy is simple,comfortable radical method for medical treatment of hyperthyroidism and indicate higher incidence of hypothyroidism in patients treated with I-131 for Graves' disease than that of patients treated for toxicum multinodular goiters and single toxic nodule

Do thyroid-stimulating immunoglobulins cause non-toxic and toxic multinodular goitre

International Nuclear Information System (INIS)

Brown, R.S.; Jackson, I.M.D.; Pohl, S.L.; Reichlin, S.

1978-01-01

The prevalence of serum thyroid-stimulating immunoglobulins, (T.S.I.) in a variety of thyroid diseases was determined in 96 patients and 35 normal controls. Significantly elevated levels of T.S.I. were found not only in patients with Graves' disease and Hashimoto's thyroiditis but also in those with non-toxic and multinodular goitre, whereas patients with a single autonomously functioning thyroid nodule, with subacute thyroiditis, and with 'hyperthyroiditis' had levels which did not differ from those in the controls. it is postulated that non-toxic multinodular goitre, like Graves' disease, may result from increased circulating T.S.I. which in some cases may be present in sufficient concentration to cause thyrotoxicosis. (author)

Intrathoracic toxic thyroid nodule causing hyperthyroidism with a multinodular normal functional cervical thyroid gland

International Nuclear Information System (INIS)

Serim, Burcu Dirlik; Korkmaz, Ulku; Can, Unal; Altun, Gulay Durmus

2016-01-01

Radionuclide scintigraphy with I-131 and Tc-99m pertechnetate ( 99 mTc0 4 ) has been widely used in detecting toxic nodules. Intrathoracic goiter usually presents as an anterior mediastinal mass. Mostly the connection between intrathoracic mass and the cervical thyroid gland is clearly and easily identified occurring as a result of inferior extension of thyroid tissue in the neck, which is called as secondary intrathoracic goiter. Completely separated, aberrant or in other words primary intrathoracic goiters arise as a result of abnormal embryologic migration of ectopic thyroid closely associated with aortic sac and descend into the mediastinum. Intrathoracic goiters are generally nontoxic nodules existing with mass effect without causing hyperthyroidism. However, mostly reported cases had enlarged thyroid glands in the neck. This report demonstrates the usefulness of I-131 and 99 mTc0 4 scintigraphy for detecting intrathoracic goiter causing hyperthyroidism with a normal functioned cervical thyroid gland

Bocio Goiter

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Judith Parlá Sardiñas

2012-12-01

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

Equine goiter associated with excess dietary iodine.

Science.gov (United States)

Eroksuz, H; Eroksuz, Y; Ozer, H; Ceribasi, A O; Yaman, I; Ilhan, N

2004-06-01

Naturally occurring goiter cases are described in 2 newborn Arabian foals whose mares were supplemented with excess iodine during the final 24 w of the pregnancy. Six nursing foals and 2 mares were also affected clinically with thyroid hypertrophy. At least 12 times the maximum tolerable level of iodine supplementation was given, as the daily iodine intake for each mare was 299 mg. The prevalence of goiter cases was 2 and 9% in the mares and foals, respectively.

Iodine versus thyroxine in treatment of simple goiter in sudan

International Nuclear Information System (INIS)

Hassan, A.M; Khangi, F.A; Ali, N.I.; Besheir, S.O.; Eltom, M.A.

2003-01-01

This study was designed to update the existing information concening goiter prevalence and iodine deficiency disorders in omdurman city and to compare the effects of thyroxine versus iodine in the treament of simlpe goiter. Thyroxine in different doses is commonly used in treatment of simple goiter in Sudan. The goiter survey was conducted in Omdurman secondary school for girls (Khartoum state). Of the goitrous subjects 99 girls were selected to participate in the treament protocol. A control group of 54 non-goitrous subjects from the same school were also included. The goitrous subjects were divided randomly into two groups receiving either daily dose of 100 μg thyroxine for six months or a single dose of 400 mg of oral iodine in the form of iodized oil. Blood and urine samples were collected from the goitrous and control group and recollected from the goitrous subjects every six weeks for six months. Goiter size was assessed at 3,6 and 14 months after the commencement of the treament. Blood samples were analyzed for serum level of T4,T3 and TSH using sensitive radioimmunoassay techniques. Urine samples were analyzed for urinary iodine excretion. Goiter was found in 139 students out of 1034, (13.4%). They were all euthyroid with simple diffuse goiter.T4 in the goitrous group (93.3±26.9 nmole /L (mean±SD)) was significanty lower than in the control group (106.4±18.2nmole/L,p<0.05). T3 was significantly higher in the goitrous (1.6±0.4 nmole/L) than in the control group (1.3±0.3 nmole/L,p<0.05) while there was no significant difference in the mean serum TSH or urinary iodine excretion between the two groups. More than 70% of the goitrous and the control subjects excreted 2 μg 1 / dI or less. Of the subjects treated with thyroxine 87.8% showed complete disappearance or definite regression of the goiter size compared with 90% of those received iodine after the treament.(Author) =

Iodine versus thyroxine in treatment of simple goiter in sudan

International Nuclear Information System (INIS)

Eltom, M.A.; Ali, N.

2003-01-01

This study was designed to update the existing information concerning goiter prevalence and iodine deficiency disorders in Omdurman city and to compare the effects of thyroxine versus iodine in the treatment of simple goiter. Thyroxine in different doses is commonly used in treatment of sample goiter in sudan. This goiter survey was conducted in Omdurman secondary school for girls (Khartoum state). Of the goitrous subjects 99 girls were selected to participate in the treatment protocol. A control group of 54 non-goitrous subjects from the same school were also included. This goitrous subjects were divided randomly into two groups receiving either daily dose of 100 μg thyroxine for six months or a single dose of 400 mg of oral iodine in the form iodized oil. Blood and urine samples were collected from the goitrous and control group and recollected from the goitrous subjects every six weeks for six months. Goiter size was assessed at 3,6 and 14 months after the commencement of the treatment. Blood samples were analyzed for serum level of T4, T3 and TSH using sensitive radioimmunoassay techniques. Urine samples were analyzed for urinary iodine excretion. Goiter was found in 139 students out of 1034, (13.4%). They were all euthyroid with simple diffuse goiter. T4 in the goitrous group (93.3±26.9 n mole/L (mean±SD)) was significantly lower than in the control group (106.4±18.2 n mole /L, p<0.05). T3 was significantly higher in the goitrous (1.3 ±0.3 n mole/L, p<0.05) while there was no significant difference in the mean serum TSH or urinary iodine excretion between the two groups. More than 70% of goitrous and the control subjects excreted 2 μg I /dl or less. Of the subjects treated with thyroxine 87.8% showed complete disappearance or definite regression of the goiter sized compared with 90% of those received iodine after the treatment

Vitamin D status in Egyptian euthyroid multinodular non-toxic goiter patients and its correlation with TSH levels.

Science.gov (United States)

Aboelnaga, Mohamed M; Elshafei, Maha M; Elsayed, Eman

2016-10-01

Although the prevalence of MNG is widespread throughout the world, its pathogenesis is poorly understood, and the complex interactions of both genetic predisposition and the individuals' environment are likely. However, to the best of our knowledge, it remains unknown whether there is a relationship between vitamin D status and prevalence or pathogenesis of euthyroid MNG. Therefore, the goal of the present study was determination of vitamin D status in euthyroid MNG as well as exploration of the correlation between vitamin D status & TSH levels. A total of 77 patients diagnosed with euthyroid MNG and 50 subjects without goiter were matched according to age, weight and BMI as control group in this case control study. We found that patients with euthyroid MNG had statistically significant lower mean of [25(OH)D] (24.21±8.68ng/mL) in comparison with its mean in control subjects (28.37±10.91ng/mL, P value=0.019). The 28 sufficient vitamin D MNG patients had statistically significant lower level of TSH than 49 insufficient vitamin D MNG patients. Vitamin D and TSH levels correlate with vitamin D levels in MNG patients in Pearson correlation. Also 25 OH vitamin D was a significant independent predictor for TSH levels among euthyroid MNG patients in regression analysis. Patients with euthyroid MNG have lower levels of vitamin D and TSH levels correlate with vitamin D levels in euthyroid MNG patients. In addition, 25 OH vitamin D was a significant independent predictor for TSH levels among euthyroid MNG patients. We recommend hypovitaminosis D evaluation and correction in patients with MNG. Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

Evaluation of human thyroid tumors by proton nuclear magnetic resonance

International Nuclear Information System (INIS)

deCertaines, J.; Herry, J.Y.; Lancien, G.; Benoist, L.; Bernard, A.M.; LeClech, G.

1982-01-01

Proton nuclear magnetic resonance (NMR) was used in a study of 40 patients with thyroid tumors following partial or total thyroidectomy. Three patient groups were considered: those with nodules showing increased uptake, those with solitary nodules with decreased uptake, and those with multinodular goiters. Spin-lattice and spin-spin relaxation times (T 1 and T 2 ) were measured on samples of nodular and extranodular tissue from each patient. Increased T 1 and T 2 were observed for benign cold nodules, an increase in T 1 alone for nodules with increased uptake, and a wide fluctuation in T 1 and T 2 for multinodular goiters. The four cancers in the series did not show a distinctive proton NMR pattern in comparison with the other nodular structures studied. The results point to the feasibility of applying NMR techniques to the detection of thyroid disease

Fetal goiter and bilateral ovarian cysts

DEFF Research Database (Denmark)

Lassen, Pernille; Sundberg, Karin; Juul, Anders

2008-01-01

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....... The thyroid gland appeared normal in size, and cord blood TSH and free T 4 were both within normal limits. At ultrasound control 6 days later, the right ovarian cyst was not visible, while the left cyst was still present. Thus, our report supports previous findings that fetal goiter can be treated...

Intervention radiology in postoperative recurrent goiter

International Nuclear Information System (INIS)

Galkin, E.V.

1995-01-01

Roentgenoendovascular functional thyroidectomy was used to suppress the pathological activity of the thyroid in postoperative recurrent goiter. The method consists in vascular isolation of hyperplastic stump of the thyroid by catheterization of the left and right thyroid arteries, followed by their material occlusion. For embolization, a wide spectrum of nonlyzed synthetic, organic, and inorganic materials were used. The results of roentgenoendovascular functional thyroidectomy in 14 patients with postoperative recurrent goiter are analyzed. The advantages of roentgenoendovascular occlusion of the thyroid arteries before subtotal thyroidectomy are emphasized. A stabile clinical and hormonal remission and reduction of the thyroid in size to stage 1 were observed during three years following roentgenoendovascular intervention [ru

The epidemiology, pathalogy, and management of goiter in Yemen

International Nuclear Information System (INIS)

Al-Hureibi, Khalid A.; Abdulmughni, Yasser A.; Ghafoor, Mohammad A.; Al-Hureibi, Mohammed A.; Al-Hureibi, Yahia A.

2004-01-01

The total goitre rate in Yemen declined by half after the country adopted universal salt iodisation in 1995. We investigated the recent epidemiology, pathalogy, and management of goiter so as to evaluate changes since the initiation of salt iodisation programme. We also sought to determine the effect of new diagnostic tools in the pre-operative work-up of surgically treated patients. Data were collected from the records of 667 patients with goitre seen in Kuwait University Hospital between 1997 and 2001. Females constituted 92.5% (n=617) of the series. The mean age of all patients was 35.2+-11.58 years range (13 to 90 years). Most patients (93%) came from highland areas with an average altitude of 2000 to 2600 meters above sea level. The average duration since patients noticed swelling untill the diagnosis was made was about 4 years. Multinodular bilateral swelling was the most common clinical finding (44.9%), while solitary nodules constituted the least common (17.4%). The most common associated symptom was dyspnoea (20.5%). The most common histopathological finding was nodular and colloid goitre (62.8%), while malignancy accounted for 17.7%. Subtotal thyroidectomy was the most frequent procedure, and the most common postoperative complication was hypocalcaemia. Goitre is a national problem in Yemen. The late presentation, which may be important in malignant transformationof the thyroid gland, makes surgery inoperative. The salt iodisation programme has been associated with a decrease in the malignancy rate. Yemen is the great need of experienced cytologists and radiologists to increase the efficacy of fine needle aspiration cytology and ultrasonography in the diagnosis of thyroid lesions. Patients need to be educated about the importance of post-operative follow up. (author)

Chylothorax Associated with Substernal Goiter in Graves' Disease Treated with Radioactive Iodine.

Science.gov (United States)

Young Oh, Seo; Hyun Kim, Bo; Young Kim, Do; Min Lee, Kyu; Jin Lee, Min; Su Kim, Sung; Ho Kim, Jong; Kyung Jeon, Yun; Soo Kim, Sang; Ki Kim, Yong; Joo Kim, In

2017-04-01

We present a rare case of chylothorax associated with an intrathoracic goiter in Graves' disease that was treated with radioactive iodine. A 23-year-old woman with Graves' disease was referred to our clinic with a pleural effusion, dyspnea, characteristic bilateral proptosis, and a diffuse goiter. The pleural fluid biochemistry was consistent with chylothorax. However, the chylothorax did not decrease with conservative therapy. Therefore, RAI was administered. Subsequently, the chylothorax and goiter improved more quickly than expected. This case illustrates that chylothorax associated with a substernal goiter in Graves' disease can be treated successfully with radioactive iodine instead of surgery.

Iodine-131 therapy for the treatment of multinodular goitre

International Nuclear Information System (INIS)

Akerman, R.L.; Howarth, D.M.

1997-01-01

Full text: The purpose of this study was to investigate the effectiveness of 131 l therapy for toxic and non-toxic multinodular goitre (MNG)in the patients treated with the standard dose of 4 x 555 MBq (total 2.2 Bq) and therefore give some indication as to the adequacy of this therapy. This was a retrospective study using information from patients' notes. All patients with large multinodular goitres who had radioiodine therapy for treatment of MNG since 1991 were selected. Data obtained included age, gender, pre, peri and post therapy symptoms and serial biochemical thyroid function results. Each patient was followed for a minimum of six months. The subjects were 35 patients (32 female, three male) with an age range of 37 - 87 years. 26 patients had non-toxic MNG, nine patients had toxic MNG, 24 patients had retrosternal or obstructive symptoms and five patients had had previous thyroid therapy. The patients with retrosternal or obstructive symptoms experienced a reduction in those symptoms. 8.6 per cent of the patients experienced no change at all in symptoms. 2.8 per cent of the patients experienced non-transient side effects (sore throat). 32.8 per cent of the patients experienced transient hyperthyroidism during 131 I therapy. In the toxic group, 77.8 per cent became euthyroid. 11.1 per cent became hypothyroid and 11.1 per cent remained hyperthyroid and required additional treatment. In the non-toxic group, 42.3 per cent became hypothyroid and 57.7 per cent remained euthyroid. The overall incidence of hypothyoidism was 34.4 per cent. The results of this study suggests 131 l therapy in the form of 4 x 555 MBq oral doses (one dose per month for four months) is effective, efficient, relatively risk-free, easy and generally well-tolerated treatment for toxic and non-toxic multinodular goitre

Iodine-131 therapy for the treatment of multinodular goitre

Energy Technology Data Exchange (ETDEWEB)

Akerman, R.L.; Howarth, D.M. [John Hunter Hospital, Newcastle, NSW, (Australia). Department of Nuclear Medicine

1997-09-01

Full text: The purpose of this study was to investigate the effectiveness of {sup 131}l therapy for toxic and non-toxic multinodular goitre (MNG)in the patients treated with the standard dose of 4 x 555 MBq (total 2.2 Bq) and therefore give some indication as to the adequacy of this therapy. This was a retrospective study using information from patients` notes. All patients with large multinodular goitres who had radioiodine therapy for treatment of MNG since 1991 were selected. Data obtained included age, gender, pre, peri and post therapy symptoms and serial biochemical thyroid function results. Each patient was followed for a minimum of six months. The subjects were 35 patients (32 female, three male) with an age range of 37 - 87 years. 26 patients had non-toxic MNG, nine patients had toxic MNG, 24 patients had retrosternal or obstructive symptoms and five patients had had previous thyroid therapy. The patients with retrosternal or obstructive symptoms experienced a reduction in those symptoms. 8.6 per cent of the patients experienced no change at all in symptoms. 2.8 per cent of the patients experienced non-transient side effects (sore throat). 32.8 per cent of the patients experienced transient hyperthyroidism during {sup 131}I therapy. In the toxic group, 77.8 per cent became euthyroid. 11.1 per cent became hypothyroid and 11.1 per cent remained hyperthyroid and required additional treatment. In the non-toxic group, 42.3 per cent became hypothyroid and 57.7 per cent remained euthyroid. The overall incidence of hypothyoidism was 34.4 per cent. The results of this study suggests {sup 131}l therapy in the form of 4 x 555 MBq oral doses (one dose per month for four months) is effective, efficient, relatively risk-free, easy and generally well-tolerated treatment for toxic and non-toxic multinodular goitre.

Study of goiter in Madagascar using biochemical and nuclear methods

International Nuclear Information System (INIS)

Ranaivoharisoa-Ravaoarinjanahary, Lala.

Physiopathological and etiological characteristics of goiter in Tananarive and Majunga were compared, using the following methods: 131 iodine uptake, thyroid scintigraphy, radioimmunoassay of thyroid hormones, neutron activation analysis of iodine. The results are discussed and differences between goiter in Tananarive and Majunga are emphasized [fr

Prenatal diagnosis and treatment perspective of fetal hypothyroidism with goiter

International Nuclear Information System (INIS)

Gulraze, A.; Kurdi, W.; Tulbah, M.; Niaz, F.A.

2013-01-01

We describe two cases of fetal goiter in women with no history of thyroid disease. Diagnosis of fetal goiter during antenatal care was made by ultrasound and MRI. Congenital hypothyroidism was confirmed by fetal blood sampling that was treated with weekly intra-amniotic injections of L-thyroxin. One fetus was initially treated with four weekly intra-amniotic injections of 200 mu gms of L-thyroxin, later increased to 400 mu gms. The other fetus was treated with only three weekly intraamniotic injections of 400 mu gms of L-thyroxin. Therapeutic response was monitored by repeated ultrasound and MRI along with fetal blood sampling. At birth, none of the babies had goiter and were put on oral thyroxin. Post-natal studies were suggestive of congenital hypothyroidism due to dyshormogenesis. No abnormality was detected at follow-up. These cases highlight the role of intra-amniotic thyroxine in management of fetal hypothyroidism with goiter. (author)

Hyperthyroidism: diagnosis and treatment.

Science.gov (United States)

Reid, Jeri R; Wheeler, Stephen F

2005-08-15

The proper treatment of hyperthyroidism depends on recognition of the signs and symptoms of the disease and determination of the etiology. The most common cause of hyperthyroidism is Graves' disease. Other common causes include thyroiditis, toxic multinodular goiter, toxic adenomas, and side effects of certain medications. The diagnostic workup begins with a thyroid-stimulating hormone level test. When test results are uncertain, measuring radionuclide uptake helps distinguish among possible causes. When thyroiditis is the cause, symptomatic treatment usually is sufficient because the associated hyperthyroidism is transient. Graves' disease, toxic multinodular goiter, and toxic adenoma can be treated with radioactive iodine, antithyroid drugs, or surgery, but in the United States, radioactive iodine is the treatment of choice in patients without contraindications. Thyroidectomy is an option when other treatments fail or are contraindicated, or when a goiter is causing compressive symptoms. Some new therapies are under investigation. Special treatment consideration must be given to patients who are pregnant or breastfeeding, as well as those with Graves' ophthalmopathy or amiodarone-induced hyperthyroidism. Patients' desires must be considered when deciding on appropriate therapy, and dose monitoring is essential.

Drains after Thyroidectomy for Benign Thyroid Disorders; Are ...

African Journals Online (AJOL)

Prophylactic drainage after thyroidectomy has been a regular practice at Kenyatta National Hospital( KNH). This has been ... stay and post-operative pain. Introduction. Prophylactic drains are still regularly used in ..... Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region.

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

Energy Technology Data Exchange (ETDEWEB)

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

2008-09-15

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.)

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

Science.gov (United States)

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

2017-12-01

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.

Preoperative risk factors in total thyroidectomy of substernal goiter

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Bove A

2016-11-01

Full Text Available Aldo Bove, Raffaella Maria Di Renzo, Gauro D’Urbano, Manuela Bellobono, Vincenzo D’ Addetta, Alfonso Lapergola, Giuseppe Bongarzoni Department of Medicine, Dentistry and Biotechnology, University “G. d’Annunzio” Chieti-Pescara, Chieti Scalo, Italy Abstract: The definition of substernal goiter (SG is based on variable criteria leading to a considerable variation in the reported incidence (from 0.2% to 45%. The peri- and postoperative complications are higher in total thyroidectomy (TT for SG than that for cervical goiter. The aim of this study was to evaluate the preoperative risk factors associated with postoperative complications. From 2002 to 2014, 142 (8.5%; 98 women and 44 men of the 1690 patients who underwent TT had a SG. We retrospectively evaluated the following parameters: sex, age, histology, pre- and retrovascular position, recurrence, and extension beyond the carina. These parameters were then related to the postoperative complications: seroma/hematoma, transient and permanent hypocalcemia, transient and permanent laryngeal nerve palsy, and the length of surgery. The results were further compared with a control group of 120 patients operated on in the same period with TT for cervical goiter. All but two procedures were terminated via cervicotomy, where partial sternotomies were required. No perioperative mortality was observed. Results of the statistical analysis (Student’s t-test and Fisher’s exact test indicated an association between recurrence and extension beyond the carina with all postoperative complications. The group that underwent TT of SG showed a statistically significant higher risk for transient hypocalcemia (relative risk =1.767 with 95% confidence interval: 1.131–2.7605, P=0.0124, and need to treat =7.1 and a trend toward significance for transient recurrent laryngeal nerve palsy (relative risk =6.7806 with 95% confidence interval: 0.8577–53.2898, P=0.0696, and need to treat =20.8 compared to the

Acute Pancreatitis Induced by Methimazole in a Patient With Subclinical Hyperthyroidism

Directory of Open Access Journals (Sweden)

Katrina Agito MD

2015-06-01

Full Text Available We report here a unique case of methimazole (MMI-induced pancreatitis. To our knowledge, this is the sixth case reported in the literature and the first diagnosed in a patient with toxic multinodular goiter. A 51-year-old Caucasian female with a history of benign multinodular goiter and subclinical hyperthyroidism was started on MMI 10 mg orally daily. Three weeks later, she developed sharp epigastric pain, diarrhea, lack of appetite, and fever. Her lipase was elevated 5 times the upper limit of normal, consistent with acute pancreatitis. There was no history of hypertriglyceridemia, or alcohol abuse. Abdominal computed tomography was consistent with acute uncomplicated pancreatitis, without evidence of gallstones or tumors. MMI was discontinued, and her hyperthyroid symptoms were managed with propranolol. Her acute episode of pancreatitis quickly resolved clinically and biochemically. One year later, she redeveloped mild clinical symptoms of hyperthyroidism with biochemical evidence of subclinical hyperthyroidism. MMI 10 mg orally daily was restarted. Five days later, she experienced progressive abdominal discomfort. Her lipase was elevated 12 times the upper limit of normal, and the abdominal computed tomography was again compatible with acute uncomplicated pancreatitis. MMI was again discontinued, which was followed by rapid resolution of her pancreatitis. The patient is currently considering undergoing definitive therapy with radioactive iodine ablation. Our case as well as previous case reports in the literature should raise awareness about the possibility of pancreatitis in subjects treated with MMI in the presence of suggestive symptoms. If the diagnosis is confirmed by elevated pancreatic enzymes, the drug should be discontinued.

Nuclear-medical local diagnosis of the enthyreotic (bland) goiter

Energy Technology Data Exchange (ETDEWEB)

Boerner, W; Reiners, C

1981-03-04

The recommendations made by the Goiter Section of the German Society for Endocrinology and by the Task Force on Short-lived Radionuclides for Medical Applications in the USA on the in-vivo application with radionuclides on the goiter are almost completely identical. They can be summarized as follows: a) in-vivo-radionuclide examinations are to be carried out only if there is an indication to do so. b) The radionuclide with the lowest radiation exposure should be applied (e.g. /sup 123/I, /sup 99/sup(m)Tc). c) /sup 131/I is being applied in a few exceptional cases only, but not for the routine scintiscanning of the bland goiter. As camera scintiscanning has been technically improved during the last years, the gamma camera might increasingly prevail over the scanner for thyroid scintiscanning. Taking into consideration possible 'pitfalls' in thyroid scintiscanning helps to avoid false diagnoses.

The pathogenetic significance of low iodine intake in non-endemic goiter

International Nuclear Information System (INIS)

Harriet, D.P.; Rigshospitalet, Copenhagen

1977-01-01

The blood inorganic iodine concentration (BII), the radioiodide clearance and the absolute iodine uptake (AIU) were determined in 27 patients with simple goiter and in 21 controls. The purpose was to evaluate the pathogenetic significance of low iodine intake for the formation of sporadic goiter. An early thyroid radioiodide clearance was measured by 132 I (5-30 min post injection), and the BII values were bases on the specific activity of I in saliva. The median BII levels of patients and controls were 1.1 and 1.5 μg/l respectively, and the urinary iodine excretion 67 and 79 μg/day respectively, the difference was not significant. The radioiodide clearance was above the normal range in 13 out of 27 patients, and 16 of 27 patients had elevated or high normal AIU values. These patients included 7 out of 9 patients with diffuse, shortlasting goiter; the AIU of those with nodular goiter ranged from slightly subnormal to elevated. Only one exhibited a typical iodine deficiency pattern of very low BII, high radioiodide clearance and normal AIU. (orig.) [de

Iodinated Contrast Media-Induced Thyroid Dysfunction in Euthyroid Nodular Goiter Patients.

Science.gov (United States)

Kornelius, Edy; Chiou, Jeng-Yuan; Yang, Yi-Sun; Lo, Shih-Chang; Peng, Chiung-Huei; Lai, Yung-Rung; Huang, Chien-Ning

2016-08-01

The risks of thyroid dysfunction after iodinated contrast media exposure in patients with euthyroid nodular goiter are largely unknown. This observational, retrospective cohort study included a random selection of one million people in Taiwan. All patients with iodinated contrast media exposure during this study period were selected. Patients with euthyroid nodular goiter were identified as cases, while patients without thyroid nodule were selected as controls. We followed these patients until the first event of thyroid dysfunction including hyperthyroidism or hypothyroidism after iodinated contrast media exposure. A total of 334 cases and 2672 matched controls were selected in this study. The mean age of cases and controls were 58.6 and 58.4 years old, and mean follow-up durations were 2.1 and 2 years respectively. After adjustment, patients with euthyroid nodular goiter had a higher risk of thyroid dysfunction (hazard ratio 5.43, [confidence interval (CI) 3.01-9.80]) compared with controls after iodinated contrast media exposure. In the subgroup analysis, the risks of hyperthyroidism and hypothyroidism in cases compared with controls were 5.77 [CI 2.64-12.62] and 4.95 [CI 2.15-11.40] respectively. Half of the euthyroid nodular goiter cases developed thyroid dysfunction within one year after iodinated contrast media exposure. Interestingly, all thyroid-related comorbidities and drug prescriptions did not increase the risk of thyroid dysfunction. Presence of euthyroid nodular goiter was associated with higher risk of thyroid dysfunction including hyperthyroidism and hypothyroidism after iodinated contrast media exposure.

Hyperthyroidism caused by a toxic intrathoracic goiter with a normal-sized cervical thyroid gland

International Nuclear Information System (INIS)

Prakash, R.; Lakshmipathi, N.; Jena, A.; Behari, V.; Chopra, M.K.

1986-01-01

The rare presentation of hyperthyroidism caused by an intrathoracic goiter with a normal-sized cervical thyroid gland is described. The toxic intrathoracic goiter demonstrated avid uptake of [ 131 I] and [99mTc]pertechnetate, with comparatively faint isotopic accumulation seen in the cervical thyroid. A chest roentgenogram and radioisotope scan should be mandatory in cases of hyperthyroidism having no cervical thyroid enlargement to explore the possibility of a toxic intrathoracic goiter

Thyroid Sporadic Goiter with Adult Heterotopic Bone Formation

Directory of Open Access Journals (Sweden)

Adriana Handra-Luca

2015-01-01

Full Text Available Thyroid heterotopic bone formation (HBF in goiter is a rare finding. Five thyroid resection specimens were analyzed for HBF. The results were correlated with clinicomorphological features. All patients were women (33–82 years. The preoperative diagnosis was thyroid goiter or nodule. Treatment consisted in thyroidectomy and lobectomy (3 and 2, resp.. Microscopy showed sporadic nodular goiter. Malformative blood vessels and vascular calcifications were seen in intra- and extrathyroid location (5 and 3, resp.. The number and size of HBFs (total: 28 ranged between 1 and 23/thyroid gland (one bilateral and 1 and 10 mm, respectively. Twelve HBFs were in contact with the thyroid capsule. Most were extranodular (21, versus 6 intranodular. The medical history was positive for dyslipidemia, hyperglycemia, renal dysfunction, and hyperuricemia (2, 3, and 3 cases and 1 case, resp. without any parathyroid abnormality. In conclusion, thyroid HBF may be characterized by subcapsular or extranodular location, various size (usually ≥2 mm, and vascular calcifications and malformations. Features of metabolic syndrome and renal dysfunction may be present, but their exact role in the pathogenesis of HBFs remains to be elucidated.

Results of scintigraphic goiter diagnostics of 1975 and 1976

International Nuclear Information System (INIS)

Holtz-Zettler, F.

1980-01-01

In 2,790 scintiscans of the thyroid gland the distribution of cold, cool, warm and hot nodules and of diffuse goiters was assessed. In 276 scintiscanned patients who underwent operation, classification based on the following criteria: nodule type, palpation, malignancy rate, histology, age and sex. In addition, the occurrence of hyper- and hypothyreosis was investigated. For cold nodules the malignancy rate was 13.7%, for cool nodules 7.7%, for warm nodules 2.7%, and for diffuse goiters 7%; hot nodules didn't show malignant growth. In 9% of all operated preparations malignant degenerations were found; the removed nodular goiters comprised 9.3%. Among all nodules the incidence was 2.2%; 4.6% of all cold nodules were malign. In 20% of all patients with cancer metastases were found; their most frequent localisations were the regional lymphatic nodes. Histologically papillary and follicular carcinomas resulted to be the most frequent carcinomas (36% each); the incidence of anaplastic carcinomas was 20%. Medullary carcinoma and sarcoma were diagnosed once each. In females benign nodules occured more than four times, diffuse goiters and cold malignomas almost three times as much as in males. In both sexes the most benign modules were found between the 50th and 70th year of life, and particularly in the 7th decade of life. Toxic adenomas occurred particularly in women up to 35 years and at the beginning of the 8th decade of life. (orig.) [de

Radiodine treatment of hyperthyroidism with a simplified dosimetric approach. Clinical results

International Nuclear Information System (INIS)

Giovanella, L.; De Palma, D.; Ceriani, L.; Garancini, S.; Vanoli, P.; Tordiglione, M.; Tarolo, G. L.

2000-01-01

In this article is evaluated the clinical and effectiveness of a simplified dosimetric approach to the iodine-131 treatment of hyperthyroidism due to Graves' disease or uninodular and multinodular toxic goiter. 189 patients with biochemically confirmed hyperthyroidism and performed thyroid ultrasonography and scintigraphy obtaining the diagnosis of Graves' disease in 43 patients, uninodular toxic goiter in 57 patients and multinodular toxic goiter in 89 patients were enrolled in order to be examined. It was found in 28 patients cold thyroid nodules and performed fine-needle aspiration with negative cytology for thyroid malignancy in all cases. Antithyroid drugs were stopped 5 days till radioiodine administration and, if necessary, restored 15 days after the treatment. Radioiodine uptake test was performed in all patients and therapeutic activity calculated to obtain a minimal activity of 185 MBq in the thyroid 24 hours after administration. The minimal activity was adjusted based on clinical, biochemical and imaging data to obtain a maximal activity of 370 MBq after 24 hours. Biochemical and clinical tests were scheduled at 3 and 12 months posttreatment and thyroxine treatment was started when hypothyroidism occurred. In Graves' disease patients a mean activity of 370 MBq (distribution 259-555 MBq) was administered. Three months after treatment and at least 15 days after methimazole discontinuation 32 of 43 (74%) patients were hypothyroid , 5 of 43 (11%) euthyroid and 6 of 43 (15%) hyperthyroid. Three of the latter were immediately submitted to a new radioiodine administration while 32 hypothyroid patients received thyroxine treatment. One year after the radioiodine treatment no patient had hyperthyroidism; 38 of 43 (89%) were on a replacement treatment while 5 (11%) remained euthyroid. In uni-and multinodular toxic goiter a mean activity of 444 MBq (distribution 259-555 MBq) was administered. Three months posttreatment 134 of 146 (92%) patients were euthyroid and

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

DEFF Research Database (Denmark)

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

2006-01-01

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...

Harmonic focus in thyroidectomy for substernal goiter

DEFF Research Database (Denmark)

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

2015-01-01

, 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...

Serum 8-OHdG and HIF-1α levels: do they affect the development of malignancy in patients with hypoactive thyroid nodules?

Science.gov (United States)

Ece, Harman; Mehmet, Erdogan; Cigir, Biray Avci; Yavuz, Dodurga; Muammer, Karadeniz; Cumhur, Gunduz; Mustafa, Harman; Sevki, Cetinkalp; Fusun, Saygılı; Gokhan, Ozgen Ahmet

2013-01-01

This study aimed to evaluate 8-OHdG and hypoxia-inducible factor 1 (HIF-1α) levels in patients with hypoactive thyroid nodules (toxic multi-nodular goiter, Graves' disease, and Hashimoto's thyroiditis), as these parameters may be related to oxidative stress and the pathogenesis of cancer. The study included patients diagnosed with Graves' disease (n = 20), toxic multinodular goiter (n = 20), and Hashimoto thyroiditis (n = 20), and 20 healthy controls. HIF-1α levels were measured in blood samples and 8-OHdG levels were measured in urine - both via ELISA. HIF-1α and 8-OHdG levels were significantly higher in the patient groups than in the control group (p 0.05). There was no significant difference in 8-OHdG or HIF-1α levels between the patients with biopsy results that were benign, malignant, and non-diagnostic (p > 0.05). Serum HIF-1α and urine 8-OHdG levels were significantly higher in the patients with thyroid diseases; however, a relationship with cancer was not observed.

Computed tomography in the evaluation of thyroid disease

International Nuclear Information System (INIS)

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

1984-01-01

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

Computed tomography in the evaluation of thyroid disease

Energy Technology Data Exchange (ETDEWEB)

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

1984-05-01

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.

Hyperfunctioning metastatic follicular thyroid carcinoma in Pendred's syndrome

International Nuclear Information System (INIS)

Abs, R.; Verhelst, J.; Schoofs, E.; De Somer, E.

1991-01-01

A 66-year-old woman with Pendred's syndrome underwent a partial thyroidectomy when she was 17 years old. At the age of 52 years, she had a second thyroid operation because of hyperthyroidism due to a toxic multinodular goiter with a mediastinal extension consisting of several separate nodules. Five years later a hyperfunctioning metastatic follicular carcinoma was diagnosed histologically. After treatment with radioactive iodine, the patient was well. To the authors' knowledge, this is the first description of a metastatic follicular thyroid carcinoma in Pendred's syndrome and the first report of hyperthyroidism occurring after malignant degeneration of a dyshormonogenetic goiter

Fetal goiter and bilateral ovarian cysts

DEFF Research Database (Denmark)

Lassen, Pernille; Sundberg, Karin; Juul, Anders

2008-01-01

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...

Prenatal diagnosis and management of fetal goiter caused by maternal Grave's disease.

Science.gov (United States)

Hadi, H A; Strickland, D

1995-07-01

We present a case of maternal Grave's disease associated with fetal goitrous hyperthyroidism. Fetal goiter was diagnosed by ultrasound and diagnosis of fetal hyperthyroidism was established by umbilical blood sampling. Fetus was successfully treated by increasing maternal propylthiouracil dosage. Fetal thyroid status was normal at birth. Role of sonography and umbilical blood sampling in management of fetal goiter complicated with maternal Grave's disease is discussed.

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

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"Moayeri H

2002-08-01

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.

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

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Mutalazimah Mutalazimah

2013-10-01

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

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

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

1969-12-01

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.

Thyrotropinoma and multinodular goiter: A diagnostic challenge for hyperthyroidism

OpenAIRE

Aksoy, Duygu Yazgan; Gedik, Arzu; Cinar, Nese; Soylemezoglu, Figen; Berker, Mustafa; Gurlek, Omer Alper

2013-01-01

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...

Low Iodine in the Follicular Lumen Caused by Cytoplasm Mis-localization of Sodium Iodide Symporter may Induce Nodular Goiter.

Science.gov (United States)

Huang, Huibin; Shi, Yaxiong; Liang, Bo; Cai, Huiyao; Cai, Qingyan

2017-10-01

Iodine is a key ingredient in the synthesis of thyroid hormones and also a major factor in the regulation of thyroid function. A local reduction of iodine content in follicular lumen leads to overexpression of local thyroid-stimulating hormone receptor (TSHr), which in turn excessively stimulates the regional thyroid tissue, and result in the formation of nodular goiter. In this study, we investigated the relationship between iodine content and sodium iodide symporter (NIS) expression by using the clinical specimens from patients with nodular goiter and explored the pathogenesis triggered by iodine deficiency in nodular goiter. In total, 28 patients were clinically histopathologically confirmed to have nodular goiter and the corresponding adjacent normal thyroid specimens were harvested simultaneously. Western blot and immunohistochemistry were performed to assay NIS expression and localization in thyrocytes of both nodular goiter and adjacent normal thyroid tissues. NIS expression mediated by iodine in follicular lumen was confirmed by follicular model in vitro. Meanwhile, radioscan with iodine-131were conducted on both nodular goiter and adjacent normal thyroid. Our data showed that NIS expression in nodular goiter was significantly higher than that in adjacent normal tissues, which was associated with low iodine in the follicular lumen. Abnormal localization of NIS and lower amount of radioactive iodine-131 were also found in nodular goiter. Our data implied that low iodine in the follicular lumen caused by cytoplasm mis-localization of NIS may induce nodular goiter.

[Influence of removing iodized salt on children's goiter status in areas with high iodine in drinking water].

Science.gov (United States)

Lu, Shengmin; Xu, Dong; Wang, Yuchun; Du, Yonggui; Jia, Lihui; Liang, Suoli

2015-05-01

To explore the changes of goiter prevalence of children living in areas with high iodine in drinking water after removing iodized salt from their diet. Three towns with median water iodine of 150 - 300 μg/L were selected randomly in Hengshui city of Hebei province of China. A total of 452 and 459 children in the 3 towns were randomly selected to measure thyroid volume by ultrasound before and after removing iodized salt, respectively. Their goiter status was judged using the criteria of age-specific thyroid volume recommended by the WHO. After removing iodized salt, the overall goiter prevalence in the three towns significantly decreased from 24.56% (111/452) to 5.88% (27/459) (P < 0.01). The goiter prevalence in 8, 9 and 10 year-old children decreased respectively from 33.70% (31/92), 23.32% (45/193) and 20.96% (35/167) to 6.10% (10/164), 5.52% (9/163) and 6.06% (8/132). The goiter prevalence in boys and girls decreased from 27.05% (66/244) and 21.63% (45/208 ) to 6.66% (15/226 ) and 5.15% (12/233), respectively. The decreases in children's goiter prevalence across gender and age group were all significant. Children's goiter prevalence decreased significantly after removing iodized salt from their diet for about one and half years in the HIA in Hebei province.

The DIAGONALE study: a survey designed to analyze the diagnosis and management of goiter in France.

Science.gov (United States)

Caron, Philippe; Lehert, Philippe; Picard, Sylvie; Landron, Frédéric

2012-06-01

Euthyroid goiter is frequent for general practitioners (GPs) and endocrinologists (ENDOs). It may induce complications especially in elderly subjects when it becomes nodular and hyperfunctional whereas in young subjects prevention of iodine deficiency may prevent this evolution. The primary objective of the observational study diagnosis of iodine deficiency induced goiter and national medical practices (DIAGONALE) was to determine the circumstances of diagnosis of euthyroid goiter, its incidence, the patient characteristics and the management. A representative sample of GPs and ENDOs working in a private medical practice (exclusively or not) was randomly drawn from a national file without changing the physician-patient relationship. Four hundred and sixty-nine GPs and 195 ENDOs participated in the study. Goiter was diagnosed in 0.86% of patients seen by GPs and 15.7% of patients seen by ENDOs. Pregnant women were mainly and teenagers exclusively seen by ENDOs. The interview and clinical examination were an important time in the management of euthyroid goiter. TSH level was systematically assayed as well as an ultrasonography; 22.6% of GPs did not perform a scintigraphy versus 63.1% of ENDOs. Levothyroxine treatment was frequently prescribed and the objective of TSH levels was 2mU/L for GPs and 1mU/L for ENDOs. This observational study showed differences in the management of euthyroid goiter between GPs and ENDOs but also many common practices. It also highlighted a higher incidence rate of goiter in pregnant women and teenagers seen by ENDOs. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Broken heart syndrome triggered by an obstructive goiter not associated with thyrotoxicosis.

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Hatzakorzian, Roupen; Bui, Helen; Schricker, Thomas; Backman, Steven B

2013-08-01

Takotsubo cardiomyopathy (TC) is described as transient ventricular dysfunction following emotional or physical trauma. A few reports have described patients with TC in association with various circumstances of thyrotoxicosis. We report an unusual case of TC in a patient with a large retrosternal goiter and normal thyroid function. We speculate that TC was triggered by compromise of tracheal flow induced by the goiter. A 68-yr-old woman without primary heart disease presented with cardiorespiratory collapse requiring ventilatory and cardiovascular support, including placement of an intra-aortic balloon pump. She was diagnosed with a severe form of TC based on characteristic echocardiography findings and clinical course. Within less than a week, her myocardial function completely normalized. The patient was later found to have a large retrosternal goiter compressing her trachea, though her thyroid function was normal. A total thyroidectomy was eventually performed, and she made a full recovery. Subsequently, the patient was found to have a positive JAK2 mutation for a myeloproliferative disorder. Takotsubo cardiomyopathy may be regarded as the final common pathway of cardiac dysfunction triggered by various stress conditions, in this case, a large retrosternal goiter not associated with thyrotoxicosis and likely exacerbated by severe leukocytosis related to a myeloproliferative disorder.

Urinary iodine excretion in relation to goiter prevalence in households of goiter endemic and non endemic regions of Ethiopia

International Nuclear Information System (INIS)

Abuye, Chernet; Hailemariam, Bantiyrgu; Neka Tibeb, Hanna; Urga, Kelbesa; Woldegebriel, Zewidie

1995-01-01

A Survey of goiter prevalence, among population of five endemic and four non endemic regions of Ethiopia was carried out prior to the distribution of iodate d salt. urine samples were collected from 327 subjects selected by systematic random sampling from endemic and 276 taken as non endemic. The lowest mean urinary iodine excretion (UIE) value was recorded in Bure (22 micro gl/day) and the highest in Alemmaya (148 micro gl/day). The highest goiter rate ( percent TGR) was recorded in Sawla 55.6 %) and the lowest (0.6 %) in Yabello. Iodine content of drinking was in the range of 0.4 - 48.5 micro gl. Iodine content of water source was correlated positively ( r0.8399) with the mean of UIE and TGR, however, indicates that sites considered as non endemic seem to be affected by iodine deficiency. The study results urge the need for intervention in controlling Iodine Deficiency Disorders. 3 tab

Nodular goiter after occupational accidental exposure to radiation

International Nuclear Information System (INIS)

Pisarev, Mario A.; Schnitman, M.A.; Buenos Aires Univ.; Hospital Frances, Buenos Aires

2008-01-01

Full text: Purpose: During a control of the safety measures at the Radiology Service in a local hospital in Buenos Aires, a lack of an appropriate shielding in the X-ray equipment was detected. Methods and Materials: Therefore studies were performed in the group of physicians and technicians exposed and in an age and sex matched group of non-exposed physicians and technicians. Check-ups included thyroid sonography, circulating thyroid hormones, TSH and thyroid antibodies. The exposed group included 9 females and 5 males, while the non-exposed group comprised 8 females and 5 males. Results: No thyroid abnormalities were found in the non-exposed patients. On the contrary in the exposed cohort in 11 out of 14 patients nodular goiter was diagnosed, while an additional patient presented diffuse goiter. In 5 out of the 12 patients with goiter, nodule growth or the appearance of new nodules was observed along the follow-up. Four patients presented changes in thyroid function: two had elevated basal TSH with increased titters of anti TPO antibodies in one, while another showed an abnormal TRH-TSH test. A fourth patient had low total T 4 values. Other abnormalities included: sperm abnormalities in 2 out of the 5 males, dry-eye syndrome in other two, mammary nodules in one female and a basocellular epithelioma in another one. Conclusions: accidental irradiation leads to thyroid abnormalities, such as the appearance of nodules and alterations in thyroid function. (author)

Total thyroidectomy: is morbidity higher for Graves' disease than nontoxic goiter?

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Welch, Kellen C; McHenry, Christopher R

2011-09-01

Total thyroidectomy for treatment of Graves' disease is controversial and much of the debate centers on the concern for complications. The purpose of this study was to evaluate the morbidity of total thyroidectomy for Graves' disease and determine if it is different than for patients with nontoxic nodular goiter. The rates of life threatening neck hematoma, recurrent laryngeal nerve (RLN) injury, transient hypocalcemia, and hypoparathyroidism were determined for consecutive patients with Graves' disease treated with total thyroidectomy from 1996 to 2010. Results were compared with patients who underwent total thyroidectomy for nontoxic nodular goiter during the same period, matched for the weight of the excised thyroid gland. Total thyroidectomy was performed in 111 patients with Graves' disease (group I) and 283 patients with nontoxic nodular goiter (group II). Parathyroid autotransplantation was performed in 31(28%) patients in group I and 98 (35%) patients in group II (P = NS). Comparative analysis of morbidity revealed no significant difference in neck hematoma, 0(0%) (I) versus 3(1%) (II); permanent RLN injury, 0(0%) (I) versus 2(1%) (II); and permanent hypoparathyroidism in 1(1%) (I) versus 1 (0.4%) (II) (P = NS). Transient hypocalcemia was more common in patients with Graves' disease, 80(72%) (I) versus 170 (60%) (II) (P Graves' disease; only transient hypocalcemia occurred more often than in patients with nodular goiter. Total thyroidectomy should be presented as a therapeutic option for all patients with Graves' disease. Copyright © 2011 Elsevier Inc. All rights reserved.

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

Science.gov (United States)

Peterson, Mark E

2014-11-01

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. © 2014 Society for Endocrinology.

Sources of circulating 3,5,3 - Triiodothyronine in hyperthyroidism estimated after blocking of type 1 and type 2 iodothyronine deiodinases

DEFF Research Database (Denmark)

Laurberg, P.; Vestergaard, Henrik; Nielsen, Søren

2007-01-01

of therapy in patients with Graves' disease. The addition of KI to PTU led to a greater fall in T(3) and T(4), but the balance was unaltered. After PTU plus ipodate, T(3)/T(4) on d 4 was lower, 34.1 +/- 1.2% of the initial value. Similar variations were observed in patients with multinodular toxic goiter...

Differentiated thyroid cancer following radioiodide 131I therapy of hyperthyroidism: a case report

Energy Technology Data Exchange (ETDEWEB)

Nemec, J; Soumar, J; Zeman, V; Nahodil, V; Zamrazil, V; Smejkal, V Jr

1978-01-01

Differentiated (papillary) thyroid cancer was detected 17 years following radioiodide 131I treatment for toxic multinodular goiter. Twenty-one cases of thyroid cancers with previous 131I therapy for hyperthyroidism were summarized. This combination is rare compared to the incidence of thyroid cancers following external irradiation. This may be due to higher absorbed dose to thyroid in 131I treatment.

Hyperfunctioning metastatic follicular thyroid carcinoma in Pendred's syndrome

Energy Technology Data Exchange (ETDEWEB)

Abs, R.; Verhelst, J.; Schoofs, E.; De Somer, E. (University Hospital, Antwerp (Belgium))

1991-04-15

A 66-year-old woman with Pendred's syndrome underwent a partial thyroidectomy when she was 17 years old. At the age of 52 years, she had a second thyroid operation because of hyperthyroidism due to a toxic multinodular goiter with a mediastinal extension consisting of several separate nodules. Five years later a hyperfunctioning metastatic follicular carcinoma was diagnosed histologically. After treatment with radioactive iodine, the patient was well. To the authors' knowledge, this is the first description of a metastatic follicular thyroid carcinoma in Pendred's syndrome and the first report of hyperthyroidism occurring after malignant degeneration of a dyshormonogenetic goiter.

Responses to TRH in patients with endemic goiter

International Nuclear Information System (INIS)

Carneiro, Laureano; Watanabe, Tomas; El Tamer, Elias; Varela, Amalia; Moran, Dardo; Rinaudo, Antonio; Staneloni, Luis; Degrossi, O.J.

1978-12-01

The response to TRH was studied in 32 patients from an endemic goiter area, 20 of them had been previously treated with iodized oil. Blood samples were taken at 0, 20, 40 and 120 minutes after de i.v. administration of 400μg of TRH, and serum levels of TSH, T3 and T4 were measured. The results obtained show that in endemic goiter area there is a modification in the hypothalamus-pituitary-thyroid feedback mechanism, with increased reserve of pituitary TSH and changes in T4 and T3 secretion. The injection of TRH gave exaggerated and delayed responses in the secretion of TSH and T3. Iodized oil used as a prophylatic method produced a disminution of pituitary TSH reserve, and of serum levels of TSH and T3, as a result of the return tonormality of the hypothalamus-pituitary-thyroid feedback mechanism. (author) [es

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.

Directory of Open Access Journals (Sweden)

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.

Iodine Excess is a Risk Factor for Goiter Formation

African Journals Online (AJOL)

Key Words: Iodine excess, Goiter, Sub Saharan Africa. Iodine Excess is a ... synthesis leading to increased thyroid stimulating hormone ..... study done in Uganda revealed a similar picture ... significant association, probably due to recall bias.

[Characteristics of thyroid carcinoma in Grave's disease Hashimoto's thyroiditis and nodular goiter].

Science.gov (United States)

Filipović, A; Paunović, I

2003-01-01

The biology of thyroid cancer represents a spectrum of behavior ranging from well-differentiated lesions with an excellent prognosis to anaplastic carcinoma, which is almost fatal. For this reason, it is important that clinicians have methods at their disposal to asses the characteristics of patient's thyroid malignancy. In this work we discuss the behavior of differentiated thyroid cancer in associated diseases of thyroid as: Graves' disease, chronic lymphocytic thyroiditis--Hashimoto and nodular goiter. This is retrospectively reviewing of 50 patients treated for differentiated thyroid carcinoma at Department of surgery, Clinical Centre of Montenegro in Podgorica from 1998 until 2003. We evaluated occurrence, as well as the role of this diseases in patients with thyroid cancer. We found a more favorable course of thyroid cancer in the presence of chronic lymphocytic thyroiditis and nodular goiter, a contrary Graves' disease. In associated diseases of thyroid, a significantly greater proportion of patients with thyroid cancer, have modular goiter.

Autonomy in the case of enthyreotic goiter

International Nuclear Information System (INIS)

Mahlstedt, J.

1981-01-01

To identify, quantify, and exclude thyroidal autonomy, under enthyreotic conditions (positive TRH-test), the in-vivo diagnosing with radionuclides is the only method available to assess the thyroidal trap in connection with the suppression test. Its application is urgently necessary for any goiter patient in the iodine lacking region, the methodical proceeding depends on the individual circumstances. (orig.) [de

Fairly elevated incidence of goiter with marginally low urinary iodine in adolescents living in the north-western part of Tunisia

International Nuclear Information System (INIS)

El May, M.V.; Bourdoux, P.; Ben Slimane, F.; Ben Abdallah, M.; Mtimet, S.

1997-01-01

In order to study the etiology of endemic goiter in the north-western part of Tunisia, we examined 93 adolescents of this region. We measured urinary iodine concentrations, serum total thyroxine, total triiodothyronine, thyrotropin, thyroglobulin and antithyrogobulin antibody concentrations. The adolescents were questioned about their alimentary habits, the origin of their drinking water and the presence of known goiter(s) in their family. Among these adolescents, 49.5% of them had a goiter. Urinary iodine concentrations showed mild iodine deficiency. The serum determinations gave results within the reference ranges, without any significative differences between adolescents, with or without goiter. We found two risk factors: the age of adolescents, and the presence of a known goiter in the family. These results suggest that the actual prevention may not be adequate, or most likely that goitrogenic factors are to be looked for, especially in drinking water, since the majority of these adolescents drink no controlled water

The Prevalence of goiter and urinary iodine exertion in school-aged children in Lorestan province

Directory of Open Access Journals (Sweden)

mozhgan Padyab

2006-06-01

Full Text Available Background: Iodine deficiency and its related disorder such as goiter are endemic in Lorestan province. Following initiation of iodine deficiency control program in 1989, production, distribution and consumption of iodinated salt were begun. This survey was conducted in the framework of national monitoring survey in 2001 to find out the prevalence of goiter and urinary iodine level in order to evaluate the iodine status of school- aged children in Lorestan. Materials and Methods: 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Lorestan. The grade of goiter in 600 boys and 600 girls, was determined according to WHO classification. Urinary iodine content was estimated using the digestion method in one tenth of the schoolchildren. Findings: Total goiter rate was 7.8% 7.8% in girls and 7.7% in boys. Median urinary iodine was 17 μg/dl. Urinary iodine was above 10 μg/dl in 85.7% and less than 5 μg/dl in 1.7%. No one had urinary iodine below 2 μg/dl. Conclusion: It is concluded that the rate of goiter in Lorestan has decreased significantly since 1996 and urinary iodine levels in schoolchildren are indicative of adequate iodine intake. Therefore Lorestan province can be considered as an 'iodine deficiency free' zone.

Outcome analysis of 250 cases of Graves disease with large goiter treated with 131I

International Nuclear Information System (INIS)

Wang Qinfen; Zhang Chenggang; Zhao Xiaobin; Shi Longbao

2003-01-01

Objective: To evaluate the treatment effects of Graves disease with large goiter treated with 131 I and the method of 131 I individualized estimated dose. Methods: Two hundred and fifty patients with Graves disease with large goiter (mean of thyroid weight 113.0 ± 39.2 g; range 90-450 g) were studied according to patient individual factors, the dose per g thyroid tissue ranging from 2. 775-5.18 MBq/g was determined, then the administered dose was calculated using the special formula. The follow-up was for 15.9 ± 9.9 (range 3-44.7) months. Results: After one dose of 131 I, 154 patients (61.6%) became euthyroid, 53 patients (21.2%) remained to be hyperthyroidism, 43 patients (17.2%) became hypothyroidism. Large goiter in 219 patients (87.6%) was normalized. Conclusions: Treatment with 131 I is an effective method for Graves disease with large goiter; According to factors affecting outcome, employing the method of individualized radioiodine therapy can improve the efficacy of 131 I treatment

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

Energy Technology Data Exchange (ETDEWEB)

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)

2012-05-15

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

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

International Nuclear Information System (INIS)

Nadyrov, Eldar; Rozhko, Alexander; Nikonovich, Sergey; Kravtsov, Viacheslav; Aleksanin, Sergey; Mabuchi, Kiyohiko; Hatch, Maureen; Nakamura, Nori

2012-01-01

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 consequences of

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

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Sevda Sert Bektaş

2010-12-01

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.

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

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

2005-06-01

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.)

Benign thyroid disorders, radioiodine therapy and diagnosis related groups (DRGs): aspects of cost/benefit

International Nuclear Information System (INIS)

Dietlein, M.; Schicha, H.

2005-01-01

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.)

Non-invasive management of fetal goiter during maternal treatment of hyperthyroidism in Grave's disease.

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Lembet, Arda; Eroglu, Derya; Kinik, Sibel Tulgar; Gurakan, Berkan; Kuscu, Esra

2005-01-01

There is an increased risk of fetal goiter in patients who have a history of Grave's disease and undergo propylthiouracil (PTU) treatment during pregnancy. In this report, we describe a case of a fetal goiter detected by antenatal ultrasound at the 26th week of gestation in a mother treated with PTU for Grave's disease. A 32 x 38 x 20 mm fetal goiter was detected, each lobe measured 30 x 18 x 18 mm and estimated volume was 10 cm3. Subsequently, fetal thyroid function was assessed by umbilical fetal blood sampling. Cord blood showed elevated serum TSH (40.2 mU/l) and normal concentrations of free T4 (9.5 pmol/l) and free T3 (2.6 pmol/l). There were no other ultrasonographic signs of fetal hypothyroidism. Based on the above findings, the mother's PTU dosage was reduced to 50 mg daily from a total of 150 mg and weekly ultrasonographic examinations were performed. Six weeks after the initial ultrasound, a complete regression of the fetal goiter was noted. At the 34th week of gestation, the patient was delivered due to intrauterine growth restriction and oligohydramnios and gave birth to a male, weighing 1,920 g. The newborn thyroid was not palpable and thyroid ultrasonography was normal. Cord blood TSH was normal (8.4 mU/l) and free T4 was within lower normal limit (9.03 pmol/l). Ten days later, newborn thyroid function was normal and the baby did well afterwards. In conclusion, after the evaluation of fetal thyroid status, selected cases with fetal goiter can be initially managed without intrauterine treatment. (c) 2005 S. Karger AG, Basel

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

DEFF Research Database (Denmark)

Graf, H; Fast, S; Pacini, F

2011-01-01

of the trachea; thyroid function tests; Thyroid Quality of Life Questionnaire; electrocardiogram; and hyperthyroid symptom scale. Results: Thyroid volume decreased significantly in all groups. The reduction was comparable in groups A and B (23.1 ± 8.8 and 23.3 ± 16.5%, respectively; P = 0.95). In group C......, the reduction (32.9 ± 20.7%) was more pronounced than in groups A (P = 0.03) and B. The smallest cross-sectional area of the trachea increased in all groups: 3.8 ± 2.9% in A, 4.8 ± 3.3% in B, and 10.2 ± 33.2% in C, with no significant difference among the groups. Goiter-related symptoms were effectively reduced...... and there were no major safety concerns. Conclusion: In this dose-selection study, 0.03 mg MRrhTSH was the most efficacious dose as an adjuvant to (131)I therapy of MG. It was well tolerated and significantly augmented the effect of (131)I therapy in the short term. Larger studies with long-term follow...

COEXISTENCE OF CARCINOMAS OF THYROID WITH MULTINODULAR GOITRES OF THYROID – A TWO-YEAR STUDY

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Kiran Kumar Epari

2016-08-01

Full Text Available BACKGROUND Multinodular goitre or nodular hyperplasia or adenomatoid goitre is the most common thyroid disease, which occurs due to deficient iodine intake. Initial hyperthyroid states, followed by follicular atrophy and secondary changes like haemorrhage, calcification and cystic degeneration occurs in most of the cases. Longstanding cases of nodular goitre can be associated with carcinomas, usually follicular carcinomas, and rarely papillary carcinomas.[1] This study was done to know the incidence of coexisting malignancies, follicular and papillary carcinomas of thyroid, in longstanding nodular goitres of thyroid. METHODS All the cases of nodular goitres examined in the last two years were studied, including the thyroidectomy specimens and FNAC slides whichever was done. Extensive grossing of the thyroidectomy specimens was done to detect the possibility of malignancy in longstanding cases of nodular goitre of thyroid. Review of FNAC slides was done in cases where cytodiagnosis of coexisting malignancy was missed and detected in histopathological examination. RESULTS In the present study, conducted over a two-year period, out of 50 cases of thyroidectomy specimens of multinodular goitres studied, six cases were diagnosed to be having coexisting malignancy of thyroid, of which four were follicular carcinomas of thyroid and two were papillary carcinomas of thyroid. FNAC diagnosis of coexisting malignancy was initially missed in FNAC in two cases, i.e. one case each of follicular carcinoma and papillary carcinoma. These FNAC slides were reviewed and the foci of malignancies detected. CONCLUSION There is a possibility of malignancy of thyroid coexisting with longstanding multinodular goitre of thyroid, which should be kept in mind, while performing the needle biopsy and thorough examination of FNAC slides is needed to avoid missing the possible detection of the coexisting malignant lesion. Thyroidectomy specimens should be extensively grossed to

Quality of life in patients with benign nontoxic goiter

DEFF Research Database (Denmark)

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

2015-01-01

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...

Impact assessment of salt iodization on the prevalence of goiter in district Swat

International Nuclear Information System (INIS)

Akhtar, J.; Zahoor-Ullah; Paracha, P.I.; Lutfullah, G.

2004-01-01

Background: To eliminate Iodine Deficiency Disorders, (IDD) universal salt iodization is the widely practiced intervention. District Swat (a hilly area of NWFP, highly endemic for IDDs is selected as a first model district of the province for salt iodization program. Objectives: To find out the proportion of the families using iodized salt, iodine contents of the salts used by the families, urinary iodine levels in school children and the effect on goiter prevalence in Swat selected as a model district in 1998. Subject and Methods: The study was conducted in 960 children of both sexes, age 8-10 years in primary schools of district Swat in the year 2000. A replicate model used for base line study in 1998 was adopted. The students were clinically examined for goiter using palpation method. 960 edible salt samples for its iodine content and 240 urine samples for iodine level were analysed. Results: The overall goiter prevalence was found to be 52 and 45% in boys and girls respectively. 23% salt samples were found un-iodized, while in 25.6% the iodine content was less than 7ppm. The results revealed 18% decrease in total goiter rate and 35% increase in the use of iodized salt from the base line survey conducted in 1998, in school children of district Swat. Conclusions: The study revealed that since the area of Swat is still highly endemic for Iodine Deficiency Disorders, sustained efforts are required to ensure 100% salt iodization. (author)

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

DEFF Research Database (Denmark)

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

2011-01-01

The optimal treatment strategy in a goiter patient depends-among other factors-on goiter size, the degree of cosmetic or compressive symptoms, the age of the patient, the impact on the upper airways, the wish to maintain normal thyroid function, the ability of the thyroid gland to take up (131)I......, and the possibility of thyroid malignancy. When treatment is warranted in a patient with benign goiter, the choice usually stands between surgery and (131)I-therapy. Focal destructive treatment, by ethanol sclerotherapy or interstitial laser photocoagulation, may be considered in patients with a solitary benign...... 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...

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

International Nuclear Information System (INIS)

Perez Fontan, F.J.; Mosquera Oses, J.; Pombo Felipe, F.; Rodriguez Sanchez, I.; Arnaiz Pena, S.

1992-01-01

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.)

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

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Bangaraiah Gari Ramesh

2016-01-01

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.

Effects of ethiodol on T3 kinetics in endemic goiter area

International Nuclear Information System (INIS)

Watanabe, Tomas; Degrossi, O.J.; Zaninovich, A.A.; Altschuler, Noe; Degrossi, E.B.

1986-01-01

T3 kinetics were carried out in 32 children (11-15 years old) of a mild endemic goiter area. The incidence of goiter of the whole school population was 19% (Ia or Ib degree of the WHO). The mean urinary iodine was 84 μ g/d+-3. Six months before this investigation, 10 of the children received 2 ml of ethiodol by mouth and the other 22 (control group-CG) a placebo. The kinetics studies were carried out using less than 0,5 μ Ci of I-125 per Kg b.w. and the single injection method, non compartimental analysis. The CG shows, distribution volumen (V) 20.1+-0.6; serum T3 (sT3) 1.55 ng/ml+-0.03; plasma T3 T1/2 21.6+-0.6 and production rate (PR) 27.4μ g/d+-1.2. The treated group (TG): V, 17.3+-0.6; sT3 1.48 ng/ml+-0.09; T1/2 17.6+-0.6 and PR 25.9μ g/d+-1.4. The TG, after 6 months of ethiodol administration, showed a decrease of the distribution volume and a slight reduction in serum T3 values. As a consequence a significant diminution on the T3 extrathyroidal pool and an increase on the T3 plasma clearance (0.68 l/h+-0.01 in CG versus 0.73+-0.3 in TG) were observed. The production ratewas similar in both groups. These results indicate that the administration of ethiodol to children of a not severe endemic goiter area, produces moderate changes in the different parameters of T3 peripheral metabolism, which compensate each other and lead to similar final values on T3-PR, that were previously normal in these cases. This mechanism reflects the role of thyroid homeostasis in maintaining euthyroidism in these children of an endemic goiter area with decreased iodine supply. (Author) [es

Incidence of hypothyroidism more than twenty years after therapy in hyperthyroid patients treated with radioactive iodine

International Nuclear Information System (INIS)

Ronga, G.; Esposito, M.; Bschieri, I.; Fenzi, G.F.; Martino, E.; Pinchera, A.

1988-01-01

It is confirmed that delayed hypothyroidism is the major complication of I 131 therapy of the hyperthyroid syndromes of toxic diffuse or toxic multinodular goiter. In a homogeneous group of 94 patients taken from case histories of 454 subjects treated between 1957 and 1967, the annual increment of complications over the years appears significantly less than that found by other Authors and by us in prior review afeter a shorter interval of time

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

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Rambha Pathak

2016-01-01

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.

The Prevalence of Goiter and Urinary Iodine Exertion in 7 – 10 year old School Children of Qom 2001 - 2002

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R. Sheikholeslam

2007-04-01

Full Text Available Background and objectivesIodine deficiency was a public health problem in Iran before the start of iodine supplementation program in 1989. This study has been conducted in the framework of the national monitoring survey in 2001 to find the prevalence of goiter and urinary iodine levels in order to evaluate the effect of national supplementation program on the iodine status of school-aged children in the city of Qom. MethodsIn a descriptive, cross-sectional study, 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Qom, and the grade of goiter was determined in 600 boys and 600 girls according to WHO classification. Urinary iodine content was estimated using the digestion method in one tenth of the schoolchildren.ResultsGoiter was observed in 26% of children (24.3% of girls and 27.7% of boys. The average urinary iodine level was 15.2 µg/dl. Urinary iodine levels higher than 10 μg/dl was measured in 71.7% and less than 5 µg/dl in 8.1% of children. Urinary iodine levels less than 2 μg/dl has not been observed in any of the cases. No significant difference was observed in prevalence of goiter and the urinary iodine level between males and females, and students in living in urban or rural areas.ConclusionComparison of these results with those of the year 1996 shows that prevalence of goiter has significantly decreased in these students. Also, it shows that in the city of Qom, the urinary iodine levels of schoolchildren fall in the standard range determined by WHO. This indicates that the iodine intake is adequate in the province of Qom. Therefore, this province can be considered as an “iodine deficiency-free” zone.Keywords: Goiter; Goiter Endemic; Iodine.

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

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S S Antonova

2006-03-01

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

Euthyroid goiter with autonomy: Results of treatment with radioiodine (131I) and by surgery

International Nuclear Information System (INIS)

Emrich, D.; Reinhardt, M.

1989-01-01

In order to evaluate the efficacy of, and the risk associated with, the definite treatment of euthyroid goiter with autonomy, the data of 88 patients treated between 1982 and 1986 (50 by subtotal thyroidectomy; 38 by 131 I-treatment, mean radiation dose 200 Gy without protection by thyroxine) were analyzed in a retrospective study. The following criteria were used before and after treatment: the results of scintigraphy under suppression qualitatively (in focal autonomy) and quantitatively (global thyroid uptake) (TcU s ), the means of FT 4 I, FT 3 I and ΔTSH after TRH, the improvement of mechanical signs and symptoms and the decrease of thyroid volume. Measured by TcU s and ΔTSH, autonomy could be removed completely in 85-90% of all patients. Surgery was slightly more successful (100%) compared to treatment by 131 I (75-80%). This was also true for removal of mechanical symptoms and reduction of the goiter. The incidence of manifest hypothyroidism was greater after surgery (16%) than after 131 I treatment (3%). At a higher grade of autonomy (TcU s > 3.2%) surgery was more effective (95-100%) than treatment with 131 I (60-70%) but at a higher risk of hypothyroidism (24 vs 0%). It is imperative to improve the methods of estimating the amount of 131 I to be administered in euthyroid goiter with autonomy. Selection of patients with autonomy in euthyroid goiter for definite treatment is difficult, since until now their risk to become hyperthyroid cannot be predicted properly. (orig.) [de

Persistent cellular metabolic changes after hemithyroidectomy for benign euthyroid goiter

DEFF Research Database (Denmark)

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

2014-01-01

, 3, 6 and 12 months after hemithyroidectomy for benign euthyroid goiter. In the hemithyroidectomy group, flow cytometry was used to measure the MMP of tetramethylrhodamine methyl ester (TMRM)- and MitoTracker Green (MTG)-stained PBMCs, and V˙O2 was measured by an Oxycon Pro apparatus. RESULTS: One...

Differential Diagnosis of Nodular Goiter by Aspiration Cytology

International Nuclear Information System (INIS)

Koh, Suk Man; Lee, Houn Young; Han, Bong Heon; Kim, Sam Young; Ro, Heung Kyu

1982-01-01

113 patients with nodular goiter were studied cytologically by needle aspiration for differential diagnosis at the department of internal medicine, Chungnam National University Hospital since October 1980 till July 1981, and the final diagnosis taken from biopsies were compared with the cytologic method on the 44 cases who received operation. The results were obtained as follows: 1. Among the 113 cases of total patients, male were 15 cases (13.3%) and female were 98 cases (86.7%) and the sex ratio (M : F) was 1 : 6.5. The peak age incidence was in the third decade followed by forth and second decades. 2. The findings of cytological diagnosis in 113 cases showed benign adenoma in 69 cases (61.1%), subacute and chronic thyroiditis in 22 cases (19.5%), papillary carcinoma in 15 cases (13.3%) and follicular carcinoma in 7 cases (6.2%), respectively, and 48 cases (69.6%) of the adenomas and 2 cases (9.1%) of papillary carcinomas showed combined cystic degeneration of the nodules. 3. The diameter of the nodules by palpation revealed within 2-5 cm in 88 cases (77.9%) out of 113 cases, below 2 cm in 17 cases and over 5 cm in 8 cases and there were no significant relationship between the size of the nodule and disease entity. 4. The findings of thyroid scintigram using 131 I in 113 cases of nodular goiter showed 'cold nodule' in 111 cases (98.2%) and normal scan (radioactivity) in 2 cases (1.8%) which showed adenoma in cytology and there was no cases with h ot nodule'. 5. The thyroid functions of the 113 cases revealed as euthyroidism in 108 cases (95.6%), hypothyroidism in 2 cases (2.7%) in adenomas but there was no evidence that the nodules of the above 3 cases were the reason of hyperthyroidism. 6. In 44 operated cases, the histological diagnosis revealed 23 cases of adenoma out of 27 cases (85.2%) who were diagnosed as adenoma by cytology and 15 cases of malignancy out of 17 cases (88.2%), and the overall diagnostic accuracy of aspiration cytology was 86.4%.

[Serum thyroxine-binding protein for determining the functional state of the thyroid gland in pregnant women with endemic goiter].

Science.gov (United States)

Korol'kova, O A; Cheremukhin, V I

1975-01-01

A determination was made of the hormone-forming capacity of the thyroid gland in pregnent women under conditions of goiter endemic at various periods of pregnancy by trimesters (123-in healthy pregnant women, 206-with euthyroid goiter of the I degree, 271-or II degree, 90-of the II degree, and 4-of the IV degree). A method of zonal electrophoresis in the medinal-veronal buffer was applied. Thyrofixin with I131 isotope (made in the USSR) was used. With increase of the periods of pregnancy and the degree of euthyroid hyperplasia of the thyroid gland and goiter the thyroid gland function became elevated irrespective of age.

The therapy for huge goiter together with hyperthyroidism through 131I case studies

International Nuclear Information System (INIS)

He Jianhua; Yu Wencai; Zeng Qingwen; Wu Congjun

2001-01-01

Objective: 214 cases of the treatment of huge goiter with hyperthyroidism are revised to collect clinic material for the improvement of therapy to hyperthyroidism indications through 131 I. Methods: In all of these cases, patients take a full dose of 131 I based on MC Garack's formula for one time. Results: Among them, 154 resolved, accounting for 72%, 139 of the cases were reduced to normal size, which accounted for 64.9% of the patients. Only 114 cases of patients had side-effect, and during one year 12.1% of them have symptoms of hypothyroidism. Conclusion: The statistics shows that 131 I is convenient, safe, well and with reduces suffering from treating huge goiter with hyperthyroidism

Thyroidectomy improves tracheal anatomy and airflow in patients with nodular goiter

DEFF Research Database (Denmark)

Sørensen, Jesper Roed; Lauridsen, Jeppe Killerich; Døssing, Helle

. Effect sizes (ES) were calculated as mean change divided by standard deviation at baseline. ES of 0.2-0.5 were defined as small, 0.5-0.8 as moderate, and values >0.8 as large. Results: Sixty-five patients completed all examinations. Median goiter volume was 58 mL (range, 14-642 mL) before surgery...... resonance images (MRI) of the neck and respiratory flow-volume curves, including both in- and expiration, were performed prior to and six months following surgery. The evaluated tracheal dimensions included the smallest cross-sectional area of the trachea (SCAT), tracheal narrowing, and tracheal deviation...... with surgical removal of median 46 mL (range, 5-642 mL) (pdeviation were diminished by median 26% (ES=0.67), and 33% (ES=0.73), respectively, while SCAT increased by 17% (ES=0.61). Correspondingly, each 10% decrease in goiter volume resulted...

Multinodular and Vacuolating Neuronal Tumor of the Cerebrum: A New "Leave Me Alone" Lesion with a Characteristic Imaging Pattern.

Science.gov (United States)

Nunes, R H; Hsu, C C; da Rocha, A J; do Amaral, L L F; Godoy, L F S; Watkins, T W; Marussi, V H; Warmuth-Metz, M; Alves, H C; Goncalves, F G; Kleinschmidt-DeMasters, B K; Osborn, A G

2017-10-01

Multinodular and vacuolating neuronal tumor of the cerebrum is a recently reported benign, mixed glial neuronal lesion that is included in the 2016 updated World Health Organization classification of brain neoplasms as a unique cytoarchitectural pattern of gangliocytoma. We report 33 cases of presumed multinodular and vacuolating neuronal tumor of the cerebrum that exhibit a remarkably similar pattern of imaging findings consisting of a subcortical cluster of nodular lesions located on the inner surface of an otherwise normal-appearing cortex, principally within the deep cortical ribbon and superficial subcortical white matter, which is hyperintense on FLAIR. Only 4 of our cases are biopsy-proven because most were asymptomatic and incidentally discovered. The remaining were followed for a minimum of 24 months (mean, 3 years) without interval change. We demonstrate that these are benign, nonaggressive lesions that do not require biopsy in asymptomatic patients and behave more like a malformative process than a true neoplasm. © 2017 by American Journal of Neuroradiology.

Two novel mutations in the sixth transmembrane segment of the thyrotropin receptor gene causing hyperfunctioning thyroid nodules.

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Gozu, Hulya; Avsar, Melike; Bircan, Rifat; Claus, Maren; Sahin, Serap; Sezgin, Ozlem; Deyneli, Oguzhan; Paschke, Ralf; Cirakoglu, Beyazit; Akalin, Sema

2005-04-01

Autonomously functioning thyroid nodules (AFTNs) can present as hyperfunctioning adenomas or toxic multinodular goiters. In the last decade, a large number of activating mutations have been identified in the thyrotropin receptor (TSHR) gene in autonomously functioning thyroid nodules. Most have been situated close to, or within the sixth transmembrane segment and third intracellular loop of the TSHR where the receptor interacts with the Gs protein. In this study we describe two novel mutations in the sixth transmembrane segment of the TSHR causing hyperfunctioning thyroid nodules. Genomic DNAs were isolated from four hyperfunctioning thyroid nodules, normal tissues and peripheral leukocytes of two patients with toxic multinodular goiter. After amplifying the related regions, TSHR and G(s)alpha genes were analyzed by single-strand conformation polymorphism (SSCP) analysis. The precise localization of the mutations was identified by automatic DNA sequence analysis. Functional studies were done by site-directed mutagenesis and transfection of a mutant construct into COS-7 cells. We identified two novel TSHR mutations in two hyperfunctioning thyroid nodules: Phe631Val in the first patient and Iso630Met in the second patient. Both mutant receptors display an increase in constitutive stimulation of basal cyclic adenosine monophosphate (cAMP) levels compared to the wild-type receptor. This confirms that these mutant receptors cause hyperfunctioning thyroid nodules.

Euthyroid goiter with autonomy: Results of treatment with radioiodine (/sup 131/I) and by surgery

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Emrich, D.; Reinhardt, M.

1989-02-01

In order to evaluate the efficacy of, and the risk associated with, the definite treatment of euthyroid goiter with autonomy, the data of 88 patients treated between 1982 and 1986 (50 by subtotal thyroidectomy; 38 by /sup 131/I-treatment, mean radiation dose 200 Gy without protection by thyroxine) were analyzed in a retrospective study. The following criteria were used before and after treatment: the results of scintigraphy under suppression qualitatively (in focal autonomy) and quantitatively (global thyroid uptake) (TcU/sub s/), the means of FT/sub 4/I, FT/sub 3/I and ..delta..TSH after TRH, the improvement of mechanical signs and symptoms and the decrease of thyroid volume. Measured by TcU/sub s/ and ..delta..TSH, autonomy could be removed completely in 85-90% of all patients. Surgery was slightly more successful (100%) compared to treatment by /sup 131/I (75-80%). This was also true for removal of mechanical symptoms and reduction of the goiter. The incidence of manifest hypothyroidism was greater after surgery (16%) than after /sup 131/I treatment (3%). At a higher grade of autonomy (TcU/sub s/ > 3.2%) surgery was more effective (95-100%) than treatment with /sup 131/I (60-70%) but at a higher risk of hypothyroidism (24 vs 0%). It is imperative to improve the methods of estimating the amount of /sup 131/I to be administered in euthyroid goiter with autonomy. Selection of patients with autonomy in euthyroid goiter for definite treatment is difficult, since until now their risk to become hyperthyroid cannot be predicted properly.

Epidemiology of Thyroid Cancer in an Area of Epidemic Thyroid Goiter

International Nuclear Information System (INIS)

Cossu, A.; Paliogiannis, P.; Scognamillo, F.; Attene, F.; Trignano, M.; Tanda, F.; Budroni, M.; Cesaraccio, R.; Palmieri, G.

2013-01-01

The aim of this study was to analyze and describe the epidemiological characteristics and trends of thyroid cancer in the province of Sassari (Sardinia, Italy), an area with epidemic thyroid goiter, in the period 1992-2010. Data were obtained from the local tumor registry which makes part of a wider registry web, coordinated today by the Italian Association for Tumor Registries. An increasing trend in the incidence of thyroid cancer in the province of Sassari was evidenced. This trend seems to follow the general worldwide trend and does not seem to be related to the high incidence of thyroid goiter in the area. The frequencies of the different histological subtypes were similar to those reported in numerous national and international reports. Women are affected earlier than men and, therefore, suffer greater professional, economic, and social impacts. Overall mortality is low and a relative 5-year survival is excellent, especially in comparison to other malignancies

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

DEFF Research Database (Denmark)

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

2007-01-01

frequent in the rhTSH group. At 12 months, goiter-related complaints were significantly reduced in both groups without any between-group difference. One and three patients in the placebo and the rhTSH group, respectively, developed hypothyroidism. CONCLUSION: rhTSH-stimulated (131)I therapy improves...

Expression level and clinical significance of IL-2, IL-6 and TGF-β in elderly patients with goiter and hyperthyroidism.

Science.gov (United States)

Lv, L-F; Jia, H-Y; Zhang, H-F; Hu, Y-X

2017-10-01

To investigate the level of expression and the clinical significance of IL-2 (interleukin-2), IL-6 (interleukin-6) and TGF-β (transforming growth factor-β) in elderly patients with goiter and hyperthyroidism. Gender, age, course of disease, BMI (Body Mass Index), serum FT3 (Free triiodothyronine-3), FT4 (Free triiodothyronine-4), TT3 (Total triiodothyronine-3), TT4 (Total triiodothyronine-4), TSH (Thyroid Stimulating Hormone) and clinical manifestations on admission and other general clinical data and laboratory examination results were collected and statistically analyzed as case group in 128 elderly patients with goiter and hyperthyroidism. Additional 128 over 60-year-old patients with hyperthyroidism were selected as control group. The thyroid tissue of these patients and the control group were examined by fine needle aspiration biopsy. The expressions of IL-2, IL-6, TGF-β of the thyroid tissue in all patients were detected by immunohistochemistry, qRT-PCR (Real-time Quantitative Polymerase Chain Reaction) and Western blot method respectively, and the statistical analysis was carried out. p hyperthyroidism and thyroid enlargement (p hyperthyroidism, and symptoms of exophthalmos, the level of expression of IL-6 was significantly higher than that of patients without exophthalmos (p hyperthyroidism and symptoms of exophthalmos, and the patients with goiter, hyperthyroidism without symptoms of exophthalmos, IL-2 and TGF-β expression level were not different (p > 0.05). The expression levels of IL-2, IL-6, and TGF-β were significantly increased in the patients with senile goiter and hyperthyroidism, but in the senile patients with goiter, hyperthyroidism and exophthalmos symptoms, IL-6 levels were significantly higher than those without exophthalmos. The use of IL-2, IL-6, and TGF-β is of great significance in the diagnosis of goiter with hyperthyroidism, especially for elderly patients with atypical clinical symptoms of hyperthyroidism.

Induction of stimulating thyrotropin receptor antibodies after radioiodine therapy for toxic multinodular goitre and Graves' disease measured with a novel bioassay

NARCIS (Netherlands)

Hovens, Guido C.; Heemstra, Karen A.; Buiting, Antoinette M. J.; Stokkel, Marcel P.; Karperien, Marcel; Ballieux, Bart E.; Pereira, Alberto M.; Romijn, Johannes A.; Smit, Johannes W.

2007-01-01

Radioactive iodine therapy (RaI) in toxic multinodular goitre (TMNG) has been associated with the occurrence of Graves'-like hyperthyroidism. It has been postulated that pre-existing autoimmunity may contribute to this phenomenon. To study whether RaI induces thyrotropin receptor stimulating

Effects of the Thyroid Status Correction on the Functional State of Digestive System in Children with Diffuse Nontoxic Goiter

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M.Ye. Mamenko

2013-11-01

Full Text Available Objective: to study the effects of the diffuse non-toxic goiter treatment on the functional state of the digestive system in children. Materials and methods. The screening survey was based on lunior comprehensive schools (695 children aged 5–11 years: questioning of families, anthropometry and examination of children, detection of ioduria, palpation of the thyroid gland. In-depth examination of children with goiter (n = 88: ultrasonography of the thyroid gland and the digestive system, determination of levels of thyroid stimulating hormone, free thyroxine, serotonin, melatonin, vasoactive intestinal peptide. Results. The high incidence of non-toxic diffuse goiter (25.8 %, associated with a reduction in functional activity of the thyroid gland to the minimum thyroid dysfunction (42.0 % and subclinical hypothyroidism (10.2 %, was detected in school-aged children. The presence of goiter leads to a static increase of the chances for functional gastrointestinal disorders developing (odds ratio 2.33, p = 0.000, mainly due to the hypokinetic conditions. The administration of potassium iodide preparations leads to the decreasing in goiter rate in high compliance up to the 27.3 % and to the normalization of the functional state of the pituitary-thyroid system (thyroid stimulating hormone — 1.66 mIU/L, that is associated with increased level of serotonin (6.14 ng/ml and vasoactive intestinal peptide (117.86 ng/ml and decreased melatonin concentration (2.5 pmol/l. In children who consistently for six months received preparations of potassium iodide, along with the normalization of thyroid status we noted the decrease of the frequency of complaints from the digestive system. Conclusions. The treatment of diffuse nontoxic goiter by potassium iodide preparations allows to achieve reduction of thyroid size and to normalize functional activity of thyroid-pituitary system. Increase in the functional activity of the pituitary-thyroid system helps reduce the

Dose evaluation in function of the thyroid captivation percentage and mass in patients under radiotherapy for toxic goiter treatment

International Nuclear Information System (INIS)

Alves, Aline Nunes; Antonio Filho, Joao

2009-01-01

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 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)

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

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Vihang Mazumdar

2010-06-01

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.

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

Science.gov (United States)

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

2014-04-01

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.

Radiodine treatment of hyperthyroidism with a simplified dosimetric approach. Clinical results; Terapia radiometabolica dell'ipertiroidismo con approccio dosimetrico semplificato. Risultati clinici

Energy Technology Data Exchange (ETDEWEB)

Giovanella, L.; De Palma, D.; Ceriani, L.; Garancini, S. [Azienda Ospedaliera Universitaria, Ospedale di Circolo e Fondazione Macchi, Dipt. di Diagnostica per Immagini e Radioterapia, Unita' Operativa di Medicina Nucleare, Varese (Italy); Vanoli, P.; Tordiglione, M. [Azienda Ospedaliera Universitaria, Ospedale di Circolo e Fondazione Macchi, Unita' Operativa di Radioterapia, Varese (Italy); Tarolo, G. L. [Milan Univ., Milan (Italy). Cattedra di Medicina Nucleare, Ist. di Scienze Radiologiche

2000-12-01

In this article is evaluated the clinical and effectiveness of a simplified dosimetric approach to the iodine-131 treatment of hyperthyroidism due to Graves' disease or uninodular and multinodular toxic goiter. 189 patients with biochemically confirmed hyperthyroidism and performed thyroid ultrasonography and scintigraphy obtaining the diagnosis of Graves' disease in 43 patients, uninodular toxic goiter in 57 patients and multinodular toxic goiter in 89 patients were enrolled in order to be examined. It was found in 28 patients cold thyroid nodules and performed fine-needle aspiration with negative cytology for thyroid malignancy in all cases. Antithyroid drugs were stopped 5 days till radioiodine administration and, if necessary, restored 15 days after the treatment. Radioiodine uptake test was performed in all patients and therapeutic activity calculated to obtain a minimal activity of 185 MBq in the thyroid 24 hours after administration. The minimal activity was adjusted based on clinical, biochemical and imaging data to obtain a maximal activity of 370 MBq after 24 hours. Biochemical and clinical tests were scheduled at 3 and 12 months posttreatment and thyroxine treatment was started when hypothyroidism occurred. In Graves' disease patients a mean activity of 370 MBq (distribution 259-555 MBq) was administered. Three months after treatment and at least 15 days after methimazole discontinuation 32 of 43 (74%) patients were hypothyroid , 5 of 43 (11%) euthyroid and 6 of 43 (15%) hyperthyroid. Three of the latter were immediately submitted to a new radioiodine administration while 32 hypothyroid patients received thyroxine treatment. One year after the radioiodine treatment no patient had hyperthyroidism; 38 of 43 (89%) were on a replacement treatment while 5 (11%) remained euthyroid. In uni-and multinodular toxic goiter a mean activity of 444 MBq (distribution 259-555 MBq) was administered. Three months posttreatment 134 of 146 (92%) patients were

Clinical-morphological characteristic of bening thyroid neoplasms in children and adolescents of Ukraine

International Nuclear Information System (INIS)

Bolgov, M.Yu.; Bogdanova, T.I.; Rybakov, S.I.; Lysenko, A.G.; Chernyshev, S.V.

1999-01-01

The data obtained testify to an increase in the number of children and adolescents operated on for thyroid benign neoplasms after the Chernobyl accident.According to pathohistological diagnosis nodular and multinodular goiters were the most frequent.A tendency towards a decrease in the percentage of follicular adenomas and cystadenomas was observed in spite of an increase in the absolute number of cases.All these changes in structure of benign surgical thyroid pathology allow us to presuppose radiation effects and demand more careful epidemiological and radiological analysis

Recombinant human thyrotropin stimulation prior to 131I therapy in toxic multinodular goitre with low radioactive iodine uptake.

Science.gov (United States)

Azorín Belda, M J; Martínez Caballero, A; Figueroa Ardila, G C; Martínez Ramírez, M; Gómez Jaramillo, C A; Dolado Ardit, J I; Verdú Rico, J

Stimulation with recombinant human thyrotropin (rhTSH) increases thyroid radioiodine uptake, and is an aid to 131 I therapy in non-toxic multinodular goitre (MNG). However, there are not many studies using rhTSH prior to 131 I in toxic multinodular goitre to improve hyperthyroidism and compressive symptoms. A prospective study was conducted on patients with MNG and hyperthyroidism. Patients were recruited consecutively and divided into group I, stimulated with 0.3mg of rhTSH before radioiodine therapy, and a control group or group II, without stimulation. Thyroid function, radioiodine thyroid uptake, thyroid weight, and compressive symptoms were measured, and patients were followed-up for 9 months. Group I consisted of 16 patients (14 women), with a mean age 69.7 years, and group II with 16 patients (12 women), with a mean age 70.7 years. After stimulation with 0.3mg rhTSH in group I, 131 I uptake (RAIU) at 24h increased by 78.4%, and the estimated absorbed dose by 89.3%. In group II, the estimated absorbed dose was lower than group I after stimulation with rhTSH (29.8Gy vs. 56.4Gy; P=0.001). At 9 months of follow-up, hyperthyroidism was controlled in 87.5% of patients in group I, and 56.2% in group II (P=0.049). The mean reduction in thyroid weight was higher in group I than in group II (39.3% vs. 26.9%; P=0.017), with a tendency towards subjective improvement of compressive symptoms in group I, although non-significant. Only 2 patients described tachycardias after rhTSH administration, which were resolved with beta-blockers. Stimulation with 0.3mg of recombinant human thyrotropin prior to radioiodine therapy achieves a reduction in thyroid weight and functional improvement in patients with hyperthyroidism and multinodular goitre with low uptake, and with no need for hospital admission. Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

Asymptomatic multinodular splenoma (splenic hamartoma in a child with sickle cell anemia

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Elenga N

2017-07-01

Full Text Available Narcisse Elenga,1 Sylvain Labbé,2 Nicolas Leduc,2 Anicet Sika,1 Emma Cuadro,1 Laurence Long,1 Falucar Njuieyon,1 Rémi Kom-Tchameni,1 Thierry Basset1 1Department of Pediatrics and Pediatric Surgery, Pediatric Medicine and Surgery, 2Pathological Anatomy Department, Cayenne Hospital, Cayenne Cedex, French Guiana Abstract: Splenoma is a rare and benign malformation usually fortuitously diagnosed during imaging, surgery or, unfortunately, at autopsy. Although splenoma was first described in 1861, its association with hematological pathology is a very unusual condition in children. We report the case of an asymptomatic splenoma in an 8-year-old boy with sickle cell anemia, whose diagnosis was confirmed after conventional splenectomy. Keywords: multinodular splenoma, child, sickle cell anemia, conventional splenectomy

[Surgery for benign goiter in Germany: fewer operations, changed resectional strategy, fewer complications].

Science.gov (United States)

Dralle, H; Stang, A; Sekulla, C; Rusner, C; Lorenz, K; Machens, A

2014-03-01

The increase of certain operations in the wake of the introduction of the German Diagnosis-Related Groups (G-DRG) system rekindled debate on the risk-benefit profile of what is widely being perceived as a too high number of thyroidectomies for benign goiter in Germany. The numbers of thyroidectomy for benign goiter from 2005-2011 were obtained from the Federal Bureau of Statistics ("Statistisches Bundesamt"). For the purpose of the study, the following operation and procedure key (OPS) codes were selected: hemithyroidectomy (OPS code 5-061); partial thyroid resection (OPS code 5-062); total thyroidectomy (OPS code 5-063); and thyroid surgeries via sternotomy (OPS code 5-064). The rates of permanent hypoparathyroidism and vocal cord palsy were calculated based on two prospective multicenter evaluation studies conducted in 1998-2001 (PETS 1) and 2010-2013 (PETS 2) in Germany. Between 2005 and 2011, the number of thyroidectomies for benign thyroid goiter decreased by 8 %, and the age-standardized surgery rate decreased by 6 % in men (2005: 599 per 1 million; 2011: 565 per 1 million) and 11 % in women (2005: 1641 per 1 million; 2011: 1463 per 1 million). At the same time, the rates of partial and subtotal thyroidectomy decreased by 59 % in men and 64 % in women, whereas the rates of hemithyroidectomy and total thyroidectomy increased by 65 % (113 %) in men and 42 % (97 %) in women. Despite a greater proportion of thyroidectomies over time, the approximated rates for postoperative hypoparathyroidism were reduced from 2.98 to 0.83 % and for postoperative vocal cord palsy from 1.06 to 0.86 %. Irrespective of that decline, either complication was more frequent after total than after subtotal thyroidectomy. The total number of thyroid surgeries due to benign goiter has decreased substantially in Germany from 2005 through 2011. Despite changes in the resectional strategy with an increase in the total number thyroidectomies and a decrease of subtotal

Thyroid-hormone concentrations after radioiodine therapy for hyperthyroidism

International Nuclear Information System (INIS)

Tamagna, E.I.; Levine, G.A.; Hershman, J.M.

1979-01-01

Fourteen hyperthyroid patients (11 men, three women), ages 28 to 66, were followed with serial measurements of serum thyroid hormone levels for 1 mo after therapy with I-131. Twelve patients had diffuse toxic goiters (25 to 70 g in size); two patients had multinodular glands (40 to 100 g). The patients were taking no antithyroid medications; ten patients were treated with propranolol. All patients received the equivalent of 5000 rad, except the two with multinodular glands, who received larger doses. There was no consistent pattern of serum T 4 and T 3 levels after the I-131 therapy. For the entire group, there was no significant increase of the mean serum hormone concentration. One group (three patients) had a mean T 4 increase of 28% and a T 3 increase of 91% above baseline at Days 10--11. Seven patients had minimal increases of hormone levels at Days 2--3, and a third group (four paients) had no increase of thyroid hormones after I-131 therapy. The patients with no rise in hormone concentrations had smaller goiters than the other groups. There was no correlation of the dose of radioactive iodine, or of the initial hormone concentration, with the rises or declines of T 4 and T 3 levels after I-131 therapy. Radioiodine therapy caused no significant increase of serum T 4 and T 3 concentrations in the majority of patients

INTELLECTUAL DEVELOPMENT OF THE SCHOOL STUDENTS WITH DIFFUSIVE CLINICALLY EUTHYROID GOITER IN THE REGIONS WITH DIFFERENT IODINE OCCURENCE

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E.A. Troshina

2009-01-01

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.

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

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Ali Jawa

2015-01-01

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

Treatment of hyperthyroidism with fixed dose form Iodine 131

International Nuclear Information System (INIS)

Pacheco Torres, P.; Cerquera, A.M.; Acosta, F.; Sierra, M.

2007-01-01

Full text: Objective: Evaluation of the response to therapy with fixed dose of Iodine-131 in patients with hyperthyroidism. One hundred seventeen patients with hyperthyroidism were tested and sent for treatment with Iodine-131. The dose of the therapy was calculated according to the pathology (Diffuser goiter (DG): Multinodular goiter (MNG) and Single toxic nodule (NST). Values of TSH confirmed hyperthyroidism by laboratory methods. The thyroid-blocking agents were discontinued: methimazole for five days and propylthiouracil two days prior to therapy. The pregnancy tests were routinely conducted in females of reproductive age group. Patients reported fasting for therapy. The doses were administered in capsule form after obtaining informed consent from the patients. The patients were normally instructed to eat only after two hours after administration of iodine to promote gastric absorption of the radionuclide. Normally a post therapy thyroid scan is performed four days after treatment. Patients are usually followed up by the endocrinologists. A three- month post therapy evaluation is done by the nuclear medicine physician by telephone. The demographic data of our patients treated are as follows: Total number of patients: 117 Female: 88 (75.21%) Male: 29 (24.79%) Age average: 45 years. Diffuse Goiter= 94 (80.34%), Multinodular Goiter= 17 (14.52%) and Toxic Adenoma (NST) = 6 (5.12%). The average administered dose was 22.5 mCi to DG, 41.8 mCi to MNG and 37.5 mCi to NST. 102 (87.14%) patients at the control at 2 years after treatment presented stable response to therapy, 15 (12.86%) required a second therapy, 11 (11.70%) with BD and 4 (23.52%) with BMN; and any patient with NST required a second therapy. 83 (88.29%) of the patients with BD; 13 (76.48%) with BMN and 6 (100%) with NST the therapy was successful. Conclusion: Fixed dose of I-131 in hyperthyroidism is useful in patients with DG (11.70%). In patients with MNG whom a fixed dose is supplied, 23.52% require a

Impact of the serum thyroglobulin concentration on the diagnostics of benign and malignant thyroid diseases

International Nuclear Information System (INIS)

Rink, T.; Schroth, H.J.; Dembowski, W.; Klinger, K.

2000-01-01

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 thyroid volume, 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 ( [de

Primary mucosa-associated lymphoid tissue thyroid lymphoma: a rare thyroid neoplasm of extrathyroid origin

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Dimitrios Hadjidakis

2012-01-01

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.

Thyrotoxicosis and radioiodine therapy: Does the dose matter?

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Andrew Collier

2012-01-01

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.

Evaluation of Goiter Prevalence and Iodine to Creatinine Ratio among School-aged Girls in Urmia County

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J nourooz-zadeh

2013-03-01

Full Text Available Introduction: Clinical evaluation of iodine deficiency disorders (IDDs is often accomplished by assessment of urinary iodine excretion (UIE in random samples; however, the utilization of 24 hour urine samples is a more reliable biomarker of nutritional iodine status. This study was designed to evaluate total goiter prevalence (TGP and iodine/creatinine ratio among school-aged children in Urmia County. Methods: Schoolchildren (n=500 were recruited by cluster sampling from different educational areas in Urmia County. Goiter prevalence was assessed by thyroid palpation, UIE was determined by Sandell-Koltoff reaction, and Urinary creatinine was measured by the Jaffe-method. Results: In general, TGP was 12.2%. Among these, there were 48 individuals (9.6% with grade I goiter and 13 subjects (2.6% with grade II goiter. Mean urinary creatinine, median UIE and median I/Cr ratio were respectively 1.36±0.76 mg/dL, 14.3µg/dL, and 11.5µg/mg. Prevalence of iodine deficiency according to UIE criteria was 22.8% and that of I/Cr ratio was 41.2%. There was a correlation between age and UIE (P=001; r=0.163. UIE and urinary creatinine were correlated as well (P<0.003; r= 0.133. A correlation was also detected between I/Cr ratios and UIE (P=0.003; r=0.133 whilst a negative association was seen between age and I/Cr ratios (P=0.001; and r=–0.263. Conclusion: This investigation reconfirms that there is slight-to-mild iodine deficiency in Urmia County. The utilization of I/Cr ratio in conjugation with UIE and palpation may provide a better assessment in investigating nutritional iodine status.

Thyroid carcinoma

International Nuclear Information System (INIS)

Lambertini, Roberto; Dalurzo, Liliana; Jaen, Ana del V.

2008-01-01

In this document the case of a 66-year old woman is presented, with record of multi nodular goiter of 5 year of evolution, which is derived to scan ultrasound office to make a puncture-aspiration with thin needle because of the growth of nodular thyroid injuries. The ultrasound scan examination made before the puncture determine multiple dominant nodules of hyperplasia aspect between 15 and 25 mm of diameter and a small nodule of 6 mm suspected proliferate process. Despite its size, it was decided to include small nodule in injuries to a biopsy. The cytological study reveals nodular hyperplasia with carcinoma in the small nodule of 6 mm. A thyroidectomy is practiced on the patient. The deferred histological study of the thyroid gland confirms the finding of multi-nodular goiter with a small focus of papillar carcinoma. The ganglions examined were negative in the deferred examination [es

[Rarer causes of thyrotoxicosis].

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Krysiak, Robert; Kowalcze, Karolina; Okopień, Bogusław

2016-01-01

Thyrotoxicosis is a pathological syndrome in which tissue is exposed to excessive amounts of circulating thyroid hormones. Including its subclinical form, it is considered as one of the most frequent endocrine disorders in the general population. If not detected in a timely fashion, thyrotoxicosis can have serious health consequences. The most common forms of thyrotoxicosis include diffuse toxic goiter (Graves' disease), toxic multinodular goiter (Plummer's disease), and toxic adenoma (Goetsch's disease). The significant progress in the fields of hormonal assessment, imaging procedures and molecular biology made in recent years has brought about great improvement in the identification, differentiation and treatment of many other disorders associated with thyrotoxicosis. Therefore, this paper discusses the etiopathogenesis, clinical manifestation, biochemical abnormalities and management of thyrotropinoma, resistance to thyroid hormone, de Quervain's, silent, acute, posttraumatic and radiation-induced thyroiditis, Riedel's goiter, differentiated thyroid cancer, struma ovarii, thyrotoxicosis factitia, other forms of iatrogenic thyrotoxicosis, gestational trophoblastic disease, neonatal Graves's disease, familial nonautoimmune hyperthyroidism and McCune-Albright syndrome. On the basis of available studies, some of whom were carried out in the recent years, we provide practical guidelines for clinical endocrinologists dealing with the diagnosis and treatment of thyrotoxicosis.

Italian Association of Clinical Endocrinologists (AME) & Italian Association of Clinical Diabetologists (AMD) Position Statement : Diabetes mellitus and thyroid disorders: recommendations for clinical practice.

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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

2015-06-01

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.

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

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

2016-01-01

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

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

DEFF Research Database (Denmark)

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

2006-01-01

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...

Recombinant human thyrotropin prior to radioiodine therapy improves the size reduction of non-toxic nodular goiter: a prospective randomized double-blinded trial

International Nuclear Information System (INIS)

E Nielsen, Viveque; Bonnema, Steen; Hegedues, Laszlo; Grupe, Peter; Boel-Joergensen, Henrik

2005-01-01

Full text: Background: rh TSH increases the thyroid 131 I uptake (RAIU) and may have a role in the context of 131 I therapy of goiter. No placebo-controlled trial has yet been performed. Methods: In a double-blinded trial, 57 patients with nodular nontoxic goiter (51 F, 6 M) were randomized to receive either 0.3 mg rh TSH (n=28) or placebo (n=29) 24 h before 131 I. The thyroid dose was calculated based on thyroid size (measured by ultrasound) and RAUI at 24 h and 96 h. Thyroid size and function and patient satisfaction were monitored for 12 months. Results: At baseline the median goiter volume was 51 ml (range: 20-99 ml) in the placebo group and 59 ml (25-92 ml) in the rh TSH group (p=0.75). Three months after 131 I the goiter size was reduced to 38 ml (15-78 ml) and 43 ml (20-75 ml) in the two groups, respectively (p=0.001 within groups, p=0.96 between groups). At 12 months, the corresponding figures were 27 ml (15-82 ml) and 20 ml (6-59 ml); p=0.001 within groups compared with baseline, p=0.12 between groups. The relative goiter reduction at this time was 46 ± 22% in the placebo group, and 61 ± 15% in the rh TSH group (p=0.004). In addition to the influence of rh TSH, the magnitude of the goiter reduction correlated inversely with the initial goiter volume (p=0.019), whereas no significant correlation was found with the RAIU during therapy or with the absorbed thyroid dose. Discomfort during 131 I was reported by 10 patients in the placebo group and by 15 patients in the rh TSH group (p=0.12). Permanent hypothyroidism developed in 12% in the placebo group and in 52% in the rh TSH group (p=0.005). Patient satisfaction was generally very high without any major within group difference. Conclusion: In the first placebo-controlled double-blinded trial, we found that rh TSH prior to 131 I -therapy significantly improves thyroid size reduction by 33%, with a four-fold higher rate of hypothyroidism. These effects are, at least partially, mediated through other

OXIDATIVE STRESS IN HUMAN THYROID GLAND UNDER IODINE DEFICIENCY NODULAR GOITER: FROM HARMLESSNESS TO HAZARD DEPENDING ON COPPER AND IODINE SUBCELLULAR DISTRIBUTION

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H. Falfushynska

2014-12-01

Conclusions. Excess of copper unbound to metallothionein in goitrous-changed tissue and high level of inorganic iodine could be the reason for elevated DNA fragmentation and increased lysosomal membrane permeability and activation of antioxidant defense. The main criterions of goiter formation were represented by low level of organificated iodine and high level of DNA damage in thyroid gland. KEY WORDS: iodine deficiency nodular colloidal goiter, iodine, copper, metallothioneins, oxidative stress, cytotoxicity

Diagnostic Accuracy of Preoperative Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Detecting Occult Papillary Thyroid Microcarcinomas in Benign Multinodular Goitres

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Dimitrios K. Manatakis

2018-01-01

Full Text Available Objective. To investigate the diagnostic accuracy of neutrophil-to-lymphocyte (NLR and platelet-to-lymphocyte (PLR ratios in detecting occult papillary thyroid microcarcinomas in benign, multinodular goitres. Methods. 397 total thyroidectomy patients were identified from the institutional thyroid surgery database between 2007 and 2016 (94 males, 303 females, mean age 53 ± 14.5 years. NLR and PLR were calculated as the absolute neutrophil and absolute platelet counts divided by the absolute lymphocyte count, respectively, based on the preoperative complete blood cell count. Results. NLR was significantly higher in carcinomas and microcarcinomas compared to benign pathology (p=0.026, whereas a direct association could not be established for PLR. Both NLR and PLR scored low in all parameters of diagnostic accuracy, with overall accuracy ranging between 45 and 50%. Conclusions. As surrogate indices of the systemic inflammatory response, NLR and PLR are inexpensive and universally available from routine blood tests. Although we found higher NLR values in cases of malignancy, NLR and PLR cannot effectively predict the presence of occult papillary microcarcinomas in otherwise benign, multinodular goitres.

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

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Haresh Rameshkumar Chandwani

2012-01-01

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.

F-18-FDG-PET in autonomous goiter

International Nuclear Information System (INIS)

Boerner, A.R.; Voth, E.; Schicha, H.

1999-01-01

Aim: Gain-of-function mutations of the thyrotropin receptor (TSHR) gene have been invoked as one of the major causes of toxic thyroid adenomas. This study evaluates F-18-FDG-PET in these patients. Methods: Twenty patients with focal autonomous nodules and ten with disseminated autonomy were investigated the day before radioiodine therapy. Twenty patients with cancer of the head or neck and normal thyroid function served as controls. Results: F-18-FDG-Uptake was higher in patients than in controls. Focal autonomous nodules were associated with focally enhanced glucose metabolism. Disseminated autonomous goiters showed various patterns of focal or global hypermetabolism. Conclusion: Autonomous thyroid tissue caused by constitutive mutations of the TSH receptor is characterised by simultaneous increases in glucose and iodine metabolism which are correlated. (orig.) [de

Quality-of-Life Impairments Persist Six Months After Treatment of Graves' Hyperthyroidism and Toxic Nodular Goiter: A Prospective Cohort Study.

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Cramon, Per; Winther, Kristian Hillert; Watt, Torquil; Bonnema, Steen Joop; Bjorner, Jakob Bue; Ekholm, Ola; Groenvold, Mogens; Hegedüs, Laszlo; Feldt-Rasmussen, Ulla; Rasmussen, Åse Krogh

2016-08-01

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. 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 treated with antithyroid drugs, radioactive iodine, or surgery. Disease-specific and generic HRQoL were assessed using the thyroid-related patient-reported outcome (ThyPRO) and the Medical Outcomes Study 36-item Short Form (SF-36), respectively, evaluated at baseline and six-month follow-up. The scores were compared with those from two general population samples who completed ThyPRO (n = 739) and SF-36 (n = 6638). Baseline scores for patients with Graves' hyperthyroidism and toxic nodular goiter were significantly worse than those for the general population scores on all comparable ThyPRO scales and all SF-36 scales and component summaries. ThyPRO scores improved significantly with treatment on all scales in Graves' hyperthyroidism and four scales in toxic nodular goiter, while SF-36 scores improved on five scales and both component summaries in Graves' hyperthyroidism and only one scale in toxic nodular goiter. In Graves' hyperthyroidism, large treatment effects were observed on three ThyPRO scales (Hyperthyroid Symptoms, Tiredness, Overall HRQoL) and moderate effects on three scales (Anxiety, Emotional Susceptibility, Impaired Daily Life), while moderate effects were seen in two ThyPRO scales in toxic nodular goiter (Anxiety, Overall HRQoL). However, significant disease-specific and generic HRQoL deficits persisted on multiple domains across both patient groups. Graves

[Epidemiologic investigation on the prevalence of goiter and urinary excretion of iodine in the school population of the province of Reggio Emilia].

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Zini, M; Poluzzi, V; Bertani, A; Portioli, I; Cavalchi, B; Valcavi, R

1998-01-01

The prevalence of goiter was evaluated in a sample from the schoolchildren population of Reggio Emilia district. 1020 children underwent physical examination of thyroid gland and thyroid ultrasonography for determination of thyroid volume. Urinary iodine excretion (UIE) was measured in 837/1020 (82.1%). Iodine content was measured in water samples collected from 65 wells and 12 springs all around the district. The prevalence of goiter according to thyroid gland palpation was 26.2%. Thyroid volume was 4.74 +/- 1.87 ml, and the median UIE value 85 micrograms/l. According to the UIE classes as defined by WHO, 57.8% of all subjects showed a UIE less than 100 micrograms/l. In 57 out of 65 wells and in all the 12 springs examined, iodine was completely absent. In the remaining 8 wells, only iodine traces were found. Based on the results of physical examination of the thyroid gland, Reggio Emilia district should be regarded as an endemic goiter area. Nevertheless, thyroid volume measurement by ultrasound indicates that goiter prevalence may be markedly overestimated by palpation. The high prevalence of subjects featuring an increased thyroid volume, the low median UIE value and the poor iodine content in the local reservoirs of drinkable water suggest the opportunity for iodine prophylaxis in the Reggio Emilia district.

Study on the relationship between the magnitude of increase of serum TMA, TGA contents and the size of goiter in patients with Graves' disease after treatment with 131I

International Nuclear Information System (INIS)

Zheng Fang; Tan Qingling

2009-01-01

Objective: To study the relationship between changes of serum TMA, TGA levels and the size of goiter in patients with Graves' disease treated with 131 I. Methods: Serum TGA, TMA levels were measured with CLIA in 327 patients with Graves' disease both before and six months after 131 I treatment. These 327 patients were of three groups: Goiter I degree n=97, II degree n=128, III degree n=102. Results: In patients with I degree goiter,the serum TGA and TMA levels were only insignificantly increased after the 131 I treatment with an early hypothroidism rate of 21.44%. In patients with II degree goiter, the serum TGA and TMA levels were significantly increased after treatment (P 131 I. (authors)

Radio-contrast agent-induced hyperthyroidism: case report and review of the literature

International Nuclear Information System (INIS)

Iakovou, Ioannis; Zapandiotis, Apostolos; Mpalaris, Vassileios; Goulis, Dimitrios G.

2016-01-01

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)

Endogenous subclinical hyperthyroidism and cardiovascular system: time to reconsider?

Science.gov (United States)

Patanè, Salvatore; Marte, Filippo; Sturiale, Mauro

2011-05-19

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.

Radio-contrast agent-induced hyperthyroidism: case report and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Iakovou, Ioannis, E-mail: iiakovou@auth.gr, E-mail: iiakovou@icloud.com [Nuclear Medicine Department, Papageorgiou Hospital, Thessaloniki (Greece); Zapandiotis, Apostolos; Mpalaris, Vassileios; Goulis, Dimitrios G. [Medical School, Aristotle University of Thessaloniki (Greece)

2016-11-01

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)

Evaluation of oxidative status with exhaled breath 8-isoprostane levels in patients with hyperthyroidism.

Science.gov (United States)

Bastug, Emrah; Tasliyurt, Turker; Kutluturk, Faruk; Sahin, Safak; Yilmaz, Ayse; Sivgin, Hakan; Yelken, Berna Murat; Ozturk, Banu; Yilmaz, Abdulkerim; Sahin, Semsettin

2013-12-01

Studies conducted so far on the effect of hyperthyroidism on oxidative stress (OS) have employed blood and urine samples. Exhaled Breath Condensate (EBC) is a non-invasive technique used to take sample from lungs to determine many biological indications. The aim of the present study was determine the possibility of using 8- isoprostane levels in EBC as an indicator of OS in hyperthyroid patients. The present study was performed on 42 patients with hyperthyroidism and 42 healthy control subjects. Hyperthyroid patients included patients with newly diagnosed Graves' disease, toxic multinodular goiter and toxic adenoma. Exhaled breath condensates were collected from patients in each group using a condensing device. 8- isoprostane levels as an indicator of OS in EBC were detected via immunoassay method. Hyperthyroid patients and control groups had 8-isoprostane levels of 6.08±6.31 and 1.56±0.88 pg/ml, respectively. The difference between patient and control groups was statistically significant (phyperthyroid patients, eleven had Graves', 21 multinodular goiter, and 10 toxic adenoma diagnosis. There were no significant differences among patients of different diagnoses for 8-isoprostane levels (p=0.541). No significant correlations were found between 8-isoprostane and free thyroxine (fT4) or thyroid stimulating hormone (TSH) levels. In the present study, 8-isoprostane levels in EBC of hyperthyroid patients were found to be significantly higher than that in healthy control group. This study is important in that it is the first to evaluate the effects on respiratory system of elevated OS of hyperthyroidism in EBC.

[Hyperthyroidism in children. Experience in internal medicine in Mali].

Science.gov (United States)

Sidibé, A T; Dembélé, M; Diarra, A S; Bocoum, A I; Mousseni, E; Ag Aboubacrine, S; Traoré, H A; Ag Rhaly, A

2007-06-01

Thyroid pathology is frequent in Mali, which is an endemic zone for goiter. But this pathology rarely occurs in children. The purpose of our study was to characterize this illness among children in Mali. We report on patients aged less than 15-year old who presented with clinical signs and symptoms with hyperthyroidism at the medicine service at Hospital de Point G from January 1999 and December 2005 to determine the characteristics of hyperthyroidism. The frequency was 9.6 per thousand (38/3972), with an average age of 12.5+/-3.34-year. The sex ratio was 3 girls/1 boys. The most common symptoms were tachycardia (n=30, 78.9%), palpitations (n=15, 34.4%). 31 patients (81.5%) presented with exophthalmoses, 93.5% being bilateral. Weight loss was present in 31.5% (n=12). Goiter was present in 37 patients (97.4%). The goiter was diffuse in 27 patients (73%) and nodular in 10 (27.%). The presence of goiter caused signs of compression in the neck in half of the cases: dyspnea and dysphonia were the most common consequences. TSH less than 0.05 microUI/1 was used to confirm the diagnosis. Graves's disease was the most common cause (n=32, 84.2%), followed by toxic adenoma (n=4, 10.5%). Other causes included toxic multinodular goiter and thyroiditis. Etiologies were independent of sex and age: (p=0.95). All patients were started on medical therapy upon diagnosis. 7 patients (18.4%) were lost to follow-up during the 6 months of treatment. Remission was obtained in 26 patients (83.9%), and relapse occurred in 5 patients (16.1%). The frequency of hyperthyroidism in children in Mali is a problem in a goiter endemic zone like Mali. Poor general health in children and signs and symptoms of neck compression are markers of progressive disease.

Radioimmunoassay of iodine metabolism state in euthyroid and nodular goiter under conditions of moderately increased intake of fluorine with drinking water

International Nuclear Information System (INIS)

Sidora, V.D.; Mazurik, M.F.; Shlyakhta, A.I.; Kuznetsov, A.A.

1987-01-01

A reliable decrease of triiodotyronine in blood cerum in the region with moderately increased intake of fluorine with drinking water (1.2-3.1 mg/l) is detected. This results in increase of euthyroid goiter among population by 14-16 times, of nodular - by 6 times. In the studied area there is indirect dependence between function of thyroid gland and degree of its hyperplasia, i.e., the larger is the gland, the weaker is its ability to produce hormones. The practical significance of detected dependence lies in the fact, that in surgical removal of the nodes (malignant cases are excluded) not only morphological but functional criteria as well of the gland increase should be taken account of. Such approach to nodular goiter therapy promotes sufficient reduction of postoperative hypothyrosis. These peculiarities of the ratio between the thyroid gland hyperplasia degree and its function under conditions of studied area must be taken account of when selecting methods of conservative treatment of patients with euthyroid goiter

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

Science.gov (United States)

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

2011-12-01

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.

Fulminant mediastinitis after goiter recurrence surgery: a case report

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Mittag-Bonsch Martina

2010-11-01

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.

Case report: An interesting case of large colloid goiter with dyspnea

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Jaya Prakasha Mayya

2017-12-01

Full Text Available Benign nodular goitre is one of the most common endocrine disorder, especially in countries like Nepal where iodine deficiency is endemic. Case History: A 59 years old female presented with large thyroid swelling. Investigations showed it to be colloid goiter compressing the airway. Left hemithyroidectomy was done. Post operative period was uneventful.Discussion: Management of thyroid nodules depends upon assessment of thyroid function, fine needle aspiration cytology and imaging. Surgery is the common method of treatment.   

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

NARCIS (Netherlands)

Zimmermann, M.B.

2008-01-01

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

Thyroidectomy improves tracheal anatomy and airflow in patients with nodular goiter. A prospective cohort study

DEFF Research Database (Denmark)

Sørensen, Jesper Roed; Lauridsen, Jeppe Killerich; Døssing, Helle

. Effect sizes (ES) were calculated as mean change divided by standard deviation at baseline. ES of 0.2-0.5 were defined as small, 0.5-0.8 as moderate, and values >0.8 as large.Results: Sixty-five patients completed all examinations. Median goiter volume was 58 mL (range, 14-642 mL) before surgery...... resonance images (MRI) of the neck and respiratory flow-volume curves, including both in- and expiration, were performed prior to and six months following surgery. The evaluated tracheal dimensions included the smallest cross-sectional area of the trachea (SCAT), tracheal narrowing, and tracheal deviation...... with surgical removal of median 43 g (range, 8-607 mL). Six months post-surgery, tracheal narrowing and deviation were diminished by median 26% (ES=0.67), and 33% (ES=0.73), respectively, while SCAT increased by 17% (ES=0.61). Correspondingly, each 10% decrease in goiter volume resulted in an increase of 6...

Serum TSH and the response to radioiodine treatment of toxic multinodular goitre

DEFF Research Database (Denmark)

Pedersen-Bjergaard, U; Kirkegaard, B C

1997-01-01

A retrospective analysis of data from 73 consecutive patients with toxic multinodular goitre treated with iodine-131 (131I) during a 2-year period was performed to investigate if serum TSH at the time of 131I treatment influences the outcome. The dose of 131I was calculated according to a model...... compensating for thyroid size estimated by palpation and 24-h 131I uptake. Serum TSH was determined by a third-generation assay with a functional sensitivity of 0.03 mU/l. A significantly more pronounced response to 131I treatment was observed in patients with TSH > 0.0 mU/l than in patients with TSH = 0.0 m......U/l (P = 0.0006. This difference resulted in a threefold lower frequency of non-responders and a fivefold higher rate of early hypothyroidism in the group with detectable serum TSH. While the high frequency of hypothyroidism among patients with measurable serum TSH can be explained by destruction...

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

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José Alberto Puerto Lorenzo

2013-06-01

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.

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

DEFF Research Database (Denmark)

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

2011-01-01

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......), or by magnetic resonance imaging (n=43). Results: The 24h and the 96h RAIU were 34.2±9.8(SD)% (range:11.4-66.0%) and 34.0±10.0% (range:10.5-60.9%), respectively. Sixty-one patients had a 24h RAIU...

Neonatal goiter with congenital thyroid dysfunction in two infants diagnosed by MRI

Energy Technology Data Exchange (ETDEWEB)

Kondoh, Mutsuko [Department of Radiology, St. Marianna University, Seibu Hospital, Kanagawa (Japan); Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa-ken 216-8511 (Japan); Miyazaki, Osamu; Imanishi, Yoshimasa; Hayakawa, Minako [Department of Radiology, St. Marianna University, Seibu Hospital, Kanagawa (Japan); Aikyou, Miho; Doi, Hiromi [Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa (Japan)

2004-07-01

It is essential to diagnose thyroid dysfunction at an early stage because congenital hypothyroidism (CH) represents one of the most common preventable causes of delayed physical and psychological development, including mental retardation. US evaluates the shape of the thyroid gland. CT and scintigraphic examinations demonstrate iodine metabolism of the thyroid, but there is associated radiation exposure. We encountered two cases of congenital goiter, in which MRI was very helpful in confirming thyroid dysfunction and was very useful in making an accurate diagnosis. (orig.)

Neonatal goiter with congenital thyroid dysfunction in two infants diagnosed by MRI

International Nuclear Information System (INIS)

Kondoh, Mutsuko; Miyazaki, Osamu; Imanishi, Yoshimasa; Hayakawa, Minako; Aikyou, Miho; Doi, Hiromi

2004-01-01

It is essential to diagnose thyroid dysfunction at an early stage because congenital hypothyroidism (CH) represents one of the most common preventable causes of delayed physical and psychological development, including mental retardation. US evaluates the shape of the thyroid gland. CT and scintigraphic examinations demonstrate iodine metabolism of the thyroid, but there is associated radiation exposure. We encountered two cases of congenital goiter, in which MRI was very helpful in confirming thyroid dysfunction and was very useful in making an accurate diagnosis. (orig.)

THYROID HORMONE RECEPTOR BETA GENE MUTATION (P453A) IN A TURKISH FAMILY PRODUCING RESISTANCE TO THYROID HORMONE

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Bayraktaroglu, Taner; Noel, Janet; Mukaddes, Nahit Motavalli; Refetoff, Samuel

2018-01-01

Two members of a Turkish family, a mother and son, had thyroid function tests suggestive of resistance to thyroid hormone (RTH). The clinical presentation was, however, different. The mother (proposita) had palpitation, weakness, tiredness, nervousness, dry mouth and was misdiagnosed as having multinodular toxic goiter which was treated with antithyroid drugs and partial thyroidectomy. Her younger son had attention deficit hyperactivity disorder and primary encopresis, but normal intellectual quotient. Both had elevated serum iodothyronine levels with nonsuppressed thyrotropin. A mutation in one allele of the thyroid hormone receptor beta gene (P453A) was identified, providing a genetic confirmation for the diagnosis of RTH. PMID:18561095

A case of neuroblastoma in DICER1 syndrome: Chance finding or noncanonical causation?

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Saskin, Avi; de Kock, Leanne; Sabbaghian, Nelly; Apellaniz-Ruiz, Maria; Bozkurt, Ceyhun; Bouron-Dal Soglio, Dorothée; Foulkes, William D

2018-01-01

DICER1 syndrome is an inherited disorder associated with at least a dozen rare, mainly pediatric-onset tumors. Its characterization remains incomplete. Some studies suggested that neuroblastoma (NB) may be involved in this syndrome. Here, we describe the case of a 14-year-old female presenting with a multinodular goiter (MNG) and a collision tumor composed of NB and cystic nephroma (CN). She is a carrier of a deleterious germline mutation in exon 23 of DICER1 and harbored different somatic mutations in the CN and MNG. However, no second hit was found in the NB, questioning its status as a DICER1-related tumor. © 2017 Wiley Periodicals, Inc.

Results of radioiodine therapy of manifest hyperthyroidism and autonomous euthyroid goiter

International Nuclear Information System (INIS)

Berding, G.; Schicha, H.

1990-01-01

In 200 patients follow-up examinations were performed up to one year after radioiodine therapy (RITh) with individual dose calculation. The mean applied dose was significantly lower in patients with immunogenic hyperhyroidism (Graves' disease) as compared to patients with non-immunogenic hyperthyroidism (disseminated/multifocal autonomy, HYDA). In Graves' disease the rate of recurrent hyperthyroidism was significantly higher and that of posttreatment hypothyroidism lower. Considering the high recurrence rate in Graves' disease a higher dose, e.g. 150 Gy, seems to be appropriate. In patients with HYDA who received antithyroid drugs during RITh, recurrence of hyperthyroidism appeared slightly more, and posttreatment hypothyroidism slightly less, frequent. The efficiency of RITh was not significantly reduced by additional treatment with antithyroid drugs. Posttreatment hypothyroidism in patients with euthyroid goiter and disseminated/multifocal autonomy (EUDA) occurred significnatly more frequent if the basal TSH level was ≥ 0.5 μIE/ml before therapy. The goiter size was reduced independent of the basal TSH level. In HYDA patients after thyroid surgery recurrence appeared less, and in those with EUDA posttreatment hypothyroidism significantly more, frequent. A lower dose seems to be suitable in patients who underwent thyroid surgery before. In patients with focal autonomy after RITh no recurrence of hyperthyroidism was observed. In 9% a suppressed basal TSH level indicating persistent autonomy was seen. Posttreatment hypothyroidism in focal autonomy appeared only in patients without manifest hyperthyroidism before RITh and was significantly more frequent in this group. In patients with focal autonomy who developed hypothyroidism the dose calculation was based on a significantly higher volume of the adenoma. (orig./MG) [de

Ten-year follow-up of thyroid epidemiology in Slovenia after increase in salt iodization

Science.gov (United States)

Zaletel, Katja; Gaberšček, Simona; Pirnat, Edvard; Krhin, Blaž; Hojker, Sergej

2011-01-01

Aim To assess iodine supply and follow thyroid epidemiology for ten years after an iodine increase from 10 to 25 mg of potassium iodide per kilogram of salt in 1999. Methods In 2002 and 2003, we determined the thyroid size by palpation and ultrasound and measured urinary iodine concentration (UIC) in 676 schoolchildren from 34 schools throughout Slovenia. From 1999 to 2009, we followed the incidence of diffuse and nodular goiter, thyroid autonomy, Graves’ disease, and Hashimoto’s thyroiditis among adults in the stable catchment area of the University Medical Centre Ljubljana with 1 000 000 inhabitants. Results In children, only 1% had a goiter grade 2 (visible and palpable thyroid gland), median thyroid volume was 5.8 mL, and median UIC was 148 µg/L. In adults, the incidence of diffuse goiter and thyroid autonomy decreased significantly (2009 vs 1999, rate ratio [RR], 0.16; 95% confidence interval [CI], 0.12-0.21 and RR, 0.73; 95% CI, 0.62-0.86, respectively), with a lower incidence in younger participants in 2009 (P < 0.001). The incidence of multinodular goiter and solitary nodule increased (2009 vs 1999, RR, 1.55; 95% CI, 1.35-1.79 and RR, 1.72; 95% CI, 1.49-1.99, respectively). No long-term changes were observed for Graves’ disease (2009 vs 1999, RR, 0.95; 95% CI, 0.81-1.13), while the incidence of Hashimoto’s thyroiditis increased strongly (2009 vs 1999, RR, 1.86; 95% CI, 1.64-2.12). Conclusions The change from mildly deficient to sufficient iodine supply was associated with a marked change in the incidence of thyroid epidemiology – a significant decline in the incidence of diffuse goiter and thyroid autonomy and a marked increase in the incidence of Hashimoto’s thyroiditis. PMID:21990079

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

OpenAIRE

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

2007-01-01

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 th...

Study of the incidence and etiology of congenital hypothyroidism in an endemic goiter area after treatment with iodine enriched salt

International Nuclear Information System (INIS)

Liu Shizhen

1992-01-01

A screening program for congenital hypothyroidism (CH) was performed in a severe endemic goiter area, Chengde district including 7 counties, after treatment with Iodine enriched salt, and Beijing city as a control area. From May 1985 to Sep. 1991, 26570 newborns in Beijing city and 16227 in Chengde were screened. The incidence of primary hypothyroidism in Beijing city was 1/8800 and that in Chengde 1/8100. Of all the 5 Ch detected, 3 from Beijing city and 2 from Chengde, were thyroid dysgenesis. Not a single case of endemic goiter cretinism (including both myxedematous and neurological cretinism) was found in our study. We conclude that Iodine deficiency is the only cause of endemic cretinism and this problem can be solved by Iodine enriched salt treatment

Pyogenic granuloma associated with mandibular odontoma.

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Karla Ocampo

2014-08-01

Full Text Available Background: pyogenic granuloma is a kind of inflammatory hyperplasia of multifactorial origin, which is usually related to trauma or constant irritation, drug use, hormonal factors, among others. Meanwhile the odontoma is a benign tumor odontogenic composed of epithelial and mesenchymal cells, their development is usually associated with trauma, infections, inherited disorders or hyperactivity odontoblast. Objectives: The objective is to present the clinical case of a patient that presented a case of pyogenic granuloma related to the presence of a mandibular odontoma, and therapeutic management and postoperative results. Case report: The case shows a female patient of 32 years old with a history of multinodular goiter and hypothyroidism, developing a mandibular odontoma of the left side associated with pyogenic granuloma in the same area, which was treated with surgical excision and reconstructed affected tissues with lyophilized bone and collagen membrane. Favorable outcome after surgery without evidence of recurrence, with proper osseointegration of alloplastic materials and soft tissues. Conclusions: The irritant effect of the presence of a tumor (odontoma in developing confirmed pyogenic granuloma.

The Count of Vitamins and Trace Elements in Adolescents with Diffuse Nontoxic Goiter in View of Food Consumption

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D.A. Kashkalda

2015-11-01

Full Text Available In adolescents with diffuse nontoxic goiter (DNG, who live in the condition of mild iodine deficiency, in a questionnaire study there was analyzed the diet and its influence on the level of vitamins and minerals. It was found that the deficiency of food fish and meat is accompanied by a decrease in the level of B1, B2 and E vitamins. Use for cooking iodine salt was associated with higher levels of selenium and vitamin A in adolescents with DNG. Goiter degree II–III was rarely diagnosed among them. The inclusion of products of animal origin, seafood and iodine salt in the diet of children and adolescents, who live in the condition of a mild iodine deficiency, is necessary for the prevention and treatment of DNG. In case of combined deficiency of iodine, selenium, and vitamins, especially in the absence of adequate nutrition, the complex therapeutic measures must include preparations of potassium iodide, selenium, vitamins A and group B.

Severe Anemia with Hemoperitoneum as a First Presentation for Multinodular Hepatocellular Carcinoma: A Rare Event in Western Countries

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Thein Swe

2016-01-01

Full Text Available Hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma is a life-threatening and rare condition in western countries with an incidence of less than 3% because of early detection of cirrhosis and neoplasm. Here, we describe a case of a 66-year-old male patient with altered mental status with hemorrhagic shock. Computed tomography scan of abdomen revealed hemoperitoneum and mass in liver. Patient underwent resection of liver tumor and biopsy revealed multinodular hepatocellular carcinoma. A high degree of suspicion is required where severe anemia and hemoperitoneum can be a first presentation for hepatocellular carcinoma especially in patients with chronic hepatitis C infection. Early diagnosis is crucial since mortality rates remain high for untreated cases.

99mTc-MIBI radio-guided minimally invasive parathyroidectomy: experience with patients with normal thyroids and nodular goiters.

Science.gov (United States)

Casara, Dario; Rubello, Domenico; Cauzzo, Cristina; Pelizzo, Maria Rosa

2002-01-01

The surgical approach to primary hyperparathyroidism (HPT) is changing. In patients with a high probability to be affected by a solitary parathyroid adenoma (PA), a unilateral neck exploration (UNE) or a minimally invasive radio-guided surgery (MIRS) using the intraoperative gamma probe (IGP) technique have recently been proposed. We investigated the role of IGP in a group of 84 patients with primary HPT who were homogeneously evaluated before surgery by a single-day imaging protocol including 99mTcO4/MIBI subtraction scan and neck ultrasound (US) and then operated on by the same surgical team. Quick parathyroid hormone (QPTH) was intraoperatively measured in all cases to confirm successful parathyroidectomy. In 70 patients with scan/US evidence of a single enlarged parathyroid gland (EPG) and with a normal thyroid gland, MIRS was planned. In the other 14 patients, the IGP technique was utilized during a standard bilateral neck exploration (BNE) because of the presence of concomitant nodular goiter (11 cases) or multiglandular disease (MGD) (3 cases). The IGP technique consisted of the following: (1) in the operating room, a low 99mTc-MIBI dose (37 MBq) was injected intravenously during anesthesia induction; (2) subsequently, the patient's neck was scanned with the probe by the surgeon to localize the cutaneous projection of the EPG; (3) in patients who underwent MIRS, the EPG was detected intraoperatively with the probe and removed through a small, 2 to 2.5 cm skin incision; (4) radioactivity was measured on the EPG both in vivo and ex vivo, the thyroid, the background and the parathyroid bed after EPG removal. In patients with concomitant nodular goiter, the radioactivity was also measured on the thyroid nodules. Surgical and pathologic findings were consistent with a single PA in 78 patients, parathyroid carcinoma in 2, and MGD in 4. MIRS was successfully performed in 67 of the 70 patients (97.7%) in whom this approach was planned. It must be pointed out that

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

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Sheela R. Brahmbhatt

2001-01-01

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.

Outcomes of surgical treatment of thyroid disease in children

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Olga S. Rogova

2017-01-01

Full Text Available Background. In recent years there has been a tendency of increase in the proportion of nodular goiter and Graves’ disease in thyroid pathology in children, which necessitates a choice of rational tactics for treatment of these diseases. At present there is no optimal method of treatment for thyroid gland pathology, but one of the methods is surgery. Thyroid surgery due to the determination of the indications and choice of the optimal volume of the surgical intervention continues to be under debate as postoperative complications of surgical treatment of thyroid diseases in children are possible.Aim: to study the outcomes of surgical treatment for thyroid pathology in children, depending on the volume of operation.Materials and methods. This article presents the results of a survey of 77 children operated on in the period of 2002–2016 for Graves’ disease, single-node goiter, and multinodular goiter. The examination included the determination of the levels of ionized calcium and TSH, FT4, FT3 in the blood serum, the evaluation of the functional state of the pituitary-thyroid system, thyroid ultrasound examination, and examination by an otolaryngologist.Results. The incidence of adverse outcomes of surgical treatment in children with nodular goiter was 27%. Adverse outcomes were observed equally often after organ-preserving operations and after thyroidectomy, but they were of different structure. The frequency of postoperative complications after thyroidectomy performed on the nodular goiter was 27%. Complications presented as postsurgical hypoparathyroidism and vocal cord paresis. In children with nodular goiter, after thyroidectomy hypoparathyroidism occurred more frequently than paresis of the vocal folds. Symptomatic hypocalcemia was observed more frequently than the asymptomatic variant, and in most cases hypoparathyrodism was transient. Among children with a single-node goiter who underwent organ-preserving surgery on the thyroid gland

New insights into thyroglobulin gene: molecular analysis of seven novel mutations associated with goiter and hypothyroidism.

Science.gov (United States)

Citterio, Cintia E; Machiavelli, Gloria A; Miras, Mirta B; Gruñeiro-Papendieck, Laura; Lachlan, Katherine; Sobrero, Gabriela; Chiesa, Ana; Walker, Joanna; Muñoz, Liliana; Testa, Graciela; Belforte, Fiorella S; González-Sarmiento, Rogelio; Rivolta, Carina M; Targovnik, Héctor M

2013-01-30

The thyroglobulin (TG) gene is organized in 48 exons, spanning over 270 kb on human chromosome 8q24. Up to now, 62 inactivating mutations in the TG gene have been identified in patients with congenital goiter and endemic or non-endemic simple goiter. The purpose of the present study was to identify and characterize new mutations in the TG gene. We report 13 patients from seven unrelated families with goiter, hypothyroidism and low levels of serum TG. All patients underwent clinical, biochemical and imaging evaluation. Single-strand conformation polymorphism (SSCP) analysis, endonuclease restriction analysis, sequencing of DNA, genotyping, population screening, and bioinformatics studies were performed. Molecular analyses revealed seven novel inactivating TG mutations: c.378C>A [p.Y107X], c.2359C>T [p.R768X], c.2736delG [p.R893fsX946], c.3842G>A [p.C1262Y], c.5466delA [p.K1803fsX1833], c.6000C>G [p.C1981W] and c.6605C>G [p.P2183R] and three previously reported mutations: c.886C>T [p.R277X], c.6701C>A [p.A2215D] and c.7006C>T [p.R2317X]. Six patients from two families were homozygous for p.R277X mutation, four were compound heterozygous mutations (p.Y107X/p.C1262Y, p.R893fsX946/p.A2215D, p.K1803fsX1832/p.R2317X), one carried three identified mutations (p.R277X/p.C1981W-p.P2183R) together with a hypothetical micro deletion and the remaining two siblings from another family with typical phenotype had a single p.R768X mutated allele. In conclusion, our results confirm the genetic heterogeneity of TG defects and the pathophysiological importance of altered TG folding as a consequency of truncated TG proteins and missense mutations located in ACHE-like domain or that replace cysteine. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Effect of Goiter Dispersion Formula on Serum Cytokines in Hyperthyroidism Patients with Neurologic Manifestations of Graves' Disease: A Randomized Trial on 80 Cases.

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Tian, Wen-Hong; Wang, Ying; Yang, Rui; Hu, Hai-Bing

2018-05-01

This study is aimed to explore the combined use of goiter dispersion formula and antithyroid drugs in the treatment of patients with neurologic manifestations of Graves' disease by examining its modulating effects on patients' cytokines. A total of 80 patients with Graves' disease were randomly divided into treatment and control groups. Patients of the treatment group received goiter dispersion formula and antithyroid drugs (methimazole or propylthiouracil), whereas those of the control group received antithyroid drug alone. FT3, FT4, and TSH contents were detected by chemiluminescence immunoassay at pre- and post-treatment; interleukin (IL)-2, IL-8, and IL-17 serum levels before and after the treatment were detected by radioimmunoassay; thyroid B-mode ultrasound and liver and renal function tests were performed in all patients of both groups. An additional cohort of 40 healthy subjects was recruited for baseline measurement. All the enrolled patients completed the trial. The effective treatment rate was higher in the treatment group than in the control group, of which the difference was statistically significant (treatment group, 95%; control group, 75%, p Graves' disease comparing with those in healthy subjects (p Graves' disease by modulating IL-2, IL-8, and IL-17. The data supported the rationale for the use of goiter dispersion formula in Graves' disease treatment.

Hypocalcaemia after total thyroidectomy for Graves' disease and for benign atoxic multinodular goitre.

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Hallgrimsson, Páll; Nordenström, E; Bergenfelz, A; Almquist, M

2012-10-01

Postoperative hypocalcaemia has been reported to be more common after total thyroidectomy (TT) for Graves' disease than after TT for benign atoxic multinodular goitre (MNG). The reasons for this potential association are not clear. In the present study, the frequency and risk factors of hypocalcaemia after TT for Graves' vs MNG were compared. Between January 1999 and October 2009, patients with first-time surgery for Graves' disease or MNG treated with a TT were included in the study. Postoperative hypocalcaemia was defined by symptoms, calcium levels and treatment with calcium and/or vitamin D analogues during postoperative hospital stay, at discharge, and at the 6-week and 6-month follow-ups. Outcomes were compared with Mann-Whitney, chi(2) and Fishers' exact test where appropriate and by multivariable logistic regression analysis. There were 128 patients with Graves' disease and 81 patients with MNG. Patients with Graves' disease were younger than patients with MNG (median age, 35 vs 51 years, p Graves' disease (p Graves' disease, there was no difference in the overall frequency of biochemical hypocalcaemia, low levels of PTH and/or treatment with calcium and vitamin D.

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

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Ali Sadrizadeh

2015-11-01

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

Radioimmune methods application to determining the functional state of STH-IGF-1 in adolescent boys with diffuse nontoxic goiter

International Nuclear Information System (INIS)

Turchina, S.Yi.

2010-01-01

The purpose of the study was to investigate the character of production of somatotropic hormone (STH) and insulin-like growth factor 1 in adolescent boys with diffuse nontoxic goiter. Blood serum STH, IGF-1, thyrotropin, thyroxin, triiodothyronine, testosterone, and estradiole level were investigated in 131 boys aged 14-17 with DNG using radioimmune method.

A Very Rare Cause of Subglottic Stenosis: Non-Malignant Intratracheal Thyroid Tissue

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Ümit Aydogmus

2014-08-01

Full Text Available We present a case of subglottic stenosis associated with benign thyroid tissue involvement due to relapse of multinodular goiter despite surgery 14 years ago.The patient had undergone bilateral subtotal thyroidectomy 14 years ago and the pathology report had been multinodular thyroid tissue at the time. The patient recently presented to an emergency service due to sudden development of respiratory distress and was then directed to our center. Cervical tomography showed bilateral thyroid tissue that narrowed the tracheal diameter by 80% by invading the trachea from the left wall at the level of the thyroid gland. The patient required urgent tracheostomy due to serious respiratory trouble. The trachea was incised vertically about 2.5 cm below the cricoid cartilage. A 2 cm endotracheal lesion with margins that could not be distinguished from the left vocal cord was observed and biopsies were taken from both this lesion and the tissue surrounding the trachea. A Montgomery T-tube extending from the subglottic area to the distal section was placed. Pathology evaluation revealed histopathological findings that matched normal thyroid tissue. Although infrequent, tracheal invasion associated with a thyroid cancer is known to occur. We present a case with postoperative intratracheal relapse due to a benign cause and the emergency treatment.

Graves Disease Induced by Radioiodine Therapy for Toxic Nodular Goiter: A Case Report

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Yakup Yürekli

2015-10-01

Full Text Available Graves’ disease (GD may be observed as an infrequent adverse effect after radioiodine therapy (RAIT for toxic thyroid adenoma (TA and toxic multi nodular goiter (MNG. We present a case of a 55-year-old male with a toxic nodule who was treated with RAI. After therapy, the patient’s serum free triiodothyronine (fT3 and free thyroxine (fT4 levels gradually increased. Antithyroid peroxidase (TPOAb, antithyroglobulin (TgAb and TSH-receptor antibodies (TRAb were also positive. Thyroid scintigraphy revealed diffuse intense uptake after four months of RAIT. Radiation-induced GD should be considered in patients with aggravated hyperthyroidism 3-4 months after therapy.

Retrosternal goiter: The need for thoracic approach based on CT findings: Surgeon’s view

International Nuclear Information System (INIS)

Sakkary, M.A.; Abdelrahman, A.M.; Mostafa, A.M.; Abbas, A.A.; Zedan, M.H.

2012-01-01

Background and purpose: The incidence of retrosternal goiter (Rg) varies from 2% to 26% of all thyroidectomies, depending on the defining criteria . There are no clear guidelines to identify patients that require an intrathoracic approach. So, we tried to correlate, between the size and/ or anatomical site of the RSG based on preoperative CT findings and the surgical approaches used, aiming at defining those patients with RSG who are in need for thoracic approach. Patients and methods: Out of 1481 patients underwent thyroidectomy at the National Cancer Institute (NCI), Cairo University, between January 2000 and December 2009, only 73 (4.93%) of them had retrosternal extension. Demographic, clinical, operative, anatomical, and pathological data of patients with RSG were recorded and analyzed. Results: The intraoperative extension of the goiter correlated with the extension seen in the CT in all except two patients. Laterality and longitudinal extension found in preoperative CT, correlated well with the surgical findings. The approach used was cervical in 66 cases (90.4%); combined approach in six patients (8.2%). Pure thoracic (full sternotomy) was used alone in one case (1.4%). Extension of the RSG down to or below the arch was associated with an increased risk of using a thoracic approach p< 0.0001. Conclusion: Preoperative CT, can be used effectively to guide the indications for using a thoracic approach. Reaching the aortic arch or beyond and loss of fat planes in CT, recurrent and malignant disease, are significant risk factors for using a thoracic approach.

Musculoskeletal System Symptoms in Goiter

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Sevim Akin

2013-04-01

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

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

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

2013-05-01

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)

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

Science.gov (United States)

Rosario, Pedro Weslley

2013-03-01

To evaluate 131I 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. Thirty-six patients with TSH ≤ 0.1 mIU/L and non-voluminous goiter (< 60 cm³) were studied. Bone mineral density (BMD) was assessed in 17 women with osteopenia. Mean 24-h 131I 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. 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.

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

International Nuclear Information System (INIS)

Rosario, Pedro Weslley

2013-01-01

Objective: To evaluate 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 ( 3 were studied. Bone mineral density (BMD) was assessed in 17 women with osteopenia. Results: Mean 24-h 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)

Current status of fine needle aspiration for thyroid nodules.

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Ogilvie, Jennifer B; Piatigorsky, Eli J; Clark, Orlo H

2006-01-01

When not to perform fine needle aspiration of a thyroid nodule In summary, FNA of thyroid nodules has become one of the most useful, safe, and accurate tools in the diagnosis of thyroid pathology. Thyroid nodules that should be considered for FNA include any firm, palpable, solitary nodule or nodule associated with worrisome clinical features (rapid growth, attachment to adjacent tissues, new hoarseness, or palpable lymphadenopathy). FNA should also be performed on nodules with suspicious ultrasonographic features (microcalcifications, rounded shape, predominantly solid composition); dominant or atypical nodules in multinodular goiter; complex or recurrent cystic nodules; or any nodule associated with palpable or ultrasonographically abnormal cervical lymph nodes. Finally, FNA should be performed on any abnormal-appearing or palpable cervical lymph nodes. The management of thyroid nodules based on FNA findings is summarized in Table 2. It can be argued that in certain circumstances the results of thyroid FNA do not change the surgical management of a thyroid nodule, and thus preoperative FNA may be unnecessary. These cases include solitary nodules in patients who have a strong family history of thyroid cancer, multiple endocrine neoplasia type II, or radiation to the head and neck. These patients when they have thyroid nodules have at least a 40% risk for thyroid cancer and frequent multifocal or bilateral disease and should undergo total thyroidectomy with or without central neck lymph node dissection. Patients who have multinodular goiter and compressive symptoms, patients who have Graves disease and a thyroid nodule, or patients who have large (greater than 4 cm) or symptomatic unilateral thyroid nodules could also be considered for total thyroidectomy or lobectomy as indicated without preoperative FNA. Finally, patients who have a solitary hyperfunctioning nodule on radioiodine scan and a suppressed TSH have an extremely low incidence of malignancy and may be

Increasing incidence of hypothyroidism within one year after radioiodine therapy for toxic diffuse goiter

International Nuclear Information System (INIS)

Von Hofe, S.E.; Dorfman, S.G.; Carrette, R.F.; Young, R.L.

1978-01-01

Patients treated with 10 mCi of I-131 for toxic diffuse goiter in the period January 1974--June 1976 were evaluated for development of hypothyroidism. Fifty percent were hypothyroid within 3 months and 69 percent within 1 year of treatment. Our data suggest that there is a higher incidence of hypothyroidism after standard doses of I-131 in the 1970s as contrasted with treatment groups in the 1950s and 1960s. The pathophysiology of this increased incidence is not known with certainty; however, infrequent use of thionamide medication, together with recent increases in dietary iodine, may render the gland more radiosensitive

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

DEFF Research Database (Denmark)

Fast, Søren; Hegedüs, Laszlo; Grupe, Peter

2010-01-01

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 mi....... This approach is attractive in terms of minimizing posttherapeutic restrictions and in reducing the potential risk of radiation-induced malignancy....

Treatment of diffuse toxic goiter with 131I doses of 80 μCi/g of thyroid tissue

International Nuclear Information System (INIS)

Ochoa Torres, Francisco; Knight Bermudez, Hugh Gregorio; Alavez Martin, Ernesto

2004-01-01

131 I 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 μCi/g of thyroid tissue, estimated by palpation and without having into account the functional activity of thyroid and whether 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 postoperative follow-up was performed every 2 months for 3 years by the same specialist and with identical procedures. The efficiency of the treatment with the first dose was 85.2 %. The frequency of hypothyroidism at 3 years of evolution was 29.5. The age of the patient, the sex, the goiter size and the treatment with PTU did not influence on the response to it. The advantages showed by the method were: high efficiency, the dose of 131 I may be easily calculated, simple application, decrease of the cost, since it is not necessary to assess the functional state of the gland, and reduction of visits

Recurrent pregnancy-related upper airway obstruction caused by intratracheal ectopic thyroid tissue

DEFF Research Database (Denmark)

Døssing, H; Jørgensen, K E; Oster-Jørgensen, E

1999-01-01

An unusual case of recurrent pregnancy-related thyroid growth stimulation is reported. A 27-year-old euthyroid woman had pulmonary symptoms, thought to be asthma during her first pregnancy, that improved postpartum. Bronchodilatators had no effect and symptoms recurred from gestational week 22...... during her second pregnancy. Her 58-mL multinodular goiter (by ultrasound) was not thought to be responsible for her upper airway symptoms. Therefore, fiber laryngoscopy and computed tomographic (CT) scan were performed and revealed a 20 x 15 x 10 mm intratracheal tumor. After tracheostomy...... developed normally. We believe that this case illustrates the recurrent effect of pregnancy-related thyroid tissue stimulation by a combination of increasing human chorionic gonadotropin (hCG) stimulation and iodine deficiency in a borderline iodine-deficient region. This is the first report on symptomatic...

[What would you do in front of a patient with a Horner syndrome?

Science.gov (United States)

Camós-Carreras, A; Fontana, S; Ortiz-Pérez, S

2018-03-01

Horner's syndrome (HS) occurs when there is disruption to the oculosympathetic pathway. Its features include eyelid ptosis, miosis and anhidrosis. The aetiology of this syndrome is varied and includes tumours, trauma, vascular disease and iatrogenic. Different pharmacologic tests are used for diagnosis, such as cocaine, hydroxyamphetamine and apraclonidine; while neuroimaging helps elucidating the aetiology. We present a case of a 63-year-old female referred to our service with a 4-month history of right eyelid ptosis. During examination right miosis was noted. The patient reported a history of multinodular goiter. Pharmacologic tests and neuroimaging confirmed the diagnosis of HS secondary to thyroid disease. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Role of AgNORs in thyroid lesions on fine needle aspiration cytology smears

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Asotra Sarita

2008-01-01

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.

No hypothyroidism after I-131 therapy in pts with toxic nodular goiter, treated under combined thyreostatic, thyreomimetic medication

International Nuclear Information System (INIS)

Giubbini, R.; Panarotto, M.B.; Paghera, B.; Pagliaini, R.; Pajoro, U.; Pizzocaro, C.; Rossini, P.L.; Terzi, A.; Maira, G.

2002-01-01

Background. Treatment of toxic nodular goiter with 131-I is generally satisfactory and will cause a reversion of hyperthyroidism. To avoid the risk of thyrotoxic storm I-131 therapy is usually performed after pre-treatment with antithyroid drugs, which causes a TSH increase and functional recruitment of previously inhibited normal thyroid tissue. In this functional state both autonomous nodule(s) and normal tissue are irradiated after I-131 administration. This may be the reason of late hypothyroidism occurring in 15-25% of Pts. Aim of the study was the evaluation of a different pre-treatment modality with combined methimazole (10-20 mg) and Triiodo-thyronine (T3 - 60 μg) in order to treat pts in euthyroid state with suppressed TSH. Study protocol. After diagnosis of hyperthyroidism with autonomous functioning tissue the pts were put under thyreostatic medication. Two months later TSH was checked and if >0.5% U.I the T3 treatment was associated. After two more months, the TSH level was checked again and, if suppressed, the pt received I-131 therapy. Study population. 93 pts (74f, 19m - age 75±10) were consecutively enrolled. 24 pts had a toxic nodular goiter and 69 a multi nodular one, respectively; they were evaluated at diagnosis, at pre-treatment, two months after therapy and at late follow-up (3.1 ± 3.5 yrs). Methods: 557±225 MBq of I-131 (according to uptake determinations and gland weight) were administered. Methymazole was discontinued 3 days before treatment whereas T3 was maintained during I-131 therapy. Results: Euthyroidism was achieved after the first treatment in 71% of pts. At late follow-up TSH values over the normal range were observed in only 4 pts (4.3% - however all 4 pts had TSH level below 6 I.U.). Summaries of FT3 and FT4 values are presented. Conclusions: The treatment of toxic nodular goiter under combined thyreostatic-thyreomimetic treatment is a safe, well tolerated and effective procedure allowing a 71% success at the first treatment

Treatment of diffuse toxic goiter with 131I. at doses of 80ΜCi/g of thyroid tissue

International Nuclear Information System (INIS)

Ochoa Torres, Francisco; Knight Bermudez, Hugh Gregorio; Alavez Martin, Ernesto

2004-01-01

131 I. 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 ΜCi/g of thyroid tissue, estimated by palpation and without having into account the functional activity of thyroid and whether 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 postoperative follow-up was performed every 2 months for 3 years by the same specialist and with identical procedures. The efficiency of the treatment with the first dose was 85.2 %. The frequency of hypothyroidism at 3 years of evolution was 29.5. The age of the patient, the sex, the goiter size and the treatment with PTU did not influence on the response to it. The advantages showed by the method were: high efficiency, the dose of 131 I. may be easily calculated, simple application, decrease of the cost, since it is not necessary to assess the functional state of the gland, and reduction of visits

Thyroidectomy improves quality of life in patients with euthyroid nodular goiter – a prospective cohort study

DEFF Research Database (Denmark)

Sørensen, Jesper Roed; Watt, Torquil; Cramon, Per

compared to a historic group from the general population (n=739). ThyPRO data before, three, and six months after surgery were compared with normative scores from the general population using a linear mixed model and non-paired t-tests. The effect size (ES) was estimated as mean change by standard...... scales either experienced no change or small changes (ES:0.00-0.50). Post-surgery, with exception a reduced level of Anxiety, all scales returned to values similar to the general population.Conclusion: Thyroid surgery leads to significant benefit among patients with euthyroid goiter, and restores Qo...

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

DEFF Research Database (Denmark)

Dümcke, Christine Elisabeth; Madsen, Jan Lysgård

2007-01-01

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...... the diagnosis of a nodular goiter with intrathoracic growth of the left lobe. A SPECT/CT scan of the mediastinum clearly showed that the soft tissue tumor was the left lobe of the thyroid gland, and not lymphatic metastases....

Radioiodine therapy in non-toxic multinodular goitre. The possibility of effect-amplification with recombinant human TSH (rhTSH)

Energy Technology Data Exchange (ETDEWEB)

Bonnema, Steen J.; Nielsen, Viveque E.; Hegedues, Laszlo [Odense Univ. Hospital (Denmark). Dept. of Endocrinology and Metabolism

2006-12-15

There is no consensus regarding the optimum treatment of benign non-toxic goitre. L-thyroxine suppressive therapy is widely used, but there is poor evidence of its efficacy, and it may have serious adverse effects on health. Surgery is first choice in large goitres or if malignancy is suspected. {sup 131}I therapy results in a one-year goitre reduction of around 40% in multinodular goitres, usually with a high degree of patient satisfaction and improvement of the inspiratory capacity. The effect is attenuated with increasing goitre size. The risk of hypothyroidism is 22-58% within 5-8 years. A sufficient thyroid {sup 131}I uptake is mandatory for {sup 131}I therapy to be feasible and pre-stimulation with recombinant human TSH (rhTSH) increases this considerably. This leads to an increased absorbed thyroid dose by approx.75%, mainly in those patients with the lowest thyroid {sup 131}I uptake, and a more homogeneous intrathyroidal isotope distribution. Pre-stimulation with even a small dose of rhTSH seems to allow a reduction of the {sup 131}I activity while still achieving a mean goitre reduction of approximately 40% within a year. A significantly lower extrathyroidal radiation is achieved by this approach. With an unchanged {sup 131}I activity, rhTSH pre-stimulation improves the goitre reduction by 30-50%. However, this is at the expense of a higher rate of hypothyroidism, cervical pain and transient thyrotoxicosis. Of particular concern is the observation made in healthy persons, that rhTSH results in a transient average thyroid volume increase of 35%. A similar goitre swelling may cause problems in susceptible patients during rhTSH-augmented {sup 131}I therapy. Thus, this concept still needs a closer evaluation before routine use.

Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists.

Science.gov (United States)

Bahn, Rebecca S; Burch, Henry B; Cooper, David S; Garber, Jeffrey R; Greenlee, M Carol; Klein, Irwin; Laurberg, Peter; McDougall, I Ross; Montori, Victor M; Rivkees, Scott A; Ross, Douglas S; Sosa, Julie Ann; Stan, Marius N

2011-01-01

Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.

Treatment of Graves' hyperthyroidism: evidence-based and emerging modalities

DEFF Research Database (Denmark)

Hegedüs, Laszlo

2009-01-01

Currently there are three well-established treatment options for hyperthyroid Graves' disease (GD): antithyroid drug therapy with thionamides (ATD), radioactive iodine treatment with (131)I, and thyroid surgery. This article reviews the current evidence so the reader can evaluate advantages...... and disadvantages of these treatment modalities. Surgery is rarely used, except for patients who have a large goiter or ophthalmopathy. Fewer than 50% of patients treated with ATD remain in long-term remission. Therefore, radioactive iodine is used increasingly. No data as yet support the routine use of biologic...

Clinical spectrum and various forms of thyrotoxcosis in endocrine clinic of Jinnah Postgraduate Medical Centre

International Nuclear Information System (INIS)

Ahsan, T.; Banu, Z.; Jabeen, R.; Farooq, M. U.

2013-01-01

Objective: To evaluate clinical symptoms, signs and various forms of thyrotoxicosis, and to assess the thyroid function status at the first 6-week follow-up. Methods: The retrospective chart review involved thyrotoxic patients presenting at the Endocrine Clinic of Jinnah Postgraduate Medical Centre, Karachi, between April 2007 and January 2011. All hyperthyroid patients were included with the exception of those with suspected or proven malignancy. The records were maintained on a structured proforma and analysed statistically to work out frequencies and percentages. Results: A total of 507 patients were included. Most common form of thyrotoxicosis was Graves disease, with diffuse toxic goiter affecting 269 (53%) patients; followed by toxic multinodular goiter in 102 (20.1%); solitary toxic nodule in 56 (11%); thyrotoxicosis without goiter in 44 (8.7%); subclinical hyperthyroidism in 22 (4.3.%); thyroiditis in 9 (1.8%); and thyrotoxicosis with solitary cold nodule in 4 (0.9%). The common presenting symptoms and signs were goiter (n=415; 85.7%), with eye signs present in 137 (27.7%) patients and heart failure in 20 (4.8%) patients. Of the 321 patients who attended the first six-week follow-up, 309 (94.4%) had their FT4 levels checked. Out of them, 130(42.1%) had euthyroid levels; 113 (36.6%) had lower but still toxic level; 36 (11.7%) had no change; and 30(9.7%) became hypothyroid. TSH levels at first follow-up remained suppressed in 211 (73%) patients; normal in 47(16.3%); and increased in 31 (10.7%). Conclusions: Graves disease was found to be the most common cause of hyperthyroidism. At first follow-up 10.4% of patients had become hypothyroid. Therefore the starting dose of antithyroid drugs was reduced in the clinic. Thyroid stimulating hormone assay was of little help in adjusting treatment at the 6-week follow-up, as almost all cases of hypothyroidism could have been picked up on FT4 assay alone. (author)

Ultrasound, elastography, and fluorodeoxyglucose positron emission tomography/computed tomography imaging in Riedel's thyroiditis: report of two cases.

Science.gov (United States)

Slman, Rouba; Monpeyssen, Hervé; Desarnaud, Serge; Haroche, Julien; Fediaevsky, Laurence Du Pasquier; Fabrice, Menegaux; Seret-Begue, Dominique; Amoura, Zahir; Aurengo, André; Leenhardt, Laurence

2011-07-01

Riedel's thyroiditis (RT) is a rare disease characterized by a chronic inflammatory lesion of the thyroid gland with invasion by a dense fibrosis. Publications of the imaging features of RT are scarce. To our knowledge, ultrasound elastography (USE) findings have not been previously reported. Therefore, we describe two patients with RT who were imaged with ultrasonography (US), USE, and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). Two women were referred for a large, hard goiter with compressive symptoms (dyspnea and dysphagia); in one patient, the goiter was associated with retroperitoneal fibrosis. In both cases, RT was confirmed by surgical biopsy with pathological examination. Thyroid US imaging was performed with a US scan and a 10-13 MHz linear transducer. The hardness of the tissues was analyzed using transient USE (ShearWave, Aixplorer-SuperSonic Imagine). PET/CT scanning was performed with a Philips Gemini GXL camera (GE Medical Systems). In the first patient, US examination revealed a compressive multinodular goiter with large solid hypoechoic and poorly vascularized areas adjacent to the nodules. The predominant right nodule was hypoechoic with irregular margins. The second patient had a hypoechoic goiter with large bilateral hypoechoic areas. In both cases, an unusual feature was observed: the presence of tissue surrounding the primitive carotid artery, associated with thrombi of the internal jugular vein. Further, USE showed heterogeneity in the stiffness values of the thyroid parenchyma varying between 21 kPa and 281 kPa. FDG-PET/CT imaging showed uptake foci in the thyroid gland. In both cases, US showed a decrease in the thyroid gland volume and the disappearance of encasement of the neck vasculature in response to corticosteroid treatment. In contrast, the FDG-PET/CT features remained unchanged. US features, such as vascular encasement and improvement under corticosteroid treatment, seem to be specific to this

The effects of oral iodized oil on intelligence, thyroid status, and somatic growth in school-age children from an area of endemic goiter.

Science.gov (United States)

Bautista, A; Barker, P A; Dunn, J T; Sanchez, M; Kaiser, D L

1982-01-01

One hundred goitrous school children received 475 mg iodized oil by mouth, while 100 controls received mineral oil, on a double-blind basis. On follow-up 22 months later the urinary iodine had increased and goiter size had decreased in both groups, more strikingly in the iodine-treated children. There were no consistent differences between the two treatment groups in rate of somatic growth or performance on the Stanford-Binet and Bender tests. Because of the complexities introduced by increases in urinary iodine in the controls, we compared goiter reduction with improvement in IQ score in all children, regardless of group, and found a significant relationship (p = 0.014), particularly in girls (p = 0.029). We conclude that oral iodized oil is an attractive alternative to its injection but we recommend an approximate doubling of the dose used here for more effective control. Also, while our data are not conclusive, they support the possibility that correction of iodine deficiency may improve mental performance in school age children, particularly girls.

Hyperthyroidism: Diagnosis and Treatment.

Science.gov (United States)

Kravets, Igor

2016-03-01

Hyperthyroidism is an excessive concentration of thyroid hormones in tissues caused by increased synthesis of thyroid hormones, excessive release of preformed thyroid hormones, or an endogenous or exogenous extrathyroidal source. The most common causes of an excessive production of thyroid hormones are Graves disease, toxic multinodular goiter, and toxic adenoma. The most common cause of an excessive passive release of thyroid hormones is painless (silent) thyroiditis, although its clinical presentation is the same as with other causes. Hyperthyroidism caused by overproduction of thyroid hormones can be treated with antithyroid medications (methimazole and propylthiouracil), radioactive iodine ablation of the thyroid gland, or surgical thyroidectomy. Radioactive iodine ablation is the most widely used treatment in the United States. The choice of treatment depends on the underlying diagnosis, the presence of contraindications to a particular treatment modality, the severity of hyperthyroidism, and the patient's preference.

Thyroid diseases among atomic bombs survivors in Nagasaki, 2

International Nuclear Information System (INIS)

Yokoyama, Naokata; Toyama, Kyoko; Ochi, Yoshimichi; Morimoto, Isao; Izumi, Motomori; Nagataki, Shigenobu.

1986-01-01

This is an interim report of the population-based study on the incidence of thyroid diseases in Nagasaki prefecture. Included in this study were 885 patients receiving detailed examination for suspected thyroid disease, consisting of 575 exposed persons (Group I) and 310 non-exposed persons (Group II). Thyroid diseases occurred in 157 (27 %) of Group I and in 65 (21 %) of Group II. According to the type of thyroid disease, thyroid cancer, thyroid adenoma, non-toxic uninodular and multinodular goiters were more common in Group I than Group II. The incidence of hypothyroidism was higher in Group I than Group II; however, the incidence of Graves' disease or chronic thyroiditis did not differ in the two groups. A trend toward a slightly higher incidence of thyroid cyst was observed in Group I than Group II. (Namekawa, K.)

Medulloblastoma in childhood: long-term results of treatment

International Nuclear Information System (INIS)

Broadbent, V.A.; Barnes, N.D.; Wheeler, T.K.

1981-01-01

Thirty-one children under the age of 15 years with verified medulloblastoma were treated at Addenbrookes Hospital from 1940 to 1976. In addition to surgical treatment, all received high dose irradiation to the whole neuraxis. Nine were still alive in 1979, of whom eight were examined. All these patients showed some residual problems, but five were leading active lives and had only minor physical disability. There was evidence of disturbance in growth, with shortening of the spine in relation to the limbs, in all the children. The height centile was lower than expected from parental height in four and one was severely dwarfed. Growth hormone secretion in response to exercise was, however, normal in five of six patients tested. Three children also showed failure of growth of the jaw sufficiently severe to be a cosmetic problem. Frank mental retardation was present in three children. A raised resting TSH level was found in two children, one of whom had a multinodular goiter. Of the three children with severe problems, two had been treated when under two years of age. Long-term follow-up of children who survive medulloblastoma is clearly necessary and consideration should perhaps be given to revision of current treatment regimes in very young children

Incidental versus non-incidental thyroid carcinoma: Clinical presentation, surgical management and prognosis.

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González-Sánchez-Migallón, Elena; Flores-Pastor, Benito; Pérez-Guarinos, Carmen Victoria; Miguel-Perelló, Joana; Chaves-Benito, Asunción; Illán-Gómez, Fátima; Carrillo-Alcaraz, Andrés; Aguayo-Albasini, José Luis

2016-11-01

Thyroid cancer may be clinically evident as a tumor mass in the neck or as a histopathological incidental finding after thyroid surgery for an apparent benign condition. Our objective was to assess the differences in clinical signs, surgical management, and course between incidental and clinically diagnosed thyroid tumors. A retrospective study was conducted on patients operated on for benign or malignant thyroid disease from January 2000 to March 2014. Among the 1415 patients who underwent any thyroid surgery, 264 neoplasms were found, of which 170 were incidental. A comparison was made of incidental versus non-incidental carcinomas. Among incidental carcinomas, cases whose indication for surgery was Graves' disease were compared to those with multinodular goiter. Incidental carcinomas were in earlier stages and required less aggressive surgery. There were no differences in surgical complications between incidental and clinical tumors, but mortality and relapses were markedly higher in non-incidental cancers (4.4% vs 0% and 13.2% vs 4.8% respectively). Carcinomas developing on Graves' disease showed no differences from all other incidental tumors in terms of complications, mortality, or relapse after surgery. Early stage thyroid cancer has better survival and prognosis after surgical treatment. Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

Radioiodine treatment of non-toxic multinodular goitre: effects of combination with lithium

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Vannucchi, Guia; Mannavola, Deborah; Dazzi, Davide; Beck-Peccoz, Paolo; Fugazzola, Laura [Ospedale Maggiore IRCCS (Pad. Granelli), Institute of Endocrine Sciences, Milan (Italy); Chiti, Arturo; Rodari, Marcello; Tadayyon, Sara [Istituto Clinico Humanitas, Nuclear Medicine Unit, Milan (Italy)

2005-09-01

This study aimed to evaluate the effects of radioiodine ({sup 131}I), alone or in combination with lithium, on thyroid volume and the prevention of radioiodine-induced thyrotoxicosis. This is the first clinical trial including only patients with multinodular goitre, normal TSH values and negative anti-thyroid auto-antibodies at baseline. Eighty consecutive patients were randomised to receive {sup 131}I plus lithium (group I+L) or {sup 131}I alone (group I). Thyroid ultrasonography and biochemical analyses were performed at baseline and at 1, 3, 6, 12 and 24 months after treatment. At 1-4 weeks after treatment, {sup 131}I-induced hyperthyroidism was observed in 58.8% of patients and was prevented by lithium administration. A low incidence of hypothyroidism (19%) was recorded at 24 months, whereas up to 44% of patients developed anti-thyroid antibodies. A significant reduction in thyroid volume was observed after {sup 131}I, with a mean decrease of 47.2% (median 48.2%) at 24 months, without differences between the groups. Moreover, it was shown that the decrease in thyroid volume after {sup 131}I was also due to the significant shrinkage of thyroid nodules. This demonstrates that adjunctive lithium is able to reduce radioiodine-induced hyperthyroidism. Therefore, such treatment appears to be safe in older patients and those with underlying cardiovascular disease. In the present large series, {sup 131}I therapy was demonstrated to be highly effective in reducing thyroid and nodular volume even in patients treated with low {sup 131}I doses (2.5 MBq/ml of thyroid tissue), further supporting the view that radioiodine therapy represents a real alternative to surgery. (orig.)

Radioiodine treatment of non-toxic multinodular goitre: effects of combination with lithium

International Nuclear Information System (INIS)

Vannucchi, Guia; Mannavola, Deborah; Dazzi, Davide; Beck-Peccoz, Paolo; Fugazzola, Laura; Chiti, Arturo; Rodari, Marcello; Tadayyon, Sara

2005-01-01

This study aimed to evaluate the effects of radioiodine ( 131 I), alone or in combination with lithium, on thyroid volume and the prevention of radioiodine-induced thyrotoxicosis. This is the first clinical trial including only patients with multinodular goitre, normal TSH values and negative anti-thyroid auto-antibodies at baseline. Eighty consecutive patients were randomised to receive 131 I plus lithium (group I+L) or 131 I alone (group I). Thyroid ultrasonography and biochemical analyses were performed at baseline and at 1, 3, 6, 12 and 24 months after treatment. At 1-4 weeks after treatment, 131 I-induced hyperthyroidism was observed in 58.8% of patients and was prevented by lithium administration. A low incidence of hypothyroidism (19%) was recorded at 24 months, whereas up to 44% of patients developed anti-thyroid antibodies. A significant reduction in thyroid volume was observed after 131 I, with a mean decrease of 47.2% (median 48.2%) at 24 months, without differences between the groups. Moreover, it was shown that the decrease in thyroid volume after 131 I was also due to the significant shrinkage of thyroid nodules. This demonstrates that adjunctive lithium is able to reduce radioiodine-induced hyperthyroidism. Therefore, such treatment appears to be safe in older patients and those with underlying cardiovascular disease. In the present large series, 131 I therapy was demonstrated to be highly effective in reducing thyroid and nodular volume even in patients treated with low 131 I doses (2.5 MBq/ml of thyroid tissue), further supporting the view that radioiodine therapy represents a real alternative to surgery. (orig.)

Outpatient management of patients with large multinodular goitres treated with fractionated radioiodine

International Nuclear Information System (INIS)

Howarth, D.M.; Thomas, P.A.; Allen, L.W.; Akerman, R.; Lan, L.; Epstein, M.T.

1997-01-01

The efficacy of fractionated out-patient radioiodine therapy in 38 patients with compressive symptoms due to long-standing large multinodular goitres was assessed. The diagnosis was established by clinical assessment in addition to technetium-99m pertechnetate thyroid scan or computed tomography scan of the thyroid and mediastinum. Oral iodine-131 therapy was administered as a 2.22 GBq (60 mCi) cumulative dose over 4 months (555 MBq per month). All patients were monitored with serum thyroid-stimulating hormone and free thyroxine (± free tri-iodothyronine) assays before the treatment and after each dose fraction. Clinical and biochemical follow-up was performed on all patients and ranged from 6 to 45 months after therapy. The patients consisted of 35 female and three male patients with a median age of 59 years (range 37-87 years). Prior to treatment 20 patients were biochemically hyperthyroid and 18 were euthyroid. Overall, 71% of patients reported a subjective improvement in compressive symptoms and 29% reported no change. Clinically assessed reduction in goitre size occurred in 92% of patients while there was no change in 8%. At 3 months of follow-up, 31% of patients had become hypothyroid and at 18 months 66% were hypothyroid. Seven hyperthyroid patients (35%) became euthyroid and 13 hyperthyroid patients (65%) became hypothyroid. Three patients who became hypothyroid experienced neck soreness (transient in one patient, persistent in two patients). There were no differences in outcome between patients who were hyperthyroid and those who were euthyroid prior to treatment. Fractionated out-patient radioiodine therapy showed excellent short- and medium-term safety, was very well tolerated and offered a satisfactory alternative treatment to surgery. (orig.)

The use of the rhTSH (thyrogen-genzyme) as adjuvant to the radioiodine (131I) in multi nodular goiter treatment : comparison among 2 therapeutic options

International Nuclear Information System (INIS)

Albino, Claudio C.; Gaviolli, Aroldo; Mesa, Cleo; Graf, Hans

2005-01-01

Full text: Introduction: In our experience and of the recent literature, the association of the recombinant TSH (rh TSH) in low doses, previously to 131 I has been value in MNG treatment. However we don't have an ideal approach on this disease. Objective: To compare two different options with rh TSH previously to fixed dose of 131 I (30 mCi) in BMN treatment. Patients and Methods: We have 18 patients in group 1 and 14 in group 2. The patients had similar age and volume goiter in both groups. They were submitted to the same diagnosis protocol: TSH, FT 4 , T 3 , Tg on days 0, 1, 2, 3, 5, 10, 30, 90, 180 and TPO ab, Tg ab and TRAB on days 0, 30, 90 and 180. The goiter was measured by helicoidal CT on days 0 and 180.The RAIU on 24 h after rh TSH was measured in both groups. The G 1 used rh TSH in two consecutive doses of 0,1 mg and the G 2 used an unique dose of 0,1 mg. Both groups were submitted to 30 mCi of 131 I 24 h after the last injection of rh TSH. Results: The increment of TSH level was bigger in group 1 than group 2 (33 times in G1 and 13 times in G2). Similar results were found on FT 4 ,T 3 and Tg levels. The hormones returned to base levels after 30 d on G1 and 90 d on G2. The RAIU 24 h peak was bigger on G1 than G2 (12% to 52% on G1 and 10,2% to 35% on G2). 39% patients on G1 and 21% on G2 had clinic thyrotoxicosis and actinic thyroiditis were prevalent in 33 % on G1 and 14% on G2. After six months 65% of patients on G1 were in hypothyroidism and 28% on G2. The reduction on goiter volume was similar in both groups: 40% on G1 and 45% on G2. Conclusion: The option with 1 injection of 0,1 mg rh TSH plus 131 I had similar efficiency on reduction of volume goiter however was safer than 2 injections of 0,1 rh TSH plus 131 I in MNG treatment. (author)

Mutational analysis of Peroxiredoxin IV: exclusion of a positional candidate for multinodular goitre

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Bonifazi Emanuela

2002-07-01

Full Text Available Abstract Background Multinodular goitre (MNG is a common disorder characterised by an enlargement of the thyroid, occurring as a compensatory response to hormonogenesis impairment. The incidence of MNG is dependent on sex (female:male ratio 5:1 and several reports have documented a genetic basis for the disease. Last year we mapped a MNG locus to chromosome Xp22 in a region containing the peroxiredoxin IV (Prx-IV gene. Since Prx-IV is involved in the removal of H2O2 in thyroid cells, we hypothesize that mutations in Prx-IV gene are involved in pathogenesis of MNG. Methods Four individuals (2 affected, 2 unrelated unaffected were sequenced using automated methods. All individuals were originated from the original three-generation Italian family described in previous studies. A Southern blot analysis using a Prx-IV full-length cDNA as a probe was performed in order to exclude genomic rearrangements and/or intronic mutations. In addition a RT-PCR of PRX-IV was performed in order to investigate expression alterations. Results No causative mutations were found. Two adjacent nucleotide substitutions were detected within introns 1 and 4. These changes were also detected in unaffected individuals, suggesting that they were innocuous polymorphisms. No gross genomic rearrangements and/or restriction fragment alterations were observed on Southern analysis. Finally, using RT-PCR from tissue-specific RNA, no differences of PRX-IV expression-levels were detected between affected and unaffected samples. Conclusions Based on sequence and genomic analysis, Prx-IV is very unlikely to be the MNG2 gene.

Bocio retrotraqueal: presentación de un caso Retrotracheal goiter: a case presentation

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Edelberto Fuentes Valdés

2007-06-01

Full Text Available Los pacientes con bocio localizado en el mediastino posterior deben ser sometidos a resección quirúrgica por la posibilidad de compromiso de los órganos vecinos o de malignidad. Se presenta el caso de un paciente previamente operado por un bocio con probable prolongación endotorácica que fue intervenido pero continuó con manifestaciones de compresión traqueal. Tras una segunda operación fallida, ahora por vía transesternal, fue remitido a nuestro servicio por una estenosis traqueal isquémica. En el estudio preoperatorio se demostró que se mantenía una masa tumoral aproximadamente de 10 cm, retrotraqueal, que comprimía y deformaba la tráquea. Además presentaba osteomielitis del esternón. Fue intervenido mediante toracotomía derecha y se logró extirpar alrededor de 95 % de la masa tumoral. El estudio radiofarmacológico posoperatorio no demostró captación del isótopo en el mediastino. Se hacen consideraciones sobre la indicación de la cirugía y las vías de abordaje utilizadas. Al momento de preparar este manuscrito (6 meses después de la operación el paciente se encuentra bien, en espera del tratamiento definitivo de la estenosis traqueal isquémicaPatients with posterior mediastinal goiter should be subjected to surgical resection because of the possibility of affecting neibouring organs or developing malignacy. This paper presented the case of a patient that had been previously operated from a goiter with possible endothoracic prolongation but continued suffering tracheal compression. After a second failed transternal surgery, he was refered to our service with ischemic tracheal stenosis. The preoperative study showed a 10cm retrotracheal tumoral mass that pressed and distorted the trachea. He also had sternal osteomyelitis. Then, he underwent right thoracotomy and roughly 95% of the mass was removed. The post-surgical radiopharmacological study did not reveal isotope uptake in the mediastinum. Surgery indications and

Simultaneous treatment of toxic diffuse goiter with I-131 and antithyroid drugs: a prospective study

International Nuclear Information System (INIS)

Steinbach, J.J.; Donoghue, G.D.; Goldman, J.K.

1979-01-01

We report a prospective study to evaluate the effect of antithyroid drugs containing the sulfhydryl radical on the outcome of I-131 (RAI) therapy. Twenty-four male patients with toxic diffuse goiter were assigned randomly into two treatment groups: Group A received RAI treatment while on antithyroid drugs after attainment of euthyroidism; Group B received no antithyroid drugs before, or when, RAI was given. Patients in each group received a dose of RAI calculated to deliver approximately 5000 rads per treatment. The incidence of hypothyroidism at 12 mo was 8% for Group A and 36% for Group B (p 0.45). The improved therapeutic outcome of patients in Group A suggests that further validation of the method in a larger patient population, including females, is warranted

A multinodular goiter as the initial presentation of a renal cell carcinoma harbouring a novel VHL mutation

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Silva Eduardo

2006-10-01

Full Text Available Abstract Background Secondary involvement of the thyroid gland is rare. Often the origin of the tumor is difficult to identify from the material obtained by fine-needle aspiration cytology. Renal cell carcinoma of the clear-cell type is one of the more common carcinomas to metastasize to the thyroid gland. Somatic mutations of the von Hippel-Lindau tumor suppressor gene are associated with the sporadic form of this tumor. We aimed to illustrate the potential utility of DNA based technologies to search for specific molecular markers in order to establish the anatomic site of origin. Case Presentation A 54-yr-old Caucasian male complaining of a rapidly increasing neck tumor was diagnosed as having a clear-cell tumor by fine-needle aspiration cytology. A positive staining for cytokeratin as well as for vimentin and CD10 in the absence of staining for thyroglobulin, calcitonin and TTF1 suggested a renal origin confirmed by computed tomography. Using frozen RNA, obtained from cells left inside the needle used for fine needle aspiration cytology, it was possible to identify a somatic mutation (680 delA in the VHL gene. Conclusion In the presence of a clear-cell tumor of the thyroid gland, screening for somatic mutations in the VHL gene in material derived from thyroid aspirates might provide additional information to immunocytochemical studies and therefore plays a contributory role to establish the final diagnosis. Moreover, in a near future, this piece of information might be useful to define a targeted therapy.

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

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Hoon Sung Choi

2017-06-01

Full Text Available BackgroundAnti-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.MethodsWe 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.ResultsThe 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.ConclusionIn 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.

Outpatient management of patients with large multinodular goitres treated with fractionated radioiodine

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Howarth, D.M.; Thomas, P.A.; Allen, L.W.; Akerman, R.; Lan, L. [Department of Nuclear Medicine, John Hunter Hospital, Newcastle, NSW (Australia); Epstein, M.T. [Department of Endocrinology, John Hunter Hospital, Newcastle, NSW (Australia)

1997-12-01

The efficacy of fractionated out-patient radioiodine therapy in 38 patients with compressive symptoms due to long-standing large multinodular goitres was assessed. The diagnosis was established by clinical assessment in addition to technetium-99m pertechnetate thyroid scan or computed tomography scan of the thyroid and mediastinum. Oral iodine-131 therapy was administered as a 2.22 GBq (60 mCi) cumulative dose over 4 months (555 MBq per month). All patients were monitored with serum thyroid-stimulating hormone and free thyroxine ({+-} free tri-iodothyronine) assays before the treatment and after each dose fraction. Clinical and biochemical follow-up was performed on all patients and ranged from 6 to 45 months after therapy. The patients consisted of 35 female and three male patients with a median age of 59 years (range 37-87 years). Prior to treatment 20 patients were biochemically hyperthyroid and 18 were euthyroid. Overall, 71% of patients reported a subjective improvement in compressive symptoms and 29% reported no change. Clinically assessed reduction in goitre size occurred in 92% of patients while there was no change in 8%. At 3 months of follow-up, 31% of patients had become hypothyroid and at 18 months 66% were hypothyroid. Seven hyperthyroid patients (35%) became euthyroid and 13 hyperthyroid patients (65%) became hypothyroid. Three patients who became hypothyroid experienced neck soreness (transient in one patient, persistent in two patients). There were no differences in outcome between patients who were hyperthyroid and those who were euthyroid prior to treatment. Fractionated out-patient radioiodine therapy showed excellent short- and medium-term safety, was very well tolerated and offered a satisfactory alternative treatment to surgery. (orig.) With 1 fig., 3 tabs., 23 refs.

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.

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

2018-06-01

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.

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

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Hugo Niepomniszcze

2004-02-01

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

Phrenic Nerve Palsy as Initial Presentation of Large Retrosternal Goitre.

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Hakeem, Arsheed Hussain; Hakeem, Imtiyaz Hussain; Wani, Fozia Jeelani

2016-12-01

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.

Low Goiter Rate Associated with Small Average Thyroid Volume in Schoolchildren after the Elimination of Iodine Deficiency Disorders.

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Peihua Wang

Full Text Available After the implementation of the universal salt iodization (USI program in 1996, seven cross-sectional school-based surveys have been conducted to monitor iodine deficiency disorders (IDD among children in eastern China.This study aimed to examine the correlation of total goiter rate (TGR with average thyroid volume (Tvol and urinary iodine concentration (UIC in Jiangsu province after IDD elimination.Probability-proportional-to-size sampling was applied to select 1,200 children aged 8-10 years old in 30 clusters for each survey in 1995, 1997, 1999, 2001, 2002, 2005, 2009 and 2011. We measured Tvol using ultrasonography in 8,314 children and measured UIC (4,767 subjects and salt iodine (10,184 samples using methods recommended by the World Health Organization. Tvol was used to calculate TGR based on the reference criteria specified for sex and body surface area (BSA.TGR decreased from 55.2% in 1997 to 1.0% in 2009, and geometric means of Tvol decreased from 3.63 mL to 1.33 mL, along with the UIC increasing from 83 μg/L in 1995 to 407 μg/L in 1999, then decreasing to 243 μg/L in 2005, and then increasing to 345 μg/L in 2011. In the low goiter population (TGR 300 μg/L was associated with a smaller average Tvol in children.After IDD elimination in Jiangsu province in 2001, lower TGR was associated with smaller average Tvol. Average Tvol was more sensitive than TGR in detecting the fluctuation of UIC. A UIC of 300 μg/L may be defined as a critical value for population level iodine status monitoring.

An association of myasthenia gravis with Hashimoto’s thyroiditis in a patient with a multinodular goitre

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Nik Siti Fatimah Mohamed

2017-08-01

Full Text Available Introduction: The association of myasthenia gravis (MG with other autoimmune diseases including autoimmune thyroid disease (ATD is well recognised, although rare. The occurrence of both diseases can occur in two ways: either disease preceding the other, or concurrently. The presentation of MG in association with ATD can range from ocular to generalised disease. Case Summary: A 26-year-old Malay female with persistent hyperthyroidism secondary to Hashimoto’s thyroiditis in multinodular goitre was diagnosed with generalised MG after 2 years. She presented with right eye ptosis (ocular and difficulty in swallowing and chewing (bulbar. The diagnosis of MG was confirmed by fatigability testing, electromyography and the presence of AChR antibodies. Her symptoms showed improvement with pyridostigmine (Mestinon 60 mg 6-hourly. Her antithyroid drug was tapered down according to her thyroid function test. Throughout a year of follow-ups, her hyperthyroidism and fatigability symptoms improved with treatment. She was later counselled for total thyroidectomy and thymectomy. Conclusion: Myasthenia gravis and hyperthyroidism may present with similar symptoms such as dysphagia due to neuromuscular weakness or fatigue. When the diseases occur together, one of the diagnoses may be missed. Therefore, the occurrence of new symptoms in a patient with underlying ATD should should trigger the early identification of other autoimmune diseases by primary care doctors.

Thyroid cancer in patients with hyperthyroidism

International Nuclear Information System (INIS)

Kabir, M.F.; Nahar, N.; Haque, F.S.; Alam, F.; Hasan, M.

2007-01-01

Full text: The coexistence of hyperthyroidism and thyroid cancer is a rare event. The aim of this study was to evaluate the relevance of the association of hyperthyroidism and thyroid cancer. Method: From 1st January 2006 to 31st December 2006, a total of 388 new hyperthyroid patients attended the Institute of Nuclear Medicine and Ultrasound for radioiodine therapy. Eighty-two of them were selected before radioiodine therapy, on the basis of findings on palpation and ultrasound (USG) examination, to undergo fine needle aspiration cytology (FNAC) for cytological diagnosis. USG examination was performed to localize and mark the position of nodule/nodules for FNAC and, in cases of nonpalpable nodules, USG guided FNAC was done. In the case of non-nodular patients, guided FNAC was done in sonographically suspicious areas. Results: FNAC report was positive for thyroid cancer in 4 patients. Histopathology examination revealed the presence of papillary carcinoma. Among the four positive cases, one had multi-nodular goitre, two had uni-nodular goiters and one had no nodule. Another patient had a negative FNAC report but due to a huge goiter, the patient underwent surgery and histopathology revealed the presence of papillary carcinoma. Conclusion: Although the occurrence of thyroid cancer in hyperthyroid patients is rare, the presence of a nodule should be carefully evaluated to exclude the presence of concurrent malignancy. FNAC (USG guided in case of non-palpable nodules) is found helpful before radioiodine therapy or surgery. (author)

Prevalence of malignancy in resected specimen of patients operated for benign nodular goitre

International Nuclear Information System (INIS)

Moosa, F.A.; Junaid, M.; Khan, F.W.; Afzal, Y.

2006-01-01

To determine the frequency of malignancy on histopathology amongst resected specimen of thyroid gland in patients, who had no evidence of malignancy pre-operatively on clinical grounds and investigations. A total of 190 patients who were operated for benign nodular thyroid disease during the study period; 100 cases had multinodular goitre and 90 solitary nodules. Biodata, clinical features, investigations, diagnosis, details of surgery, complications and histopathology reports of all the patients were reviewed and analyzed. Amongst the 190 patients the mean age was 33.42+-12.4 years (range 17-45 years), while the male: female ratio was 1:6.6. Seven (3.6%) cases were found to be malignant on histopathology, with a frequency of 3% (3/100) amongst multinodular cases and 4.4% (4/90) amongst solitary nodules. Prevalence of malignancy in multinodular goitre does not differ significantly from solitary nodules. Hence, multinodularity should no longer be considered as an indicator of benign disease. Both varieties of nodular goitres should be considered for surgery even if there is no suspicion of malignancy. (author)

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

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

2007-09-01

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.

Remarkable Presentation: Anaplastic Thyroid Carcinoma Arising from Chronic Hyperthyroidism

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Habib G. Zalzal

2018-01-01

Full Text Available Background. Undifferentiated anaplastic carcinoma rarely develops from chronic hyperthyroidism. Although acute hyperthyroidism can develop prior to anaplastic transformation, chronic hyperthyroidism was thought to be a protective measure against thyroid malignancy. Methods. A 79-year-old female presented acutely to the hospital with dyspnea. She had been taking methimazole for chronic hyperthyroidism due to toxic thyroid nodules, previously biopsied as benign. Upon admission, imaging showed tracheal compression, requiring a total thyroidectomy with tracheostomy for airway management. Results. Pathology demonstrated undifferentiated anaplastic thyroid carcinoma. The patient passed away shortly after hospital discharge. Despite treatment with methimazole for many years, abrupt enlargement of her toxic multinodular goiter was consistent with malignant transformation. Chronic hyperthyroidism and toxic nodules are rarely associated with thyroid malignancy, with only one previous report documenting association with anaplastic thyroid carcinoma. Conclusion. Progressive thyroid enlargement and acute worsening of previously controlled hyperthyroidism should promote concern for disease regardless of baseline thyroid function.

A new gammagraphic and functional-based classification for hyperthyroidism

International Nuclear Information System (INIS)

Sanchez, J.; Lamata, F.; Cerdan, R.; Agilella, V.; Gastaminza, R.; Abusada, R.; Gonzales, M.; Martinez, M.

2000-01-01

The absence of an universal classification for hyperthyroidism's (HT), give rise to inadequate interpretation of series and trials, and prevents decision making. We offer a tentative classification based on gammagraphic and functional findings. Clinical records from patients who underwent thyroidectomy in our Department since 1967 to 1997 were reviewed. Those with functional measurements of hyperthyroidism were considered. All were managed according to the same preestablished guidelines. HT was the surgical indication in 694 (27,1%) of the 2559 thyroidectomy. Based on gammagraphic studies, we classified HTs in: parenchymatous increased-uptake, which could be diffuse, diffuse with cold nodules or diffuse with at least one nodule, and nodular increased-uptake (Autonomous Functioning Thyroid Nodes-AFTN), divided into solitary AFTN or toxic adenoma and multiple AFTN o toxic multi-nodular goiter. This gammagraphic-based classification in useful and has high sensitivity to detect these nodules assessing their activity, allowing us to make therapeutic decision making and, in some cases, to choose surgical technique. (authors)

[Immunohistochemical profile of angiogenesis in the thyroid gland in various thyroid diseases].

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Rurua, N Z; Gogiashvili, L E; Tsagareli, Z G

2013-12-01

The purpose of the study - to determine the feature of the vascular endothelial growth factor (VEGF) and thyroid-stimulating hormone (TSH) expression in the thyroid gland (TG) in various thyroid diseases. Material - thyroid tissue (operative material) with histologically confirmed diagnosis: 10 - follicular adenoma, 17 - multinodular goiter, 8 - thyroiditis Hashimoto, 8 - papillary carcinoma, 10 - intact (normal) thyroid samples (forensic autopsy). The immunohistochemical study of the material showed the following results: the increase of the Hürtle cells population 40 % or more indicates a hyperthyroidism tendency despite TSH+ receptor status. Under the thyroid pathology TSH and VEGF expression appears in thyrocytes and also in microvascular endothelial cells. VEGF expression is below the norm in the Hashimoto thyroiditis. VEGF is involved not only in angiogenesis, but in pathophysiological shifts in thyroid tissue. Microvessel density (MVD) and TSH positive receptor status under the thyroid pathology testify the absence of the endothelial cells transformation, however, this index can not serve as a biopothential prognostic marker of thyroid disease.

Hyperthyroidism caused by a germline activating mutation of the thyrotropin receptor gene: difficulties in diagnosis and therapy.

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Bertalan, Rita; Sallai, Agnes; Sólyom, János; Lotz, Gábor; Szabó, István; Kovács, Balázs; Szabó, Eva; Patócs, Attila; Rácz, Károly

2010-03-01

Germline activating mutations of the thyrotropin receptor (TSHR) gene have been considered as the only known cause of sporadic nonautoimmune hyperthyroidism in the pediatric population. Here we describe the long-term follow-up and evaluation of a patient with sporadic nonautoimmune primary hyperthyroidism who was found to have a de novo germline activating mutation of the TSHR gene. The patient was an infant who presented at the age of 10 months in an unconscious state with exsiccation, wet skin, fever, and tachycardia. Nonautoimmune primary hyperthyroidism was diagnosed, and brain magnetic resonance imaging and computed tomography showed also Arnold-Chiari malformation type I. Continuous propylthiouracil treatment resulted in a prolonged clinical cure lasting for 10 years. At the age of 11 years and 5 months the patient underwent subtotal thyroidectomy because of symptoms of trachea compression caused by a progressive multinodular goiter. However, 2 months after surgery, hormonal evaluation indicated recurrent hyperthyroidism and the patient was treated with propylthiouracil during the next 4 years. At the age of 15 years the patient again developed symptoms of trachea compression. Radioiodine treatment resulted in a regression of the recurrent goiter and a permanent cure of hyperthyroidism without relapse during the last 3 years of his follow-up. Sequencing of exon 10 of the TSHR gene showed a de novo heterozygous germline I630L mutation, which has been previously described as activating mutation at somatic level in toxic thyroid nodules. The I630L mutation of the TSHR gene occurs not only at somatic level in toxic thyroid nodules, but also its presence in germline is associated with nonautoimmune primary hyperthyroidism. Our case report demonstrates that in this disorder a continuous growth of the thyroid occurs without any evidence of elevated TSH due to antithyroid drug overdosing. This may justify previous recommendations for early treatment of affected

Natural history of lesions with the MR imaging appearance of multinodular and vacuolating neuronal tumor

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Alsufayan, Reema [University of Toronto, Toronto (Canada); Alcaide-Leon, Paula; De Tilly, Lyne Noel [University of Toronto, St. Michael' s Hospital, Toronto (Canada); Mandell, Daniel M.; Krings, Timo [University of Toronto, Toronto Western Hospital, UHN Division of Neuroradiology, Toronto, ON (Canada)

2017-09-15

Multinodular and vacuolating neuronal tumor (MVNT) have been recently added to the WHO classification of CNS tumors and has not been extensively reported upon in the radiological literature. We report the first radiological and the largest series of cases, aiming to highlight the natural history of lesions with the imaging appearance of MVNT with long follow-up time. In this retrospective study, we collected cases with the imaging appearance of MVNT. All lesions were evaluated by using routine MR imaging, with follow-up of up to 93 months. Patient demographics, clinical course, and MRI features of the lesions were recorded. Twenty-four subjects were enrolled, f/m = 16:8, age range 24-59 years, with a median age of 45 years. The patients' symptoms were often episodic and most frequently due to headaches in 12 (50%), visual symptoms in 6 (25%), seizures in 5 ± 1 (20-25%), paresthesia in 4 (∝17%), cognitive difficulties in 4 (∝17%), in addition to other variable neurological symptoms, or incidental. A total of 30 lesions identified, 77% of the lesions had gadolinium-enhanced MRI and only 13% showed enhancement. A 6.7% of the lesions that had MRI followed up showed progression, while the rest remained stable up to 93 months interval. All patients had intact neurological examinations (except one case that was diagnosed with optic neuritis), were managed conservatively, and did well. The natural history of lesions with imaging features of MVNT is overall stable from a clinical and imaging appearance over time. (orig.)

Natural history of lesions with the MR imaging appearance of multinodular and vacuolating neuronal tumor

International Nuclear Information System (INIS)

Alsufayan, Reema; Alcaide-Leon, Paula; De Tilly, Lyne Noel; Mandell, Daniel M.; Krings, Timo

2017-01-01

Multinodular and vacuolating neuronal tumor (MVNT) have been recently added to the WHO classification of CNS tumors and has not been extensively reported upon in the radiological literature. We report the first radiological and the largest series of cases, aiming to highlight the natural history of lesions with the imaging appearance of MVNT with long follow-up time. In this retrospective study, we collected cases with the imaging appearance of MVNT. All lesions were evaluated by using routine MR imaging, with follow-up of up to 93 months. Patient demographics, clinical course, and MRI features of the lesions were recorded. Twenty-four subjects were enrolled, f/m = 16:8, age range 24-59 years, with a median age of 45 years. The patients' symptoms were often episodic and most frequently due to headaches in 12 (50%), visual symptoms in 6 (25%), seizures in 5 ± 1 (20-25%), paresthesia in 4 (∝17%), cognitive difficulties in 4 (∝17%), in addition to other variable neurological symptoms, or incidental. A total of 30 lesions identified, 77% of the lesions had gadolinium-enhanced MRI and only 13% showed enhancement. A 6.7% of the lesions that had MRI followed up showed progression, while the rest remained stable up to 93 months interval. All patients had intact neurological examinations (except one case that was diagnosed with optic neuritis), were managed conservatively, and did well. The natural history of lesions with imaging features of MVNT is overall stable from a clinical and imaging appearance over time. (orig.)

Effect of neck position during radionuclide superior cavography. Its value in the diagnosis of superior vena cava obstruction due to retrosternal goiter

International Nuclear Information System (INIS)

Vincken, W.; Roels, P.; Soenstaboe, R.; DeGreve, J.; Bossuyt, A.; Jonckheer, M.

1983-01-01

In five patients with substernal goiter, three of whom presented with superior vena cava (SVC) syndrome, and in five normal subjects, radionuclide superior cavography (RNSC) was performed with extension and flexion of the neck during tracer administration (simultaneous bilateral injection of Tc- 99 m pertechnetate). When the tracer was injected during neck extension, venous flow pattern was abnormal in four of five patients, and transit time (TT) prolonged in three of five patients. In this posture, mean TT +/- 1 standard deviation (SD) was 6.3 +/- 2.6 s (range 3.5 to 9 s) for the five patients and 3.5 +/- 0.7 s (range 2.5 to 4.5 s) for a group of five control subjects. When the tracer was injected during neck flexion, all five patients showed abnormal flow patterns and prolonged TT (mean +/- 1 SD 10.1 +/- 4.1 s; range 4.4 to 16 s), in contrast to the control group where a slight decrease in TT was found (mean +/- 1 SD 3 +/- 0.6 s; range 2 to 3.5 s). In the presence of a substernal goiter, or any mobile mass at the thoracic inlet, impairment of venous flow through the SVC system appears to be a common occurrence, readily detectable by RNSC. RNSC should be performed with neck flexion during tracer injection, since in this posture its ability to detect compromised venous flow through the SVC system is enhanced, even in patients without a clinically apparent SVC syndrome

Limited value of delayed radiothallium image in the diagnosis of nodular goiter

International Nuclear Information System (INIS)

Misaki, Takashi; Yagi, Kanji; Dokoh, Shigeharu; Koh, Toshikiyo; Shimbo, Shin-ichiro

1991-01-01

To test whether delayed thallium image can improve the diagnostic accuracy of thyroid tumor, we have reviewed 35 patients with cold nodules of proven histopathology. Early and delayed images were taken 10-20 min and 3-4 hr postinjection, respectively. In this study, a thyroid nodule was interpreted as malignant if it had normal or increased uptake on early scan and more residual radioactivity than paranodular tissue on delayed scan. In the eighteen patients who had carcinoma, a disappointing 44% false negative rate was observed. No significant difference was seen between retention-positive and negative cases in tumor size or histological type of cancer. Nor could any demographic bias explain the low sensitivity. Of the six false negatives, macroscopic cystic degeneration was seen in two cases, but tumors in the other four were grossly solid. Considering the histological heterogeneity often seen within a thyroid tumor, the portion with increased retention of radiothallium may be too small to be detected in the false negative cases. Furthermore, 3 false positive readings were obtained in 17 patients with benign conditions. We conclude that the contribution of the delayed thallium image was quite limited in predicting or ruling out malignancy in nodular goiters. (author)

Differentiating Graves' disease from subacute thyroiditis using ratio of serum free triiodothyronine to free thyroxine.

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Sriphrapradang, Chutintorn; Bhasipol, Adikan

2016-09-01

The measurement of free thyroid hormone, instead of the total form, is more commonly used in current practice. We aimed to evaluate the usefulness of the ratio of serum free triiodothyronine (FT3, pg/mL) to free thyroxine (FT4, ng/dL) for differentiating Graves' disease from subacute thyroiditis. Medical records of thyrotoxic patients aged >15 years who had measurement of FT3, FT4 and thyrotropin on the first diagnosis of thyrotoxicosis before initiating treatment were retrospectively reviewed. Data were collected from all clinics, and were not limited to the endocrine clinic. Pregnant women were excluded. A total of 548 patients (468 with Graves' disease, 40 with subacute thyroiditis and 40 with toxic adenoma/multinodular goiter) were recruited. Mean age was 43.9 ± 15.4 years. Most were female 434 (79.2%), and goiter was present in 55.3%. Prevalence of T3-toxicosis and T4-toxicosis were 5.6% and 6.6%, respectively. Mean FT3/FT4 ratios were 4.62 ± 2 (10(-2) pg/ng) in patients with Graves' disease and 2.73 ± 0.5 in subacute thyroiditis. The area under the ROC curve of the FT3/FT4 ratio for diagnosis of Graves' disease was 0.83 (95%CI, 0.76-0.91). Cutoff level of this ratio >4.4 offered sensitivity of 47.2% and specificity of 92.8%. FT3/FT4 ratio of >4.4 (10(-2) pg/ng) may help in differentiating the cause of thyrotoxicosis.

Amiodarone-induced thyroid dysfunction

African Journals Online (AJOL)

multinodular disease or Graves' disease, who on exposure to an excessive .... where the cardiovascular status permitted this, radioactive ... antedating the initiation of amiodarone therapy in the current cohort. .... an evidence-based protocol.

Hyperthyroidism in patients with thyroid cancer.

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Sharma, Sunil Dutt; Kumar, Gaurav; Guner, Karen; Kaddour, Hesham

2016-06-01

We present a retrospective case series of patients with hyperthyroidism and thyroid cancer. Our goal was to look at their clinical characteristics and outcomes to determine which patients would require further investigation. We reviewed the case notes of all patients with a histopathologic diagnosis of thyroid cancer and biochemical evidence of hyperthyroidism who had been treated at a thyroid cancer center from January 2006 through October 2013. During that time, 66 patients had been diagnosed with thyroid cancer. Of these, 8 patients (12%)-all women, aged 29 to 87 years (mean: 55.6; median: 50.5)-had biochemical evidence of hyperthyroidism. Among these 8 patients, 4 had an autonomously functioning toxic nodule (AFTN), 3 were diagnosed with Graves disease, and 1 had a toxic multinodular goiter. Five patients had suspicious features on preoperative ultrasonography. All 8 patients were diagnosed with the papillary type of thyroid carcinoma. The mean size of the tumor in the 4 patients with AFTN was significantly larger than it was in those with Graves disease (42.3 ± 23.8 mm vs. 3.8 ± 1.6; p = 0.04). The 3 patients with Graves disease all had incidentally found papillary microcarcinoma. Between these two groups, the patients with AFTN had a poorer prognosis; 2 of them had extracapsular invasion and lymph node metastasis, and another died of her disease. We found that the incidence of hyperthyroidism in thyroid cancer patients was relatively high (12%). In contrast to what has previously been reported in the literature, patients with AFTN seem to have more aggressive disease and poorer outcomes than do patients with Graves disease. Any suspicious nodule associated with hyperthyroidism should be evaluated carefully.

[Classification and etiology of hyperthyroidism].

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Łacka, Katarzyna; Fraczek, Magdalena Maria

2014-03-01

The prevalence of hyperthyroidism in women is between 0.5-2% and it is 10 times less common in men. The most common causes are Graves' disease, toxic multinodular goiter, and autonomously functioning thyroid adenoma. Rare causes of hyperthyroidisms are as follow: pituitary adenoma, autoimmune thyroiditis (Hashitoxicosis), levothyroxine overdose, inadequate iodine supplementation (including amiodaron induced hyperthyroidism, iodine-based contrast media), hCG excess (pregnancy, gestational trophoblastic disease, germ-cell tumors), drug induced hyperthyroidism, differentiated thyroid carcinomas and/or their metastases, struma ovarii, and familial nonautoimmune hyperthyroidism. This article focuses on the current data of etiopathogenesis of hyperthyroidisms. Genetic factors (like HLA-DR3,CD40, CTLA-4, PTPN22, FOXP3 CD25) and thyroid specific genes (thyroglobulin, TSHR, G(s)alpha) and environmental and endogenous factors (such as age, iodine, selenium, emotional stress, smoking, gender, pregnancy, sex hormones, fetal microchimerism, fetal growth, bacterial infections, viral infections, allergies, drugs (alemtuzumab, interferon alpha, iplimumab/tremelimumab, tyrosine kinase inhibitors, denileukindiftitox, thalidomide/lenalidomide, exposition to fallout and radiotherapy) have been described.

Occult Breast Cancer due to Multiple Calcified Hamartomas in a Patient with Cowden Syndrome

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E. B. Gómez García

2012-01-01

Full Text Available Cowden syndrome (CS is an autosomal dominant disorder characterized by presence of multiple hamartomas, and other benign and malignant abnormalities of the breasts, skin, thyroid, endometrium, gastrointestinal tract, and central nervous system. Hamartomas are benign, developmentally disorganized tumors that can develop in any of the above mentioned organs. The presence of massive calcifications in the breasts in very young women is an indication to perform a breast MRI to exclude a neoplasm since, like in the current case report, presence of breast calcifications may obscure a neoplasm. Although fibrocystic disease and cooccurrence of fibrocystic disease and breast cancer are much more common than CS, the presence of massive calcifications in the breasts of very young women should elicit the possibility of an underlying genetic disease. Furthermore, breast cancer and macrocephaly are considered major criteria for the diagnosis of CS and the combination of both is enough to establish the clinical diagnosis of this entity. Fibrocystic disease of the breasts and multinodular goiter are minor criteria. Family history is also important for the diagnosis of (any hereditary disease.

TRAb negative entities of hyperthyroid syndrome: Our experience of the past 5 years

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Paunković Nebojša

2013-01-01

Full Text Available Over the past five years, since we moved to private practice, we continued with testing of TSH receptor antibodies. So far we have carried out 775 tests and examined 260 patients. We used TRAb human, BRAHMs. We carried out our research on 192 patients with untreated immune hyperthyroidism and 37 with the disease in remission. As the subject of this study was TRAb negative hyperthyroidism, the examination of this group of patients was comprehensive. The largest was a group of patients with Plummer disease (13 in total - 4 with toxic adenoma, 7 with multinodular toxic goiter and 2 with disseminated thyroid autonomy.Nine experienced thyroid destruction (eight with painful thyroiditis, one with post-partal thyroiditis and one with thyroid infarction. Five patients had amiodaron induced hyperthyroidism. Diagnosis was based on the following criteria: clinical features and symptoms, 'free' thyroxin concentration, concentration of ultrasensitive TSH, ultrasonography of thyroid gland and scinigraphy with Tc 99m pertehnetat. The analysis of each method was used for diagnosis and differential diagnosis of each type of occurrences of TRAb negative hyperthyroidism.

Clinical evolution of hyperthyroid patients treated with radioactive iodine and/or propylthiouracil, at Hospital Nacional de Geriatria y Gerontologia: January 2005 - August 2010

International Nuclear Information System (INIS)

Gutierrez Delgado, Alejandro

2011-01-01

The epidemiological and clinical characteristics of the elderly population with hyperthyroidism disorders are presented. The integral valuation was performed in the external consultation endocrinology of Hospital Nacional de Geriatria y Gerontologia. The approach to 81 patients with radioactive iodine and/or propylthiouracil is determined, its clinical evolution and possible side adverse effects to established treatment. An instrument was designed for the collection of data in the clinical records of the patients studied. The ANOVA analysis and Bonferroni Post Hoc test is performed to compare quantitative variables. The crossing of qualitative variables has used the Chi square with a confidence level of 95%. The toxic multinodular goiter has resulted the main etiology of the disease. The 24.7% of patients have presented cognitive impairment, 27.2% have showed suspicion of depressive disorders. Weight loss has been the most frequent suggestive clinical symptom and propylthiouracil the main antithyroid treatment. Better detection in such patients is obtained and has helped to establish in a timely manner the best available therapeutic. Likewise, morbidity is reduced [es

Ovarian embryonal rhabdomyosarcoma is a rare manifestation of the DICER1 syndrome.

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de Kock, Leanne; Druker, Harriet; Weber, Evan; Hamel, Nancy; Traubici, Jeffrey; Malkin, David; Arseneau, Jocelyne; Stewart, Colin J R; Bouron-Dal Soglio, Dorothée; Priest, John R; Foulkes, William D

2015-06-01

Embryonal rhabdomyosarcoma (ERMS), a soft tissue sarcoma, is one of the most common pediatric cancers. Certain ERMSs are associated with the DICER1 syndrome, a tumor predisposition syndrome caused by germ-line DICER1 mutations. Characteristic somatic mutations have also been identified in DICER1-associated tumor types. These "hotspot" mutations affect the catalytic activity of the DICER1 ribonuclease IIIb domain. Primary ovarian ERMS (oERMS) is extremely rare. We present a case of a 6-year-old girl with an oERMS harboring 2 DICER1 mutations. The girl also exhibited other DICER1 phenotypes: cystic nephroma (CN) and multinodular goiter. Somatic investigations of the CN identified a hotspot DICER1 mutation different from that in the oERMS. Significantly, the CN presented at 12 years of age, which is much older than the previously reported age range of susceptibility. This report documents the occurrence of DICER1 mutations in a case of oERMS, expanding the spectrum of DICER1-associated tumors. Copyright © 2015 Elsevier Inc. All rights reserved.

2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis.

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Ross, Douglas S; Burch, Henry B; Cooper, David S; Greenlee, M Carol; Laurberg, Peter; Maia, Ana Luiza; Rivkees, Scott A; Samuels, Mary; Sosa, Julie Ann; Stan, Marius N; Walter, Martin A

2016-10-01

Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the

Review of American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis.

Directory of Open Access Journals (Sweden)

Valentin V. Fadeyev

2017-12-01

Full Text Available Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. The American Thyroid Association (ATA previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves’ hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves’ disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves’ orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves’ hyperthyroidism with antithyroid drugs, the management of pregnant

Ghrelin and obestatin in thyroid gland - immunohistochemical expression in nodular goiter, papillary and medullary cancer.

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Gurgul, Edyta; Kasprzak, Aldona; Blaszczyk, Agata; Biczysko, Maciej; Surdyk-Zasada, Joanna; Seraszek-Jaros, Agnieszka; Ruchala, Marek

2015-01-01

Previous studies analyzing ghrelin and obestatin expression in thyroid gland tissue are not unanimous and are mostly related to ghrelin. The role of ghrelin and obestatin in the thyroid gland appears very interesting due to their probable involvement in cell proliferation. Furthermore, since the thyroid gland is associated with the maintenance of energy balance, the relationship between ghrelin, obestatin and thyroid function is worthy of consideration. The aim of the study was to assess ghrelin and obestatin immunocytochemical expression in nodular goiter (NG), papillary cancer (PTC) and medullary cancer (MTC). Analyzed samples included 9 cases of NG, 8 cases of PTC and 11 cases of MTC. The analysis of ghrelin and obestatin expression was performed by use of the immunohistochemical (IHC) EnVision system and evaluated with filter HSV software (quantitative morphometric analysis). Quantitative ghrelin expression in MTC cells was higher than in NG (p = 0.013) and correlated negatively with the size of the tumor (r= -0.829, p thyroid cell proliferation. The differences between ghrelin and obestatin immunoreactivity in benign and malignant thyroid tumors could support the theory of alternative transcription of the preproghrelin gene and independent production of ghrelin and obestatin.

Correlation between serum lead and thyroid diseases: papillary thyroid carcinoma, nodular goiter, and thyroid adenoma.

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Li, Hui; Li, Xiang; Liu, Jie; Jin, Langping; Yang, Fan; Wang, Junbo; Wang, Ouchen; Gao, Ying

2017-10-01

Studies have showed that lead was associated with human health. However, the effects of lead on thyroid functions are inconsistent, and studies based on Chinese population are fragmentary. To evaluate the correlation between lead and thyroid functions of Chinese with different thyroid diseases, we conducted a hospital-based study. Ninety-six papillary thyroid carcinoma (PTC), 10 nodular goiter (NG), and 7 thyroid adenoma (TA) patients were recruited from the First Affiliated Hospital of Wenzhou Medical University, China. Serum triiodothyronine (T3), free triiodothyronine (FT3), free thyroxin (FT4), and thyroid stimulating hormone (TSH) were evaluated with chemiluminescent microparticle immunoassay. Serum lead was assessed with ICP-MASS. Partial correlation was used to explore the correlations of serum lead and thyroid diseases. Compared to PTC, the level of lead was significantly higher in TA, and lower in NG (p lead was negatively correlated with TSH (r s  =  - 0.27, p lead at quartile4 (r s  = 0.61, p lead and FT3 or FT4 in any group. The results suggested that lead might have different etiological roles in these three thyroid diseases.

Incidence of hyperthyroidism in Sweden.

Science.gov (United States)

Abraham-Nordling, Mirna; Byström, Kristina; Törring, Ove; Lantz, Mikael; Berg, Gertrud; Calissendorff, Jan; Nyström, Helena Filipsson; Jansson, Svante; Jörneskog, Gun; Karlsson, F Anders; Nyström, Ernst; Ohrling, Hans; Orn, Thomas; Hallengren, Bengt; Wallin, Göran

2011-12-01

The incidence of hyperthyroidism has been reported in various countries to be 23-93/100,000 inhabitants per year. This extended study has evaluated the incidence for ~40% of the Swedish population of 9 million inhabitants. Sweden is considered to be iodine sufficient country. All patients including children, who were newly diagnosed with overt hyperthyroidism in the years 2003-2005, were prospectively registered in a multicenter study. The inclusion criteria are as follows: clinical symptoms and/or signs of hyperthyroidism with plasma TSH concentration below 0.2 mIE/l and increased plasma levels of free/total triiodothyronine and/or free/total thyroxine. Patients with relapse of hyperthyroidism or thyroiditis were not included. The diagnosis of Graves' disease (GD), toxic multinodular goiter (TMNG) and solitary toxic adenoma (STA), smoking, initial treatment, occurrence of thyroid-associated eye symptoms/signs, and demographic data were registered. A total of 2916 patients were diagnosed with de novo hyperthyroidism showing the total incidence of 27.6/100,000 inhabitants per year. The incidence of GD was 21.0/100,000 and toxic nodular goiter (TNG=STA+TMNG) occurred in 692 patients, corresponding to an annual incidence of 6.5/100,000. The incidence was higher in women compared with men (4.2:1). Seventy-five percent of the patients were diagnosed with GD, in whom thyroid-associated eye symptoms/signs occurred during diagnosis in every fifth patient. Geographical differences were observed. The incidence of hyperthyroidism in Sweden is in a lower range compared with international reports. Seventy-five percent of patients with hyperthyroidism had GD and 20% of them had thyroid-associated eye symptoms/signs during diagnosis. The observed geographical differences require further studies.

Quality of life improvement in patients with Hashimoto thyroiditis and other goiters after surgery: A prospective cohort study.

Science.gov (United States)

Zivaljevic, Vladan R; Bukvic Bacotic, Branka R; Sipetic, Sandra B; Stanisavljevic, Dejana M; Maksimovic, Jadranka M; Diklic, Aleksandar D; Paunovic, Ivan R

2015-09-01

Hashimoto thyroiditis (HT) and other benign goiters (BG) might influence patients' quality of life (QoL). The objective of this study was to analyze influence of surgery on these patients' QoL. A prospective cohort study was conducted. The ThyPRO questionnaire was used in the QoL assessment. The HT patients experienced significantly worse hypothyroid symptoms and sex life than the BG patients. The improvement in QoL in the BG patients was significant after surgery in all ThyPRO domains. In the HT patients, the improvement was significant in all but two domains, eye symptoms and cognitive impairment. The best improvement in both groups was in overall QoL. None of the patients developed permanent consequences. The QoL of HT and BG patients is impaired and improves significantly after surgical treatment. Thyroidectomy should be considered as a treatment option in the HT patients more often as in the BG patients. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Ultrasound-guided laser thermal ablation in the treatment of autonomous hyperfunctioning thyroid nodules and compressive nontoxic nodular goiter.

Science.gov (United States)

Spiezia, Stefano; Vitale, Giovanni; Di Somma, Carolina; Pio Assanti, Angelo; Ciccarelli, Antonio; Lombardi, Gaetano; Colao, Annamaria

2003-10-01

Percutaneous laser thermal ablation (LTA) has been applied in several tumors. In this study we evaluated the safety and long-term efficacy of LTA in the treatment of benign thyroid nodules. Seven patients with autonomous hyperfunctioning thyroid nodule (group A) and five patients with compressive nodular goiter (group B) were treated with LTA. Up to three needles were positioned centrally in the thyroid nodule and laser fiber was placed in the lumen of the needle. Laser illumination was performed reaching a maximal energy deposition of 1800 J per fiber. Thyroid nodule volume, endocrinologic, and clinical evaluation were performed at baseline, 3, and 12 months after the treatment. Scintigraphy was performed at diagnosis and 12 months after the first session in group A. In group A, mean thyroid volume decreased from 3.15 +/- 1.26 mL to 0.83 +/- 0.49 mL (p thyroid volume decreased from 11.14 +/- 4.99 mL to 3.73 +/- 1.47 mL (p thyroid nodules.

Explore the Possibility of Early Clinical Diagnosis of Endocrine Ophthalmopathy Based on Eye Symptoms of Hyperthyroidism

OpenAIRE

V. G. Likhvantseva; E. A. Rudenko; S. G. Kapkova; V. A. Vygodin

2016-01-01

Purpose: to study the possibility of early clinical diagnosis of endocrine ophthalmopathy based on ocular symptoms of hyperthyroidism. Patients and methods: we analyzed the prevalence of ocular symptoms of hyperthyroidism in 139 patients (278 orbits) with newly diagnosed endocrine ophthalmopathy (group 1), developed on the background of diffuse toxic goiter. The comparison group consisted of 80 patients (160 orbits) with newly diagnosed diffuse toxic goiter with no radiographic evidence of en...

Is it worth to calculate the dose of radioiodine?

International Nuclear Information System (INIS)

Mikalauskas, V.; Kuprionis, G.; Vajauskas, D.

2005-01-01

Full text: Administration of empirical doses of radioiodine (RAI) has been preferred to calculated doses in many hospitals, because the need to measure the size and the iodine uptake in the thyroid involves considerable inconvenience to the patient and additional costs. The preparation of RAI of varying activities also means extra work. Today there is no general consensus on whether radioiodine should be given as a fixed dose or should be calculated. There is also no consensus regarding the question of which radiation burden should be administered to a given volume of thyroid if the activity is calculated. However, while it is possible to deliver a relatively precise dose of radiation to the thyroid gland, maybe it is worth doing this?The aim of this study was to investigate the results of different uptake and volume dependent target doses on clinical outcome of patients with hyperthyroidism in Graves' disease, multi-nodular toxic goiter or toxic adenoma after radioiodine therapy. We reviewed the records of 428 patients (389 women and 39 men, mean age 56.8±12.9 years) who had received radioiodine treatment for Graves' disease and multinodular toxic goiter (n=312) or toxic adenoma (n=116) during the period of 2000-2004 in Kaunas Medical University Hospital. Most patients were given antithyroid drug therapy in order to achieve euthyroidism before treatment with RAI. Radioiodine uptake test with repeated measurements at 2, 6, 24, 48 and/or 72 and/or 96 hr to define the effective half-life was performed. In addition, all the patients underwent thyroid ultrasonography and scintigraphy to define the volume of the thyroid. The 131I activities were calculated according to the formula of Marinelli. In addition to the normal calculation individual target doses were adjusted to the thyroid volumes of each patient before therapy. For statistical evaluation, the patients were divided into four groups: group I included those with a thyroid volume 51 ml. Statistical analysis was

The effectiveness of iodine prophylaxis and frequency of thyroid enlargement (thyroid goiter) and clinical diagnosis of thyroid diseases in inhabitants of Szczecin's region after Chernobyl accident

International Nuclear Information System (INIS)

Syrenicz, A.; Gozdzik, J.; Pynka, S.

1991-01-01

The study, supported by program MZ-17, 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 anti thyroglobulin antibodies and antithyroid membrane 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 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 intra thyroid 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 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 woman than in man (most of 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 in frequency of antithyroid antibodies. (author). 1 ref, 6 tabs

High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area

DEFF Research Database (Denmark)

Laurberg, P; Pedersen, K M; Vestergaard, H

1991-01-01

Little is known about the optimum level of iodine intake for iodine supplementation programmes, or about the effects of the high levels of iodine intake that are found in some countries. We compared the incidence of different types of hyperthyroidism in East-Jutland Denmark with a low average...... that even mild iodine deficiency has a significant effect on population health, since it leads to a high incidence of autonomous thyroid nodules with hyperthyroidism in the elderly population. However, population iodine intake probably should not exceed a level much higher than that necessary to avoid...... iodine intake but no endemic goitre, and the incidence in Iceland with a relatively high iodine intake. Hyperthyroidism was more common in East-Jutland than in Iceland, due to a much higher incidence of multinodular toxic goitre and also of single toxic adenoma. Most of the patients with these diseases...

Prevention, screening and therapy of thyroid diseases and their cost-effectiveness

International Nuclear Information System (INIS)

Dietlein, M.; Moka, D.; Schmidt, M.; Theissen, P.; Schicha, H.

2003-01-01

Cost-effectivness analyses focused on benign thyroid diseases are under-represented in the literature. The calculation of costs per additionally gained life year is difficult: The benefit of prevention is shifted into the distant future. The influence of an untreated subclinical thyroid disease on life expectancy can only be demonstrated by a long-term follow-up and by epidemiological databases. Iodine supplementation and programs for the prevention of tobacco smoking (primary prevention) are very cost-effective. Smoking increases the risk both of multinodular goiter and of Graves' disease. Screening programs (secondary prevention) are discussed for the laboratory parameters thyrotropin (TSH), calcium and calcitonin. TSH testing seems to be very cost-effective for epidemiological considerations in a certain lifespan (newborn, pregnancy, postpartal), older persons, hospitalisation due to acute diseases and in persons with previously elevated TPO-antibodies for TSH-values >2 mU/l, but dedicated cost-effectiveness analyses are lacking. On the other hand, the cost-effectiveness of a routine TSH testing beyond the age of 35 years has been shown by a high-quality decision analysis. Therapeutic strategies (tertiary prevention) aim at the avoidance of complications (atrial fibrillation, myocardial infarction, death for cardiac reasons) and of iatrogenic complications. Examples of a tertiary prevention are: firstly the definitive therapy of Graves' disease in patients who have on increased risk of relapse after antithyroid drugs (ATD), secondly the radioiodine therapy for subclinical hyperthyroidism and the radioiodine therapy of large goiters in older patients or in patients suffering from a relevant comorbidity. Cost-effectiveness analyses for different therapeutic strategies of Graves' disease were published using a lifelong time-horizon. The ablative radioiodine dose-regime is cost-effective as a fist line therapy if the risk of relapse after ATD exceeds 60%. (orig

Thyroid and thymic exeresis in surgery of hyperparathyroidism.

Science.gov (United States)

Diaconescu, Mr; Glod, M; Costea, I; Grigorovici, M; Diaconescu, S

2014-01-01

Owing to close anatomical and embryological connexions between the thyroid, parathyroids and thymus,manifold coexisting pathology can be identified during the surgery of hyperparathyroidism (Hp). In this retrospective study we report the incidence, clinical forms, histology and management of thyroid and thymic synchronous lesions encountered in as eries of 82 consecutive patients with various types of Hp operated on in the last three decades. Demography, clinical records, biochemical data, imaging procedures, pathology reports and surgical protocols were revised. Between 1984-2013, 82 cases of Hp, 20 primary and 62 renal (27 secondary and 35 tertiary), 57 women and 25 males (sex ratio: 2.3 1) of 15-72 (mean 46.5) years, under went surgery in our clinic. Concomitant thyroid exereses were performed in 32 patients (2 subtotal thyroidectomies, 12 lobectomies, 8 atypical resections and 10 diagnosis biopsies), foruni- or bilateral (multi)nodular goiters or different €œminutelesions. Pathology showed 11 colloid goiters, 3 follicular adenomas,5 nodular hyperplasias and 6 thyroiditis cases, 3 papillary microcarcinomas and 4 specimens with normal thyroid tissue.Excision of the fibrofatty retromanubrial tissue in total parathyroidectomies for renal Hp (19 cases) revealed one nonmyastenicthymoma, one thymic cyst and thymic remnants in 6 patients.Morbidity in these extended operations was not significantly increased, comparing to the parathyroid exploration alone. Meticulous pre- and intraoperative evaluation in all cases of Hp enables the actual shift from bilateral neck exploration to minimally invasive surgery,increasing however the potential risk of missing thyroid or thymic coexistent significant lesions. The surgeon dedicated to this pathology must be aware of the possibility of encountering such synchronous association and make generous efforts to wards their complete cure in a single operation. Celsius.

[Hyperthyroidism in older patients].

Science.gov (United States)

Brun, R; Jenny, M; Junod, J P

1978-09-30

This study comprises 81 thyrotoxic patients with onset after the age of 60. In elderly persons, toxic multinodular goiter is the most common cause (68%) of hyperthyroidism, followed by solitary thyroid nodules (16%) and Graves' disease (16%). Cardiovascular disorders (cardiac failure, arrythmias etc.) constitute the first and often the only symptom in 62% of the cases. The other forms of appearance are both various and deceptive: depression, slight fever, asthenia or nausea. Separate analysis of the three forms of hyperthyroidism did not reveal clinical, biological or therapeutic differences between them, except an inferior rate of captation for the toxic nodules. Isolated measurement of T3 or T4 is often insufficient to confirm the diagnosis because either of these hormones may appear at a normal rate. In three cases only the free thyroxin index was pathological on first determination. The authors have established that the autonomous nodules are larger and more active after, rather than before, 60 years of age, and have attempted to define their morphological identity. The results of the treatment are analyzed and preference is expressed for radioactive iodine in every form of hyperthyroidism.

Acute Thyrotoxic Bulbar Myopathy with Encephalopathic Behaviour: An Uncommon Complication of Hyperthyroidism

Directory of Open Access Journals (Sweden)

Neeraja J. Boddu

2013-01-01

Full Text Available Objective. Acute thyrotoxic bulbar palsy is rare, severe, and rapidly progressive. We describe a case of thyrotoxicosis with bulbar palsy, encephalopathy, and pyramidal tract dysfunction. Case Report. 64-year-old white male with toxic multinodular goiter presented with rapid atrial fibrillation. He had mild tremor, normal cranial nerve examination, 4/5 strength in all extremities, normal reflexes, and down going plantars. TSH was low at 0.09 (normal: 0.34–5.6 uIU/mL, and free T4 was high at 5.22 (normal: 0.47–1.41 ng/dL. Despite optimal AV nodal blockade, he had persistent rapid atrial fibrillation. He later developed cervical dystonia, rigidity, clonus, dysarthria, dysphagia, vocal cord palsy, and absent gag reflex. Thyroid storm was suspected. Neuroimaging and cerebrospinal fluid cultures were nondiagnostic. Acetylcholine receptor antibodies were negative. Swallow ability was impaired with heavy secretions. Remarkable improvement in symptoms was noted after initiation of treatment for thyroid storm. Conclusion. Pyramidal tract symptoms and bulbar palsy may occur with thyrotoxicosis. Cranial nerve involvement and encephalopathy raise a question of primary brain mechanism causing bulbar palsy. This is reversible with prompt treatment of thyroid storm.

Lymphocyte-platelet crosstalk in Graves' disease.

Science.gov (United States)

Kuznik, Boris I; Vitkovsky, Yuri A; Gvozdeva, Olga V; Solpov, Alexey V; Magen, Eli

2014-03-01

Platelets can modulate lymphocytes' role in the pathophysiology of thyroid autoimmune diseases. The present study was performed to clarify the status of platelet-lymphocyte subpopulations aggregation in circulating blood in patients with Graves' disease (GD). One hundred and fifty patients with GD (GD group) and 45 hyperthyroid patients with toxic multinodular goiter (TMG group) were recruited in the study. Control group consisted 150 healthy subjects. Immunophenotyping of lymphocytes was performed by flow cytometry. Detection of lymphocyte-platelet aggregates (LPAs) was done using light microscope after Ficoll-gradient centrifugation. The group of GD patients exhibited reduced CD8 lymphocyte and higher CD19 cell counts compared with TMG group and healthy controls. A greater number of activated CD3, HLA-DR+ lymphocytes were observed in GD than in TMG group and control group. GD group was characterized by lower blood platelet count (232 ± 89 × 10 cells/µL) than TMG group (251 ± 97 × 10 cells/µL; P TMG group (116 ± 67/µL, P < 0.005) and control group (104 ± 58 /µL; P < 0.001). GD is associated with higher levels of activated lymphocytes and lymphocyte-platelet aggregates.

Iodine-131 treatment of hyperthyroidism in the elderly. Results in 180 patients. Radioprotection and waste management in 131-iodine therapy; Traitement de l'hyperthyroidie du sujet age par l'iode 131. A propos de 180 patients. Problemes de radioprotection et de gestion des dechets lies au traitement par l'iode 131

Energy Technology Data Exchange (ETDEWEB)

Dejax, C.; Freitas, D. de; Leroux, M.A.; Aubert, B. [Centre Jean-Perrin, Medecine Nucleaire, 63 - Clermont-Ferrand (France); Vennat, J.C. [Centre Jean-Perrin, Radiopharmacie, 63 - Clermont-Ferrand (France); Kwiatkowski, F. [Centre Jean-Perrin, Biostatistiques, 63 - Clermont-Ferrand (France)

2005-09-15

A retrospective study has been performed in patients treated by iodine-131 for hyperthyroidism between April 1999 and February 2004..Among the 270 patients, 180 were more than 65 years old. After 65 years, hyperthyroidism is most often the consequence of a toxic adenoma or multi-nodular goiter while Graves' disease is most frequent in young patients. Iodine-131 is usually proposed as first line treatment in the elderly, at the opposite of young patients. With a mean follow-up of 12 months, return to euthyroidism is observed in 56.5% of the older patients and in 73.6% of the young patients. We explain this results by the lower incidence of Graves' disease in the elderly. Nuclear medicine physicians are legally obliged to provide patients with a proper information about radioprotection. Recommendations should nevertheless not induce overdue nor illegitimate fear. They should not only be written and standardized, but also given orally and adapted to each patient. Urinary incontinence is not specific to the old patients, but it is more frequent after 65. Collection and storage of contaminated waste is sometimes difficult and has often to be solved on a case by case basis. (author)

Dynamics of Hormonal and Immunological Indexes during Conservative Treatment of Patients with Diffuse Toxic Goiter

Directory of Open Access Journals (Sweden)

Yu.V. Buldyhina

2015-09-01

Full Text Available The dynamics of structural and functional state of thyroid gland was studied, as well as the levels of antithyroid antibodies in patients with diffuse toxic goiter (DTG during long-term treatment with thyrostatic agents. Objective of the study — to perform the analysis of changes in the levels of thyrotropin receptor antibodies (TRAbs, antibodies to thyreoproxidase (ATPO at DTG manifestation and during long-term drug therapy, as well as to determine TRAbs levels in relapsing course of disease. Materials and methods. 112 patients with DTG were examined. The duration of the disease at the examination beginning was from 1 month to 15 years. All patients were divided into two groups depending on the DTG duration: the first group consisted of 46 patients with disease duration up to 1 year (3.96 months in average, the second one consisted of 66 patients with disease duration more than 1 year (3.32 years in average. This distribution was specified by desire to study the dynamics of antithyroid antibody levels at disease manifestation and during long-term course of autoimmune process. Results. On the background of thyrostatic therapy, the number of patients with focal thyroid gland formations increased. When analyzing the levels of antithyroid antibodies at baseline, it was revealed that ATPO level in both groups of patients with DTG significantly exceeded the performance of the control group (group1 — 283.33 ± 86.61 U/ml vs 35.65 ± 4.90 U/ml; group 2 — 207.34 ± 42.52 U/ml vs 35.65 ± ± 4.90 U/ml and did not depend on disease duration and preliminary treatment duration. In 6 months of treatment, the level of ATPO in both groups was not decreased. The study of TRAbs dynamics during thyrostatic therapy revealed that in patients of the first and second groups, the decrease of TRAbs level was noted only 6–12 months after the start of thyrostatic therapy (group 1 — from 17.19 ± 2.17 IU/l to 6.95 ± 2.39 IU/l, p < 0.05; group 2 — from 14

The additional diagnostic value of a single-session combined scintigraphic and ultrasonographic examination in patients with thyroid and parathyroid diseases.

Science.gov (United States)

Gedik, G K; Bozkurt, F M; Ugur, O; Grassetto, G; Rubello, D

2008-09-01

The aim of this study was to investigate the diagnostic efficacy and the clinical impact of scintigraphy combined with ultrasonography (USG) in the management of thyroid and parathyroid disorders in a large series of patients. A total of 387 consecutive patients referred to the Nuclear Medicine Department of Hacettepe University in the period from January to September 2007 for investigating a thyroid (N. 339 patients: 232 females and 107 males, mean age+/-SD=48.9+/-13.6 years) or a parathyroid disease (N. 48 patients: 34 females and 14 males, mean age+/-SD=47.4+/-9.6 years) were prospectively evaluated, systematically performing both scintigraphy and USG in a single-day session. All the examinations were independently reviewed by two nuclear medicine physicians; in cases of discrepancy (3%) a final diagnosis was reached by consensus. For thyroid pathologies, USG results were considered to provide additional diagnostic information over scintigraphy: 1) if more nodules were identified; 2) if an irregular hyperactive area at scintigraphy suspicious for the presence of a nodule was clearly characterized at USG; 3) if a nodule missed at scintigraphy because of small size (thyroid diseases, scintigraphy was considered to provide additional diagnostic information over USG, if the functional status of a diffuse or uni- or multi-nodular goiter were clearly defined at scintigraphy. In parathyroid diseases, scintigraphy was considered to provide additional diagnostic information over USG, if the differential diagnosis between a lymph node or a muscle or a vessel depicted at USG was clearly defined as a parathyroid enlargement at scintigraphy. Lastly, the clinical impact of the single-day combined scintigraphic/USG protocol was evaluated. USG. In the thyroid diseases group, USG was particularly useful: 1) to detect additional nodules in glands with suppressed thyroid tissue; 2) to disclose small thyroid nodules (thyroid diseases group, scintigraphy was particularly useful: 1

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

Energy Technology Data Exchange (ETDEWEB)

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

2000-08-01

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

Determination of the iodine concentration of the thyroid gland in an endemic goiter area by computed tomography (CT)

Energy Technology Data Exchange (ETDEWEB)

Joseph, K.; Berg-Schlosser, F.; Herbert, K.

1986-04-01

We determined the CT density of the thyroid gland in 60 patients with normal thyroids and 176 patients with various thyroid disorders. The density was 75+-6.2 H.U. in normal thyroids, which was markedly higher than in goiters (66+-6.0 H.U.), while there was a considerable further decrease in patients with immunogenic hyperthyrodism, the density being 48.5+-7.9 H.U. The thyroids of patients with nonimmunogenic hyperthyroidism differed from these by virtue of a significantly greater density, 79.8+-12.5 H.U. The clinical importance of CT investigation of the thyroid is its ability to distinguish rapidly between immunogenic hyperthyroidism without ocular symptoms and the (mostly iodine induced) nonimmunogenic form. There is a linear correlation between CT density and iodine concentration in the thyroid tissue; this was determined in surgical specimens from 17 patients. Iodine concentration in the thyroid, as well as the iodine content of the whole gland, can thus be calculated from the measured CT density at any time by estimating the volume of the gland with ultrasound and combining this value with the measured iodine concentration. The results correlate well with those found using the X-ray fluorescence method.

Antithyroid antibodies in hyperthyroidism - personal experience

International Nuclear Information System (INIS)

Dedoussis, H.

2003-01-01

Thyroid diseases of autoimmune type may be expressed by symptoms and signs of either hyperthyroidism or euthyroidism or even hypothyroidism. Common factor in these diseases is the presence in the serum of these patients of antithyroid or anti-TSN autoantibodies in various percentages. Since there is not always a positive correlation between the levels of these antibodies and the severity of thyroid disease we have studied in cases of Graves disease (GD), Multinodular toxic goiter (MTG) and Toxic adenoma (TA), the anti-microsomal antibody (antithyroid peroxidase-ATPO-Ab), the antithyroglobulin antibody (Tg-Ab) and the anti-TSH receptor antibody (TSH-Ab) in 260 patients with the three above forms of hyperthyroidism. In Group A, GD, 23 men and 44 women, in Group B MTG, 24 men and 71 women in Group C TA, 8 men and 25 women and in Group C patients with clinical hyperthyroidism without detectable goiter, 19 men and 46 women. thyroid status was assessed clinically by the so called thyroid index of hyperthyroidism, modified by the authors and by the laboratory tests of free thyroxine (FT4), free triiodothyronine (FT3), TSH and the I-131 uptake by the thyroid gland. Results showed that TPO-Ab were in the 4 Groups:75%, 36%,6%, and 66%. The Tg-Ab were:48%, 25%, 0% and 28%. The TSH-Ab were: 49%, 27%, 12% and 23% respectively. Results show that: a) the percentage of TPO-Ab an GD is high and is related to the duration and or the size of the goiter, since in Group D there was a lower percentage of positive TPO-Ab. b) TSH-Ab and Tg-Ab are of minor importance in differentiating different types of hyperthyroidism and may as well be omitted. c) in patients with GD the high levels of TPO-Ab are not synchronous but are related to the severity and/or the relapse of the disease. d) Tg-Ab although not expected are sometimes increased in hypothyroidism as well as in normal people. e) in order to realize the importance of TSH-Ab we should be able to test the number and the sensitivity of

The current status of robotic transaxillary thyroidectomy in the United States: an experience from two centers.

Science.gov (United States)

Zaidi, Nisar; Daskalaki, Despoina; Quadri, Pablo; Okoh, Alexis; Giulianotti, Pier Cristoforo; Berber, Eren

2017-08-01

Few studies exist regarding the state of robotic transaxillary thyroidectomy (RT) and its outcomes at high-volume institutions. Eighty-nine patients underwent RT between January 2009 and September 2015 at two tertiary centers. Data were collected from prospectively-maintained IRB-approved databases. Patient demographic and clinical data, and trends were evaluated. Indications for RT included biopsy-proven or suspicion for malignancy in 20.2%, atypical cells or follicular neoplasm in 27.7%, multinodular goiter in 26.6%, thyrotoxicosis in 8.5%, need for completion thyroidectomy in 5.3%, and non-diagnostic FNA in 3.2%. 56% underwent total thyroidectomy and 44% lobectomy. Operative time (OT) was 153.5 minutes for lobectomies and 192.6 minutes for total thyroidectomy. The complication rate was 11.7%: temporary RLN neuropraxia in 2 patients, permanent hypoparathyroidism in 1 patient, temporary hypoparathyroidism in 6 patients, flap seroma in 1 patient, and flap hematoma in 1 patient. Pathology showed malignancy in 43 patients. At a mean follow-up of 31.9 months, there were no recurrences. Since 2013, the number of RTs performed has risen. The number of out-of-state patients increased from 18% to 37% after 2011. RT was performed without compromising outcomes in selected patients. There remains interest among patients seeking this procedure in expert centers.

Should neck pain in a patient with Hashimoto′s thyroiditis be underestimated? A case and review of the literature

Directory of Open Access Journals (Sweden)

Umut Mousa

2012-01-01

Full Text Available Hashimoto′s Thyroiditis (HT is an autoimmune disease and the most frequent cause of hypothyroidism. Subacute thyroiditis (SAT overlapping HT is a rare entity. A 69-year-old female patient with HT and multinodular goiter has been followed on levothyroxine replacement therapy for 7 years. She presented with neck pain radiating to the right ear persisting for 2 months. She was prescribed analgesics and antibiotics by other physicians during that period, which did not work. Her vital signs were stable with no tachycardia or fever. The right lobe of the thyroid gland was tender on palpation. Her TSH level was 3.94 mIU/ml, ESR 23 mm/h, CRP 3.2 mg/l, WBC 4900/μl at presentation. Thyroid ultrasonography revealed a hypoechoic area over the tender lobe. Power Doppler imaging revealed almost no blood flow in that area. She was started on methylprednisolone 32 mg/day. At day 10 of therapy, her symptoms had completely resolved. Ultrasonography repeated showed that the hypoechoic area had disappeared. Glucocorticoid dosage was tapered and stopped. Emergence of subacute thyroiditis in a case with preexisting Hashimoto′s thyroiditis is a quite rare condition, but should be kept in mind along with a painful attack of HT in the differential diagnosis.

Thyroid nodular disease: their usefulness of diagnostic methods

International Nuclear Information System (INIS)

Mendez Ayala, Irene Maria; Sanchez Luthard, Maria de los Angeles; Martins Schmitz; Gomez, Silvia

2009-01-01

The thyroid nodular disease is defined by the presence of nodules of thyroid of solid, liquid or mixed consistency, they are or non concrete. Solitary nodule thyroid, diffuse and multinodular goiter forms can be presented in. The thyroid nodule is a frequent clinical problem, the clinical prevalence in adult population is of 4%. Objective: to make a bibliographical revision to near the utility of the different methods available for the thyroid nodular pathology diagnosis and determining which of them turns out more specific to differentiate benignancy from malignancy in the found nodules. Materials and Methods: the bibliographical search was made in the data base Medline (Pubmed), in scientific magazines of the region and text books. Criteria of inclusion: bibliographical references pertaining to medical magazines and free full text with an antiquity nongreater to 8 years were included. Conclusion: the presence of thyroid nodules constitutes a reason for frequent consultation, the main diagnostic method at the moment is the fine needle aspiration cytology, due to its simple accomplishment, low cost, not requiring the hospitalization of the patient, and being fundamental in the decision making of the doctor. This diagnostic method is, in addition, the one that with greater certainty allows to differentiate benign from malignant nodules. (authors) [es

Sclerostin and bone metabolism markers in hyperthyroidism before treatment and interrelations between them.

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Sarıtekin, İlker; Açıkgöz, Şerefden; Bayraktaroğlu, Taner; Kuzu, Fatih; Can, Murat; Güven, Berrak; Mungan, Görkem; Büyükuysal, Çağatay; Sarıkaya, Selda

2017-01-01

Sclerostin, which is a glycoprotein produced by osteocytes, reduces the formation of bones by inhibiting the Wnt signal pathway. Thyroid hormones are related with Wnt signal pathway and it has been reported that increased thyroid hormones in hyperthyroidism fasten epiphysis maturation in childhood, and increase the risk of bone fractures by stimulating the bone loss in adults. The aim of this study was to examine the sclerostin serum levels, the relation between sclerostin and thyroid hormones as well as the biochemical markers of the bone metabolism in patients with hyperthyroidism (including multinodular goiter and Graves' disease), whose treatments have not started yet. No difference was found in the serum sclerostin levels between the hyperthyroidism group (n=24) and the control group (n=24) (p=0.452). The serum osteocalcin levels and 24-hour urinary phosphorus excretion were found to be higher in the hyperthyroid group than in the control group (p0.05). Therefore, we consider that a long-term study that covers the pre-post treatment stages of hyperthyroidism, including both the destruction and construction of the skeleton would be more enlightening. Moreover, the assessment of the synthesis of sclerostin in the bone tissue and in the serum level might show differences.

Myelodysplastic syndrome and pancytopenia responding to treatment of hyperthyroidism: Peripheral blood and bone marrow analysis before and after antihormonal treatment

Directory of Open Access Journals (Sweden)

Akoum Riad

2007-01-01

Full Text Available Hematological disorders, especially single lineage abnormalities, have been described in hyperthyroidism. Pancytopenia has been reported, without myelodysplastic syndrome or megaloblastic anemia. We studied the peripheral blood smear and the bone marrow aspiration and biopsy of a 65-year-old lady, who presented with pancytopenia and thyrotoxicosis due to multinodular goiter. She denied ingesting any toxic medication. At diagnosis: WBC: 2500 /ul, platelets count: 58.000/ul, hemoglobin level: 6.5 g/dl. The bone marrow was moderately hyper cellular with moderate myelofibrosis and arrested hematopoiesis. The TSH level was: 0.02 mIU/l (N: 0.25-4, the fT3: 18 pmol/l (N: 4-10, the routine serum immunologic tests were negative. After treatment with single agent neomercazole (carbimazole, complete recovery of the blood cell counts was obtained within one month. The bone marrow aspiration, performed three months after starting therapy, showed normal hematopoiesis. The thyroid function tests returned to normal and no autoimmune reaction was detected on routine serum testing. Persistent response was observed six months later under medical treatment. The patient has refused surgical treatment. Reversible myelodysplastic syndrome may also be part of the changes in blood picture of patients with hyperthyroidism, probably due to direct toxic mechanism.

Lithium-associated primary hyperparathyroidism complicated by nephrogenic diabetes insipidus.

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Aksakal, Nihat; Erçetin, Candaş; Özçınar, Beyza; Aral, Ferihan; Erbil, Yeşim

2015-01-01

Lithium-associated hyperparathyroidism is the leading cause of hypercalcemia in lithium-treated patients. Lithium may lead to exacerbation of pre-existing primary hyperparathyroidism or cause an increased set-point of calcium for parathyroid hormone suppression, leading to parathyroid hyperplasia. Lithium may cause renal tubular concentration defects directly by the development of nephrogenic diabetes insipidus or indirectly by the effects of hypercalcemia. In this study, we present a female patient on long-term lithium treatment who was evaluated for hypercalcemia. Preoperative imaging studies indicated parathyroid adenoma and multinodular goiter. Parathyroidectomy and thyroidectomy were planned. During the postoperative course, prolonged intubation was necessary because of agitation and delirium. During this period, polyuria, severe dehydration, and hypernatremia developed, which responded to controlled hypotonic fluid infusions and was unresponsive to parenteral desmopressin. A diagnosis of nephrogenic diabetes insipidus was apparent. A parathyroid adenoma and multifocal papillary thyroid cancer were detected on histopathological examination. It was thought that nephrogenic diabetes insipidus was masked by hypercalcemia preoperatively. A patient on lithium treatment should be carefully followed up during or after surgery to prevent life-threatening complications of previously unrecognized nephrogenic diabetes insipidus, and the possibility of renal concentrating defects on long-term lithium use should be sought, particularly in patients with impaired consciousness.

Case-based learning in endocrine physiology: an approach toward self-directed learning and the development of soft skills in medical students.

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Gade, Shubhada; Chari, Suresh

2013-12-01

The Medical Council of India, in the recent Vision 2015 document, recommended curricular reforms for undergraduates. Case-based learning (CBL) is one method where students are motivated toward self-directed learning and to develop analytic and problem-solving skills. An overview of thyroid physiology was given in a didactic lecture. A paper-based case scenario of multinodular goiter was given to phase I Bachelor of Medicine, Bachelor of Surgery students in two sessions. An attitude survey of the students and teachers was done using a Likert scale ranging from strongly disagrees to strongly agree. A pretest and posttest were conducted. The students opined that CBL helped them to better their understanding of a particular topic, gave them better retention of knowledge, helped them to relate clinical conditions to basic sciences, improved soft skills such as communication skills and group dynamics, and promoted a better teacher-student relationship. There was significant improvement in student's performance when pre- and posttest scores were compared (P = 0.018). Furthermore, faculty members opined that CBL promoted self-study and problem-solving abilities of the students. In conclusion, CBL motivates students toward self-directed learning and to develop analytic and problem-solving skills; thus, CBL could be beneficial for students' entry into clinical departments and, finally, in managing patients.

Early diagnostics and treatment of thyroid carcinoma

International Nuclear Information System (INIS)

Ismailov, S.I.; Nugmanova, L.B.; Nasirkhodjaev, Ya. B.

2004-01-01

Full text: Analysis of data of the oncological outpatient clinics of the Republic of Uzbekistan confirms our data obtained in the Institute of Endocrinology showing growth in iodine deficiency disorders. In the Republic of Uzbekistan, during period from 1983 to 1999, 6374 people were detected to have thyroid carcinoma. If in 1989, 1.95 cases of thyroid tumor accounted for 100000 population, in 1999 this index reached to 2.39. Moreover, among metropolitan population this was 4.6 cases in 1989, and 8.0 in 1999. Of the 4280 patients operated for different thyroid pathologies from 1989 to 1999 in the Institute of Endocrinology, 335 (7.9%) were diagnosed to have thyroid carcinoma. Clinical presentation was: multinodular goiter in 50.8%, nodular goiter in 37.3% and autoimmune thyroiditis in 4.2% of cases. The average age of patients operated for thyroid carcinoma was 42.8 years in 1989 and 32 years in 1999. Treatment of patients with thyroid carcinoma should be near total thyroidectomy with selective lymphadenectomy independent of morphologic form of the tumor. Our data showed that only surgical method of treatment was used in 7.4% of patients but in combination of radioiodine in 81.9% of patients. Radioiodine was used to destroy remnant thyroid tissue and iodine concentrating metastases. 131I treatment for destruction of thyroid remnants after measured from the front, back and lateral positions in radical operation was given by fractionation method with average total activity being 25 mCi to 75 mCi. Metastases into neck lymph nodes and mediastinum were treated with radioactivity ranging from 50 mCi to 100 mCi. Of the total patients of differentiated thyroid cancer treated from 1995-1999, 148 were alive on 01.01.2003 with five-year survival rate of 91.4%. Our results highlight that combined surgical and radioiodine treatment of thyroid carcinoma helps in preventing recurrence, metastasis and results in increasing the lifespan of patients. (author)

Evaluation and Management of the Child with Thyrotoxicosis.

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Leung, Alexander K C; Leung, Alexander A C

2018-03-26

Uncontrolled thyrotoxicosis, especially in early infancy, may cause irreversible damage to the central nervous system as well as profound effects on the function of many organs. Thyrotoxicosis has multiple etiologies and treatment depends on the underlying etiology. An accurate diagnosis is essential so that appropriate treatment can be initiated without undue delay. To review in depth the evaluation, diagnosis, and treatment of children with thyrotoxicosis. A PubMed search was completed in Clinical Queries using the key terms "thyrotoxicosis" and "hyperthyroidism". The search strategy included meta-analysis, randomized controlled trials, clinical trials, observational studies, and reviews. Patents were searched using the key terms "thyrotoxicosis" and "hyperthyroidism" from www.freepatentsonline.com and www.google.com/patents. Graves' disease accounts for approximately 96% of pediatric cases of thyrotoxicosis. Other causes include Hashitoxicosis, toxic adenoma, toxic multinodular goiter, subacute granulomatous thyroiditis, acute suppurative thyroiditis, pituitary thyroid-stimulating hormone-secreting adenoma, pituitary thyroid hormone resistance, iodine-induced thyrotoxicosis, and drug-induced thyrotoxicosis. Familiarity of the clinical features would allow prompt diagnosis and institution of treatment. The underlying cause of thyrotoxicosis should be treated if possible. Treatment options for Graves' disease include antithyroid medications, radioiodine therapy, and surgery. Recent patents related to the management of thyrotoxicosis are discussed. Currently, antithyroid medications are considered to be the initial treatment of choice for Graves' disease in the pediatric age group. Radioactive iodine treatment is generally used for children with poor compliance with antithyroid medications, children not in remission after 1 to 2 years of antithyroid medications, and children with a major adverse effect while receiving an antithyroid medication. Total or near

Prophylactic oral calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: A prospective randomized study.

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Arer, Ilker Murat; Kus, Murat; Akkapulu, Nezih; Aytac, Huseyin Ozgur; Yabanoglu, Hakan; Caliskan, Kenan; Tarim, Mehmet Akin

2017-02-01

Postoperative hypocalcemia is the most common complication after total thyroidectomy. Postoperative parathyroid hormone (PTH) measurement is one of the methods to detect or prevent postoperative hypocalcemia. Prophylactic oral calcium supplementation is another method to prevent early postoperative hypocalcemia. The aim of this study is to detect the accurate timing of PTH and evaluate efficacy of routine oral calcium supplementation for postoperative hypocalcemia. A total of 106 patients were performed total thyroidectomy. Rotuine oral calcium supplementation was given to group 1 and no treatment to group 2 according to randomization. Serum calcium and PTH level of patients in group 2 at postoperative 6, 12 and 24 h and patients in both groups at postoperative day 7 were evaluated. Patients were compared according to age, sex, operation findings, serum calcium and PTH levels and symptomatic hypocalcemia. Half of the patients (50%) were in group 1. Most of the patients were female (83%). The most common etiology of thyroid disease was multinodular goiter (64.1%). Oral calcium supplementation was given to 18 (33.9%) patients in group 2. Symptomatic hypocalcemia for group 1 and 2 was found to be 1.9 and 33.9% respectively (p hypocalcemia. Prophylactic oral calcium supplementation therapy can prevent early post-thyroidectomy hypocalcemia with advantages of being cost effective and safe. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

The non-conventional therapeutical indications of I 131

International Nuclear Information System (INIS)

Delisle, M.J.; Schvartz, C.; Maes, B.; Vaudrey, C.; Pochart, J.M.

1997-01-01

In our therapeutic activity the non-conventional indications represent 5-10% relative to the indisputable indications which the hyperthyroidism in the second half of the life and the differential thyroid cancers are. In this paper our experience since 1966 is revised and confronted with the data of international literature. In the last almost 40 years we have treated 178 hyperthyroidism of which 17 were youngsters between 16 and 20 years old, 17 multi-nodular euthyroid goiters (MEG), 85 advanced cardiopathies and 8 Cordarone cardiopathies. The indications are precise: relapses after ATS or surgery in young subjects, counter-indications or surgery refusal for the MEGs and cardiologic indications. The long term surveillance was managed by an adequate code. Immediate morbidity is null. The efficiency is high in the hyperthyroidism treatment. The hypothyroidism is diagnosed and early treated. The reduction of the MEG mass is significant. An objective amelioration of the heart state was obtained (23%). The evaluation of the preventive effect of induced hyperthyroidism by Cordarone is underway. In conclusion, the enlargement of indications concerns mainly the hyperthyroidism in young subjects. In order to avoid carcinogenic risks we excluded the children under 16 years, excepting for special situations. This extension to the procreation age imposes a rigorous application of contraception and radiation protection instructions and needs a prolonged evaluation of results

The non-conventional therapeutical indications of I 131; Les indications therapeutiques non conventionnelles de l`I 131

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Delisle, M.J.; Schvartz, C.; Maes, B.; Vaudrey, C.; Pochart, J.M. [I.J.G. BP 171, 51056 Reims (France)

1997-12-31

In our therapeutic activity the non-conventional indications represent 5-10% relative to the indisputable indications which the hyperthyroidism in the second half of the life and the differential thyroid cancers are. In this paper our experience since 1966 is revised and confronted with the data of international literature. In the last almost 40 years we have treated 178 hyperthyroidism of which 17 were youngsters between 16 and 20 years old, 17 multi-nodular euthyroid goiters (MEG), 85 advanced cardiopathies and 8 Cordarone cardiopathies. The indications are precise: relapses after ATS or surgery in young subjects, counter-indications or surgery refusal for the MEGs and cardiologic indications. The long term surveillance was managed by an adequate code. Immediate morbidity is null. The efficiency is high in the hyperthyroidism treatment. The hypothyroidism is diagnosed and early treated. The reduction of the MEG mass is significant. An objective amelioration of the heart state was obtained (23%). The evaluation of the preventive effect of induced hyperthyroidism by Cordarone is underway. In conclusion, the enlargement of indications concerns mainly the hyperthyroidism in young subjects. In order to avoid carcinogenic risks we excluded the children under 16 years, excepting for special situations. This extension to the procreation age imposes a rigorous application of contraception and radiation protection instructions and needs a prolonged evaluation of results

Iodine replition, thyrotoxicosis and fibrillation in Isfahan, Iran

International Nuclear Information System (INIS)

Aminorroaya, Ashraf; Rohani, Sina; Sattari, Goshtasb; Haghighi, Sasan; Amini, Masoud

2004-01-01

Iodized salt was reintroduced in Iran in 1989. Just before distribution of iodized salt, thyrotoxicosis was observed in 3.7% of the patients with atrial fibrillation (AF) in university teaching hospitals in Isfahan, a centrally located city in Iran. As repletion of iodine may increase the rate of autoimmune thyroid diseases and toxic multinodular goiter, this study was designed to evaluate the rate of thyrotoxicosis in patients with AF in the same hospitals after about a decade of iodide salt consumption. In a case- control study with convenience sampling, 100 patients with AF and an equal number of age and sex matched subjects taking the same medications were selected as case and control groups, respectively in university hospitals in 1997. 8% of patients with atrial fibrillation had overt thyrotoxicosis versus one percent in the control group (odds ratio =8.6, 95% CI =6.5 to 10.7, p<0.02). Thyrotoxicosis in patients with AF was 8 times higher than in control group without AF. In comparison with the period before use of iodized salt, AF more than doubled (8%vs. 3.7%). Thyroid function should be evaluated in all patients older than 40 years of age with AF. The benefits of iodine supplementation are great, but more attention should be paid to the complications of iodine repletion, including thyrotoxicosis and its frequent accompaniment, AF. (author)

Serum cytokine levels in autoimmune and non-autoimmune hyperthyroid states

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L.S. Ward

2000-01-01

Full Text Available Although the role of interleukin-2 (IL-2 and interferon gamma (gIFN is still poorly understood in hyperthyroid diseases, it is reasonable to assume that these cytokines may be present at higher levels in Graves' disease (GD than in other primarily non-autoimmune thyroid diseases. In order to look for an easy method to distinguish GD from primarily non-autoimmune causes of hyperthyroidism, we compared 13 healthy individuals with 21 treated and untreated hyperthyroid GD patients and with 19 patients with hyperthyroidism due to other etiologies: 7 cases of multinodular goiter, 5 cases of excessive hormone replacement and 7 cases of amiodarone-associated hyperthyroidism. All patients presented low TSH levels and a dubious clinical thyroid state. We found a good correlation between TSH and serum IL-2 levels (r = 0.56; PgIFN (P<0.01 levels were lower in the hyperthyroid group of patients than in control subjects, suggesting a depressed TH1 pattern in the T-cell subset of hyperthyroid patients. GD had normal IL-2 levels, while patients with other forms of thyrotoxicosis presented decreased IL-2 levels (P<0.05. There was no difference between treated and untreated GD patients. We suggest that the direct measurement of serum IL-2 level may help to confirm hyperthyroidism caused by GD.

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

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Yaniv S. Ovadia

2014-01-01

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.

[Hyperthyroidism and carcinoma of the thyroid gland].

Science.gov (United States)

Ardito, G; Mantovani, M; Vincenzoni, C; Guidi, M L; Corsello, S; Rabitti, C; Fadda, G; Di Giovanni, V

1997-01-01

The incidence of thyroid carcinoma in hyperthyroidism varies considerably from as low as 0.3% to as high as 16.6% with a higher rate in toxic nodular goiters. Occult thyroid carcinoma (thyroid carcinoma was 5.6% (23 cases). In detail, a neoplasm occurred in 5 cases of Graves' disease (specific incidence: 3.8%), in 13 cases of toxic nodular goiter (12.5%) and in 5 cases of hyperfunctioning adenomas (2.8%). 19 cancers were papillary (12 in toxic nodular goiter, 3 in Graves' disease, 4 in hyperfunctioning adenomas), three were follicular (1 in Graves' disease, 1 in toxic nodular goiter, 1 in hyperfunctioning adenomas) and 1 medullary in Graves' disease. A papillary carcinoma was diagnosed preoperatively on fine needle aspiration with ultrasonography in only two patients with Graves' disease and confirmed by postoperative histological examination on permanent section. We do not believe in the frozen-section examination intraoperatively because it's not diagnostical for follicular lesions and evaluates rarely capsular invasion. Twenty patients received total thyroidectomy and four of them also lymphoadenectomy. Three patients received emithyroidectomy: in two cases for occult papillary carcinoma and in the last case for local cancer invasion (T4N0M0). Twenty patients are alive and with no evidence of cancer recurrence. Mean follow-up is 59.6 months. Our retrospective study shows a progressive increase of the incidence of coexisting thyroid malignancy and hyperthyroidism especially in toxic nodular goiter, probably related to extended surgical indications. Our findings do confirm that, even in the presence of hyperthyroidism, all thyroid nodules require careful diagnostics for exclusion of malignancy.

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

DEFF Research Database (Denmark)

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

2011-01-01

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...... 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....

Goiter

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... where your collarbones meet. The gland makes the hormones that control the way every cell in the body uses energy. This process is called metabolism . Iodine deficiency is the most common cause of ...

Clinical Observation on Hyperthyroidism

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Lee, Kyu Bo; Kang, Bann; Song, Suk Ho; Park, Hi Myung; Whnag, Kee Suk [Kyungpook National University School of Medicine, Deagu (Korea, Republic of)

1969-09-15

A clinical analysis was made on 161 cases of hyperthyroidism seen at the Radioisotope Laboratory of Kyungpook National University Hospital. This series consisted of 144 cases of diffuse goiter and 17 cases of nodular goiter. 1) Hyperthyroidism was most prevalent in the 4th decade and male to female ratio was 1 : 4.6. 2) Cardinal symptoms in the order of frequency were weakness, easy fatigability, palpitation, weight loss, nervousness, perspiration, heat intolerance, increased appetite, insomnia and dysmenorrhoea. 3) Major physical findings in the order of frequency were goiter, fine tremor, tachycardia, wide pulse pressure, emaciation, warm moist skin, exophthalmos, systolic hypertension and atrial fibrillation. 4) The complications were ophthalmopathy (34.2%), thyrotoxic heart disease (5.6%), thyroid crisis (1 case), pretibial myxedema (1 case) and thyrotoxic myopathy (1 case). 5) Mean values of the six hour and twenty-four hour {sup 131}I uptakes by the thyroid glands were 67.5% and 71.6%, respectively, in diffuse goiter and 64.5% and 65.0%, respectively, in nodular goiter. 6) Mean values of twenty-four PB{sup 131}I conversion ratio were 76.3% in diffuse goiter and 70.2% in nodular goiter and those of the basal metabolic rate was +51% in the former and +41% in the latter. Mean serum cholesterol level was 152 mg% in diffuse goiter and that in nodular goiter was 175 mg%. 7) Among the 134 cases treated with {sup 131}I, 66 cases (49.3%) were successfully controlled with single dose and in the majority of the cases the initial therapeutic dose required was 4.1-4.0 mC in diffuse goiter and 5.1-6.0 mC in nodular goiter. 8) With {sup 131}I treatment the symptoms improved in the following order: heat intolerance, emaciation, nervousness, insomnia, easy fatigability, weakness, fine tremor, goiter, perspiration, exertional dyspnea and palpitation. And in a few cases improvement of even exophthalmos was seen. 9) Following {sup 131}I treatment myxedema occurred in 4 cases (3

Clinical Observation on Hyperthyroidism

International Nuclear Information System (INIS)

Lee, Kyu Bo; Kang, Bann; Song, Suk Ho; Park, Hi Myung; Whnag, Kee Suk

1969-01-01

A clinical analysis was made on 161 cases of hyperthyroidism seen at the Radioisotope Laboratory of Kyungpook National University Hospital. This series consisted of 144 cases of diffuse goiter and 17 cases of nodular goiter. 1) Hyperthyroidism was most prevalent in the 4th decade and male to female ratio was 1 : 4.6. 2) Cardinal symptoms in the order of frequency were weakness, easy fatigability, palpitation, weight loss, nervousness, perspiration, heat intolerance, increased appetite, insomnia and dysmenorrhoea. 3) Major physical findings in the order of frequency were goiter, fine tremor, tachycardia, wide pulse pressure, emaciation, warm moist skin, exophthalmos, systolic hypertension and atrial fibrillation. 4) The complications were ophthalmopathy (34.2%), thyrotoxic heart disease (5.6%), thyroid crisis (1 case), pretibial myxedema (1 case) and thyrotoxic myopathy (1 case). 5) Mean values of the six hour and twenty-four hour 131 I uptakes by the thyroid glands were 67.5% and 71.6%, respectively, in diffuse goiter and 64.5% and 65.0%, respectively, in nodular goiter. 6) Mean values of twenty-four PB 131 I conversion ratio were 76.3% in diffuse goiter and 70.2% in nodular goiter and those of the basal metabolic rate was +51% in the former and +41% in the latter. Mean serum cholesterol level was 152 mg% in diffuse goiter and that in nodular goiter was 175 mg%. 7) Among the 134 cases treated with 131 I, 66 cases (49.3%) were successfully controlled with single dose and in the majority of the cases the initial therapeutic dose required was 4.1-4.0 mC in diffuse goiter and 5.1-6.0 mC in nodular goiter. 8) With 131 I treatment the symptoms improved in the following order: heat intolerance, emaciation, nervousness, insomnia, easy fatigability, weakness, fine tremor, goiter, perspiration, exertional dyspnea and palpitation. And in a few cases improvement of even exophthalmos was seen. 9) Following 131 I treatment myxedema occurred in 4 cases (3%) and reoccurrence in 9

Effectiveness of radioiodine (131-I) as definitive therapy in patients with autoimmune and non-autoimmune hyperthyroidism.

Science.gov (United States)

Tarantini, B; Ciuoli, C; Di Cairano, G; Guarino, E; Mazzucato, P; Montanaro, A; Burroni, L; Vattimo, A G; Pacini, F

2006-01-01

We evaluated the outcome of radioiodine (RAI) therapy in 100 consecutive patients treated in the period 2000-2001 for hyperthyroidism due to Graves' disease (GD), toxic adenoma (TA) and toxic multinodular goiter (TMG). Thyroid function was measured before and after therapy every 3-6 months up to 3 yr. Three years after therapy, 75% of TA patients were euthyroid, 18.7% were hypothyroid and 6.3% hyperthyroid. Of the TMG patients, 62.2% were euthyroid, 18.9% were hypothyroid and 18.9% hyperthyroid. In GD patients euthyroidism was achieved in 12.9% of the patients, hypothyroidism in 74.2% and hyperthyroidism persisted in 12.9%. Definitive hypothyroidism was significantly higher in GD (p<0.0001) than in TA and TMG patients. Overall, positive effect of RAI (definitive hypothyroidism or euthyroidism) was very high: 93.7% in TA, 81.1% in TMG and 87.1% in GD patients. Thyroid volume reduction was observed in all patients, but was higher in GD patients (mean reduction of 76%) and in TA patients (mean nodule reduction of 69%). In TMG, mean reduction was of 32%. The median activity of RAI received by the 86 cured patients was 555 MBq (15 mCi) compared to 407 Mbq (11 mCi) received by the 14 patients who remained hyperthyroid. No influence was found between outcome and clinical parameters at the moment of 131-I therapy. In conclusion, our results indicate that RAI therapy is highly effective and safe for the control of hyperthyroidism.

Role of Nuclear Medicine in the Diagnosis of Benign Thyroid Diseases.

Science.gov (United States)

Garberoglio, Sara; Testori, Ornella

2016-01-01

A deep understanding of thyroid pathophysiology is the basis for diagnosing and treating benign thyroid diseases with radioactive materials, known as radiopharmaceuticals, which are introduced into the body by injection or orally. After the radiotracer administration, the patient becomes the emitting source, and several devices have been studied to detect and capture these emissions (gamma or beta-negative) and transform them into photons, parametric images, numbers and molecular information. Thyroid scintigraphy is the only technique that allows the assessment of thyroid regional function and, therefore, the detection of areas of autonomously functioning thyroid nodules. Scintigraphy visualizes the distribution of active thyroid tissue and displays the differential accumulation of radionuclides in the investigated cells, thus providing a functional map. Moreover, this technique is a fundamental tool in the clinical and surgical management of thyroid diseases, including: single thyroid nodules with a suppressed thyroid-stimulating hormone level, for which fine-needle aspiration biopsy (FNAB) is used to identify hot nodules; multinodular goiters, especially larger ones, to identify cold or indeterminate areas requiring FNAB and hot areas that do not need cytologic evaluation, and to evaluate mediastinal extension; the diagnosis of ectopic thyroid tissue; subclinical hyperthyroidism to identify occult hyperfunctioning tissue; follicular lesions to identify a functioning cellular adenoma that could be benign, although such nodules are mostly cold on scintigraphy; to distinguish low-uptake from high-uptake thyrotoxicosis, and to determine eligibility for radioiodine therapy. © 2016 S. Karger AG, Basel.

APE/Ref-1 is increased in nuclear fractions of human thyroid hyperfunctioning nodules.

Science.gov (United States)

Russo, D; Celano, M; Bulotta, S; Bruno, R; Arturi, F; Giannasio, P; Filetti, S; Damante, G; Tell, G

2002-08-30

Apurinic/apyrimidinic endonuclease APE/Ref-1 is a multifunctional protein provided with DNA repair, transcription-factor regulation and anti-apoptotic activities. We have previously reported that, in thyroid cells, TSH regulates both the synthesis and nuclear translocation of APE/Ref-1. We have also shown that nuclear levels of this protein are reduced both in thyroid carcinoma tissues and cell lines. In the present study, APE/Ref-1 expression and cellular localization were analysed by Western blot in hyperfunctioning thyroid nodules from patients with toxic adenoma and/or toxic multinodular goiter. The total content of APE/Ref-1 protein was increased in the majority of the hyperfunctioning tissues with respect to normal adjacent tissue. There was also an increase in the nuclear levels of APE/Ref-1, suggesting enhanced cytoplasm-to-nucleus translocation of the protein in addition to its increased rate of synthesis. These results demonstrate that the phenomenon of nuclear translocation of APE/Ref-1 hypothesized on the basis of cell culture experiments does actually occur in vivo. Together with previous observations in thyroid carcinomas and tumoral cell lines, our findings suggest a two-stage model of APE/Ref-1 behaviour during malignant thyrocyte transformation: an early stage characterized by simple hyperplasia and upregulation of APE/Ref-1 in the nuclear compartment of the cell and a later stage in which nuclear levels of the protein drop to below-normal levels as the cell becomes progressively undifferentiated.

Treatment of hyperthyroidism in community hospital

International Nuclear Information System (INIS)

Gossain, V.V.; Heath, R.C.; Rovner, D.R.

1989-01-01

The preferred treatment of hyperthyroidism remains controversial. Most of this data is derived from large, university-based medical centers. We report here our experience with treatment of hyperthyroidism in a community setting. This involves 144 patients with hyperthyroidism who were seen over a 10 year period at Michigan State University Clinical Center and were treated in the community hospitals and private physicians' offices, and by community surgeons. Follow-up data were available on 119 of these patients; 105 of them were hyperthyroid because of Graves' disease and multinodular goiter. Patients were encouraged to make their own decisions regarding choice of therapy, as independently as possible. Sixty-five percent of these patients were treated by 131I, 18% by antithyroid drugs, and 17% by surgery. The mean follow-up period was 2.5 years (range 2 months to 19 years). Hyperthyroidism was controlled in 84% of the patients treated by 131I and 83% of the patients treated by surgery. Forty percent of the patients treated by 131I and 33% treated by surgery became hypothyroid. Fifty percent of the patients achieved remission when treated by antithyroid drugs alone. Our results indicate that when patients are encouraged to make their own decisions regarding the treatment of hyperthyroidism, their choices are similar to those of the thyroidologists. Secondly, the results obtained with different modalities of treatment for hyperthyroidism in a community setting are similar to those obtained in university medical centers

Hydatid cyst disease of the thyroid gland: report of two cases.

Science.gov (United States)

Akbulut, Sami; Demircan, Firat; Sogutcu, Nilgun

2015-04-01

Hydatid cyst disease may develop in any organ of the body, most frequently in the liver and lung, but occasionally can affect other organs such as the thyroid gland. Although the prevalence of thyroidal cyst disease varies by region, literature data suggest that it ranges between 0% and 3.4%. The aim of this report was to share 2 cases with thyroid hydatid cyst. Two female patients aged 26 and 57 years were admitted to our outpatient clinic with different complaints. While the first case presented with front of the neck swelling and pain, the second case presented with hoarseness, sore throat, and neck swelling. Both patients were living in a rural area in the southeastern region of Turkey and had had a long history of animal contact. Both patients had undergone previous surgeries for hydatid cyst disease. Both patients presented with a clinical picture consistent with typical multinodular goiter, and both underwent total thyroidectomy after detailed examinations and tests. The exact diagnosis was made after histopathologic examination in both patients. They both had a negative indirect hemagglutination test studied from blood samples. They both have had no recurrences during a 4-year follow-up. In conclusion, although thyroid gland is rarely affected, hydatid cyst disease should not be overlooked in differential diagnosis of cystic lesions of thyroid gland in patients who live in regions where hydatid cyst disease is endemic and who had hydatid cysts in other regions of their body.

Changes in Swallowing Symptoms and Esophageal Motility After Thyroid Surgery

DEFF Research Database (Denmark)

Sorensen, Jesper Roed; Markoew, Simone; Døssing, Helle

2018-01-01

INTRODUCTION: Swallowing difficulties, the pathophysiology behind which is incompletely understood, have been reported in 47-83% of goiter patients referred for thyroidectomy. We aimed at examining the influence of thyroid surgery on swallowing symptoms and esophageal motility. METHODS: Thirty-th...... to esophageal motility disturbances. This information is essential when interpreting dysphagia in patients with nodular goiter, and when balancing patients' expectations to surgical goiter therapy. REGISTRATION NUMBER: NCT03100357 ( www.clinicaltrials.org ).......INTRODUCTION: Swallowing difficulties, the pathophysiology behind which is incompletely understood, have been reported in 47-83% of goiter patients referred for thyroidectomy. We aimed at examining the influence of thyroid surgery on swallowing symptoms and esophageal motility. METHODS: Thirty......-three patients with benign nodular goiter undergoing thyroid surgery were included. All completed high-resolution esophageal manometry examinations and the goiter symptom scale score, assessed by the thyroid-specific patient-reported outcome measure. The evaluations were performed before and 6 months after...

Enfermedad tiroidea autoimnune en pacientes con bocio y/o hipotiroidismo

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Guido Lastra

1998-01-01

Full Text Available We studied the presence of antithyroid antibodies in subjects with slight to overt thyroid disfunction. Fifty nine subjects that showed goiter or TSH levels above 5.0 mU/L were included. The percentage of patients with positive anti Thyroid Peroxidase antibodies (anti TPO was 18.63%. From them, 90.9% exhibited goiter along with thyroid dysfunction, whereas only 9.1 % had goiter without thyroid disfunction. There was no patient without goiter that showed anti TPO levels above 100 mUl/ mL.We conclude that thyroid autoimmune disease is very prevalent among our patients, so it must be suspected in subjects with or without goiter, as well as in those with slight thyroid disfunction, because it could progress to overt hypothyroidism.

Long-Term Results of Fixed High-Dose I-131 Treatment for Toxic Nodular Goiter: Higher Euthyroidism Rates in Geriatric Patients

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Gül Ege Aktaş

2015-10-01

Full Text Available Objective: Geriatric patient population has special importance due to particular challenges. In addition to the increase in incidence of toxic nodular goiter (TNG with age, it has a high incidence in the regions of low-medium iodine intake such as in our country. The aim of this study was to evaluate the overall outcome of high fixed dose radioiodine (RAI therapy, and investigate the particular differences in the geriatric patient population. Methods: One hundred and three TNG patients treated with high dose I-131 (370-740 MBq were retrospectively reviewed. The baseline characteristics; age, gender, scintigraphic patterns and thyroid function tests before and after treatment, as well as follow-up, duration of antithyroid drug (ATD medication and achievement of euthyroid or hypothyroid state were evaluated. The patient population was divided into two groups as those=>65 years and those who were younger, in order to assess the effect of age. Results: Treatment success was 90% with single dose RAI therapy. Hyperthyroidism was treated in 7±7, 2 months after RAI administration. At the end of the first year, overall hypothyroidism rate was 30% and euthyroid state was achieved in 70% of patients. Age was found to be the only statistically significant variable effecting outcome. A higher ratio of euthyroidism was achieved in the geriatric patient population. Conclusion: High fixed dose I-131 treatment should be preferred in geriatric TNG patients in order to treat persistent hyperthyroidism rapidly. The result of this study suggests that high fixed dose RAI therapy is a successful modality in treating TNG, and high rates of euthyroidism can be achieved in geriatric patients.

Factors affecting sustainable iodine deficiency elimination in Pakistan: A global perspective

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Rehman Mehmood Khattak

2017-06-01

Full Text Available Iodine deficiency remains a considerable challenge worldwide, even after decades of efforts to address the problem. The aim of this review is to present the current situation in historically iodine-deficient Pakistan regarding iodine nutritional status and place it in a global perspective. We collected relevant articles from online bibliographic databases and websites of concerned organizations that addressed prevalence of goiter/iodine deficiency and barriers to sustainable control. We divided the studies into pre- and post-1994, a landmark year when Pakistan formally adopted the universal salt iodization (USI programme. Overall, 56 studies reported goiter/iodine deficiency prevalence in Pakistan. Before 1994, six studies (30% reported a goiter prevalence ≥70%, while nine studies (45% reported a goiter prevalence between 30% and 70%. Only five studies (25% found a goiter prevalence less than 30%, of which only two studies reported prevalence <10%. From 1994 onwards, 15 studies (41.7% reported a goiter/iodine deficiency (ID prevalence ≥50%, of which seven studies reported prevalence ≥70%, while three studies (8.3% found a goiter prevalence of 30%–49%, nine studies (25% found a goiter prevalence of 10%–29%, and five studies (13.9% reported prevalence of <10%. Four studies (11.1% reported lower goiter prevalence but higher prevalence of iodine deficiency. The efforts in the past two decades resulted in up to a 50% decline in iodine deficiency disorders (IDD. Variable remaining factors and the recent results, however, indicate that this decline may be non-uniform and even over-estimated. Coordinated and regionally adopted efforts for eradication of IDD from all stakeholders should be pursued. Policy makers should take steps to protect future generations and alert concerned organizations about the importance of careful assessments and estimates of iodine nutritional status.

Permanent Hypothyroidism after Radioactive Iodine(131I) Treatment in Diffuse Toxic Goiter

International Nuclear Information System (INIS)

Park, Soon Yang; Lee, Jung Sang; Lee, Hong Kyu; Koh, Chang Soon; Lee, Mun Ho

1977-01-01

Radioactive iodine (RAI), principally 131 I, effectively controls hyperthyroidism in the majority of patients. The subsequent development of hypothyroidism, however, has been of increasing concern since it was first pointed out by Chapman and Maloof in 1955. And the steady increase of late hypothyroidism during the passage of time was known with its relation with dosage of RAI. The authors have investigated the development of hypothyroidism in 935 patients with diffuse toxic goiter (DTG) who were treated with RAI ( 131 I) at the Seoul National University Hospital from 1960 to 1977 to reveal its relation with the number of RAI treatments, dosage of RAI, age of patients and exophthalmos with the following results. 1) The incidence of hypothyroidism by year after RAI therapy among 631 patients with DTG who were treated with single RAI regimen was 7.4% (1 year), 11.8% (2 year), 16.2% (3 year), 22.1% (4 year) and 25.5% (5 year), and that among 163 patients given multiple RAI treatments was 8.6% (1 year), 10.4% (2 year), 13.3% (3 year), 29.1% (4 year), and 54.1% (5 year) respectively showing much higher yearly increments from 4 years after RAI treatment in comparison with the former. 2) Among 550 patients in the lower dose group treated with single RAI regimen less than 5.0 mCi (Mean±S.D.: 4.3±0.6 mCi), the incidence of hypothyroidism by year after RAI treatment was 6.8% (1 year), 11.4% (2 year), 15.4% (3 year), while among 81 patients in the higher dose group given single RAI treatment not less than 5.5 mCi (Mean±S.D.: 6.3±0.5 mCi) it was 12.0% (1 year), 15.4% (2 year) and 20.4% (3 year) respectively. However, the duration till euthyroid state after RAI therapy in the two groups was 5.1±3.6 months and 4.8±2.8 months respectively showing no statistically significant difference (p>0.1). 4) The incidence of hypothyroidism after RAI treatment in patients younger than 30 years of age was 4.3% (1 year) and 7.7% (2 year); in patients from 30 years to 49 years of age, 5

Painless giant cell thyroiditis diagnosed by fine needle aspiration and associated with intense thyroidal uptake of gallium

International Nuclear Information System (INIS)

Sanders, L.R.; Moreno, A.J.; Pittman, D.L.; Jones, J.D.; Spicer, M.J.; Tracy, K.P.

1986-01-01

A 52-year-old woman presented with fever, goiter, and no evidence of pain or tenderness in the thyroid. A diagnosis of silent thyroiditis was made after obtaining evidence of biochemical thyrotoxicosis, intense gallium-67 citrate thyroidal localization, and cytologic thyroiditis. Fine needle aspiration biopsy of the thyroid revealed numerous giant cells in all areas of the thyroid, typical of subacute thyroiditis. This is believed to be the first time painless thyroiditis is reported with the classic cytologic feature of painful subacute thyroiditis

[Amyloid goiter].

Science.gov (United States)

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

1999-03-21

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.

Silent (painless) thyroiditis. Evidence of a geographic variation in frequency

Energy Technology Data Exchange (ETDEWEB)

Vitug, A.C.; Goldman, J.M.

1985-03-01

Recent reports suggest that 14% to 23% of thyrotoxic patients have silent (painless) thyroiditis, a newly described syndrome characterized by transient thyrotoxicosis with a low radioactive iodine uptake. A three-year review at a Brooklyn (NY) hospital showed only one definite and three possible cases of silent thyroiditis among 86 thyrotoxic patients. At most, 4% to 5% of thyrotoxic patients had silent thyroiditis. The authors suggest a geographic variation in this syndrome. Most cases and the largest series are from Japan and the Great Lakes area of North America. The latter may be related to increased iodine intake over many years in a previously endemic area of hypoiodidism and goiter, although other local factors may also be involved.

Silent (painless) thyroiditis. Evidence of a geographic variation in frequency

International Nuclear Information System (INIS)

Vitug, A.C.; Goldman, J.M.

1985-01-01

Recent reports suggest that 14% to 23% of thyrotoxic patients have silent (painless) thyroiditis, a newly described syndrome characterized by transient thyrotoxicosis with a low radioactive iodine uptake. A three-year review at a Brooklyn (NY) hospital showed only one definite and three possible cases of silent thyroiditis among 86 thyrotoxic patients. At most, 4% to 5% of thyrotoxic patients had silent thyroiditis. The authors suggest a geographic variation in this syndrome. Most cases and the largest series are from Japan and the Great Lakes area of North America. The latter may be related to increased iodine intake over many years in a previously endemic area of hypoiodidism and goiter, although other local factors may also be involved

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

Energy Technology Data Exchange (ETDEWEB)

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

2000-12-01

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)

First results with a radioreceptor-assay (TRAK-Assay) for TSH-receptor-autoantibodies

International Nuclear Information System (INIS)

Becker, W.; Reiners, C.; Boerner, W.

1983-01-01

A new radioreceptor-assay (TRAK-assay) for autoantibodies against TSH-receptors was tested in 48 untreated thyrotoxic patients (26 regional autonomies, 22 toxic diffuse goiters). None of the 26 patients with regional autonomy showed positive autoantibody-titers. 4 patients with toxic diffuse goiter and thyrotoxic exophthalmos were TRAK-positive. Positive titers of microsomal and thyreoglobulin autoantibodies could be seen in 8 of 9 patients with positive TRAK-titers. In accordance with the conventional methods for detecting thyroid-stimulating immunoglobulins the new TRAK-assay seems to be suited for differentiating between immunogenic toxic diffuse goiter (Graves' disease) and goiter with disseminated autonomy as well as for prediction of relapse. (orig.) [de

Thyroid abnormality trend over time in northeastern regions of Kazakstan, adjacent to the Semipalatinsk nuclear test site. A case review of pathological findings for 7271 patients

International Nuclear Information System (INIS)

Zhumadilov, Z.; Gusev, B.I.; Takada, Jun; Hoshi, Masaharu; Kimura, Akiro; Hayakawa, Norihiko; Takeichi, Nobuo

2000-01-01

From 1949 through 1989 nuclear weapons testing carried out by the former Soviet Union at the Semipalatinsk Nuclear Test Site (SNTS) resulted in local fallout affecting the residents of Semipalatinsk, Ust-Kamenogorsk and Pavlodar regions of Kazakstan. To investigate the possible relationship between radiation exposure and thyroid gland abnormalities, we conducted a case review of pathological findings of 7271 urban and rural patients who underwent surgery from 1966-96. Of the 7271 patients, 761 (10.5%) were men, and 6510 (89.5%) were women. The age of the patients varied from 15 to 90 years. Overall, a diagnosis of adenomatous goiter (most frequently multinodular) was found in 1683 patients (63.4%) of Semipalatinsk region, in 2032 patients (68.6%) of Ust-Kamenogorsk region and in 1142 patients (69.0%) of Pavlodar region. In the period 1982-96, as compared before, there was a noticeable increase in the number of cases of Hashimoto's thyroiditis and thyroid cancer. Among histological forms of thyroid cancer, papillary (48.1%) and follicular (33.1%) predominated in the Semipalatinsk region. In later periods (1987-96), an increased frequency of abnormal cases occurred among patients less than 40 years of age, with the highest proportion among patients below 20 in Semipalatinsk and Ust-Kamenogorsk regions of Kazakstan. Given the positive findings of a significant cancer-period interaction, and a significant trend for the proportion of cancer to increase over time, we recommend more detailed and etiologic studies of thyroid disease among populations exposed to radiation fallout from the SNTS in comparison to non-exposed population. (author)

Follicular Adenoma with Extensive Extracellular Mucin Deposition: Report on Two Cases

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Na Rae Kim

2012-01-01

Full Text Available We report two cases of follicular adenoma of the thyroid with extensive extracellular mucin deposition. Fine needle aspiration in Case 1 showed singly discohesive polygonal cells in a granular mucinous background. They contained abundant eosinophilic cytoplasm, nuclear irregularities, and frequent nuclear inclusions with occasional bizarre mitoses. A right lobectomy was done. In Case 2, a 47-year-old Caucasian woman with multinodular goiter had total thyroidectomy and a yellow-tan nodule was found within the right lobe. Both tumors were well-encapsulated masses with thick capsules. Each was characterized by microfollicles without papillae in a mucinous stroma. Tumor cells were positive for thyroglobulin and negative for calcitonin, CEA, galectin-3, HBME-1, and CK19. The extracellular mucin stained with Alcian-blue and colloidal iron but not with mucicarmine and D-PAS. No BRAF gene mutation was detected. Because there were neither capsular nor vascular invasions, both cases were diagnosed as follicular adenomas of the thyroid with extensive extracellular mucin deposition, which as proposed by the WHO classification can be categorized as a mucinous variant of follicular adenoma. Retrospectively, frequent nuclear inclusions and the absence of nuclear grooves in the mucin-containing background of cytologic smears and histologic sections were shared by those of mucin-producing papillary carcinoma. It is unclear whether it belongs to an existing category of thyroid neoplasm with mucin production or whether it is truly a new tumor variant. Furthermore, pathologists should pay attention to avoid misdiagnosis of this variant of follicular neoplasm that shows an overlapping cytology with that of papillary carcinoma.

Weight homeostasis & its modulators in hyperthyroidism before & after treatment with carbimazole.

Science.gov (United States)

Dutta, Pinaki; Bhansali, Anil; Walia, Rama; Khandelwal, Niranjan; Das, Sambit; Masoodi, Shariq Rashid

2012-08-01

Hyperthyroidism is associated with increased food intake, energy expenditure and altered body composition. This study was aimed to evaluate the role of adipocytokines in weight homeostasis in patients with hyperthyroidism. Patients (n=27, 11men) with hyperthyroidism (20 Graves' disease, 7 toxic multinodular goiter) with mean age of 31.3±4.2 yr and 28 healthy age and body mass index (BMI) matched controls were studied. They underwent assessment of lean body mass (LBM) and total body fat (TBF) by dual energy X-ray absorptiometer (DXA) and blood sample was taken in the fasting state for measurement of leptin, adiponectin, ghrelin, insulin, glucose and lipids. Patients were re-evaluated after 3 months of treatment as by that time all of them achieved euthyroid state with carbimazole therapy. The LBM was higher (Phyperthyroid patients even after adjustment for body weight (BW), whereas total body fat was comparable between the two groups. Serum leptin levels were higher in patients with hyperthyroidism than controls (22.3±3.7 and 4.1±0.34 ng/ml, Ptreatment. Serum leptin positively correlated with TBF and this correlation persisted even after adjustment for BW, BMI, gender and age (r=0.62, P=0.001). However, serum leptin and acylated ghrelin did not correlate with the presence or absence of hyperphagia. Patients with hyperthyroidism predominantly had decreased lean body mass which increased after achievement of euthyroidism with carbimazole. The hyperphagia and the alterations in weight homeostasis associated with hyperthyroidism were independent of circulating leptin and ghrelin levels.

[Anaplastic carcinoma of the thyroid at the Instituto Nacional de la Nutrición Salvador Zubirán].

Science.gov (United States)

Sierra, M; Gamboa-Domínguez, A; Herrera, M F; Barredo-Prieto, B; Alvarado de la Barrera, C; Llorente, L; Pérez-Enriquez, B; Rivera, R; González, O; Rull, J A

1997-01-01

Anaplastic thyroid carcinoma (ATC) is a highly aggressive tumor with a median survival rate of 6 months. To analyze presentation, treatment, morphology, immunohistochemistry, and nuclear DNA analysis of a cohort of patients with ATC. Twelve patients with ATC (11 female) with a mean age of 65 years were seen at our hospital from 1970-1995. The data were obtained from the clinical records and the morphology, immunohistochemic studies and DNA pattern were performed in slides obtained from archival specimens. Previous or coexisting thyroide disease was documented in 10 patients (9 multinodular goiters and one Grave's). The most frequent presentation was a rapidly growing tumor associated with dysphagia, cervical pain, hoarseness and dyspnea. A cold thyroid nodule was detected by thyroid scan in 10 patients. The most frequent subtype was the spindle cell variety. Papillary thyroid carcinoma coexisted in eight cases, two of them corresponded to the tall cell variant. Reactivity for S-100 protein and vimentin was studied in six patients: all were positive for S-100 protein and vimentin, 5/6 for epithelial membrane antigen, half for carcinoembriogenic antigen, 2/6 for thyroglobulin and calcitonin, and one for neuronal specific enolase. These six tumors showed a diploid DNA pattern. Tumor resection was achieved in 2/11 and none survived six years after diagnosis. ATC is a highly aggressive tumor coexisting with thyroid pathologies. Spindle cell variant is the most frequent with positive reactivity for S-100 protein, vimentin and epithelial membrane antigen. Most tumors have a diploid DNA content.

Do expandable metallic airway stents have a role in the management of patients with benign tracheobronchial disease?

Science.gov (United States)

Madden, Brendan P; Loke, Tuck-Kay; Sheth, Abhijat C

2006-07-01

With increasing availability many centers are deploying expandable metallic stents to manage patients with diverse endobronchial disorders. Although these devices have an important role in malignant disease their usefulness in benign large airway disorders is less defined. Between 1997 and 2005, 31 patients aged 34 to 83 years with benign large airway compromise secondary to tracheomalacia (n = 7), posttracheostomy stricture (n = 8), posttracheostomy rupture (n = 2), postpneumonectomy bronchopleural fistula (n = 2), stricture after lung transplantation (n = 3), lobectomy, tuberculosis, traumatic injury to right main bronchus (n = 1 patient each), and external compression of the airway secondary to achalasia, multinodular goiter, aortic aneurysm, right brachiocephalic artery aneurysm, right interrupted aortic arch, and dissecting aneurysm (n = 1 patient each) who were medically unfit for formal surgical intervention were treated by Ultraflex stent deployment. The range of follow-up was 1 week to 96 months. Stents were deployed under anesthesia using rigid bronchoscopy. Complications included granulation tissue formation (n = 11) treated with Nd: YAG laser ablation, stent migration (n = 1; stent removed, another deployed), metal fatigue (n = 1), stent removal (n = 1), mucus plugging (n = 2), and halitosis (n = 6) difficult to treat despite antibiotics. Thirteen patients died of unrelated causes between 1 week and 15 months after stent deployment. Endobronchial metallic stents should be considered only for selected patients with large airway compromise secondary to benign airway diseases for whom other medical comorbidities contraindicate formal airway surgery. Once deployed, they are difficult to remove, are associated with significant complications, and require prospective bronchoscopic surveillance and often further therapeutic intervention.

Thyroid abnormality trend over time in northeastern regions of Kazakstan, adjacent to the Semipalatinsk nuclear test site. A case review of pathological findings for 7271 patients

Energy Technology Data Exchange (ETDEWEB)

Zhumadilov, Z. [Semipalatinsk State Medical Academy (Kazakstan); Gusev, B.I.; Takada, Jun; Hoshi, Masaharu; Kimura, Akiro; Hayakawa, Norihiko; Takeichi, Nobuo

2000-03-01

From 1949 through 1989 nuclear weapons testing carried out by the former Soviet Union at the Semipalatinsk Nuclear Test Site (SNTS) resulted in local fallout affecting the residents of Semipalatinsk, Ust-Kamenogorsk and Pavlodar regions of Kazakstan. To investigate the possible relationship between radiation exposure and thyroid gland abnormalities, we conducted a case review of pathological findings of 7271 urban and rural patients who underwent surgery from 1966-96. Of the 7271 patients, 761 (10.5%) were men, and 6510 (89.5%) were women. The age of the patients varied from 15 to 90 years. Overall, a diagnosis of adenomatous goiter (most frequently multinodular) was found in 1683 patients (63.4%) of Semipalatinsk region, in 2032 patients (68.6%) of Ust-Kamenogorsk region and in 1142 patients (69.0%) of Pavlodar region. In the period 1982-96, as compared before, there was a noticeable increase in the number of cases of Hashimoto's thyroiditis and thyroid cancer. Among histological forms of thyroid cancer, papillary (48.1%) and follicular (33.1%) predominated in the Semipalatinsk region. In later periods (1987-96), an increased frequency of abnormal cases occurred among patients less than 40 years of age, with the highest proportion among patients below 20 in Semipalatinsk and Ust-Kamenogorsk regions of Kazakstan. Given the positive findings of a significant cancer-period interaction, and a significant trend for the proportion of cancer to increase over time, we recommend more detailed and etiologic studies of thyroid disease among populations exposed to radiation fallout from the SNTS in comparison to non-exposed population. (author)

Calcitonin assay in wash-out fluid after fine-needle aspiration biopsy in patients with a thyroid nodule and border-line value of the hormone.

Science.gov (United States)

Massaro, F; Dolcino, M; Degrandi, R; Ferone, D; Mussap, M; Minuto, F; Giusti, M

2009-04-01

Assaying calcitonin (CT) in the wash-out fluid from fine-needle aspiration biopsies (CT-FNAB) could be useful in the diagnosis of medullary thyroid carcinoma (MTC). The aim of this study was to correlate serum CT with cytology and CT-FNAB. Twenty-seven subjects (age range 27-75 yr) were studied. FNAB was performed in a thyroid nodule (no.=16) or lymph-node (no.=1 previously operated on for MTC) or in the prevalent nodule of multinodular goiters (no.=10). CT-FNAB values obtained in 37 subjects with normal serum CT (thyroid nodules served as a negative control. In these subjects, CTFNAB values were 8.2+/-6.4 ng/l (range 2-30 ng/l). In patients with a thyroid nodule under evaluation for MTC, serum CT and CT-FNAB values were 14.5+/-3.9 ng/l (range 10-24 ng/l) and 16.4+/-29.8 ng/l (range 2-144 ng/l), respectively. In 4 patients, CT-FNAB values were higher than the highest values found in our negative controls (30 ng/l), but cytology results were compatible with a benign thyroid lesion and pentagastrin testing was negative. In 3 cases with CT-FNAB 100 ng/l. Our data do not show any correlation between CT-FNAB and serum CT. In conclusion, borderline CT values in patients with thyroid nodules are not rare. Our experience suggests that CT-FNAB does not have the same importance as that reported in the literature for thyroglobulin and PTH assay in wash-out fluid after FNAB in malignant thyroid and hyperfunctioning parathyroid lesions.

FAKTOR-FAKTOR SOSIAL EKONOMI KELUARGA YANG BERHUBUNGAN DENGAN KEJADIAN GONDOK PADA MURID SD

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Siti Madanijah

2012-03-01

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

CLINICAL AND MORPHOLOGICAL CHARACTERIZATION OF FETOPLACENTAL COMPLEX IN PREGNANT PATIENTS WITH DIFFUSE TOXIC GOITER

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V. A. Petrukhin

2015-01-01

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

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

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Hendra Budi Sungkawa

2015-12-01

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

High relative frequency of thyroid papillary carcinoma in northern Portugal.

Science.gov (United States)

Sambade, M C; Gonçalves, V S; Dias, M; Sobrinho-Simões, M A

1983-05-01

Two hundred and twelve papillary and 40 follicular carcinomas were found in 3002 thyroid glands examined from 1931 to 1975 in four Laboratories of Pathology that fairly cover northern Portugal. There was a striking preponderance of women both in papillary (female:male = 6.9:1) and follicular carcinoma (5.7:1). Sex-specific frequency of malignancy was significantly greater in men (13.3%) than in women (8.8%). The overall papillary/follicular ratio was 5.3:1 and did not significantly change throughout the study period. Papillary/follicular ratio was not significantly greater in litoral (5.5:1) than in regions with a low iodine intake and a relatively high prevalence of goiter (3.5:1). It is advanced that this high relative frequency of papillary carcinoma in northern Portugal, even in goiter areas, may reflect the existence of a racial factor since there is not enough evidence to support the influence of dietary iodine, previous irradiation and concurrent thyroiditis.

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

International Nuclear Information System (INIS)

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

1979-01-01

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 3 -RU, T 3 , T 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

Clinical outcomes after estimated versus calculated activity of radioiodine for the treatment of hyperthyroidism: systematic review and meta-analysis.

Science.gov (United States)

de Rooij, A; Vandenbroucke, J P; Smit, J W A; Stokkel, M P M; Dekkers, O M

2009-11-01

Despite the long experience with radioiodine for hyperthyroidism, controversy remains regarding the optimal method to determine the activity that is required to achieve long-term euthyroidism. To compare the effect of estimated versus calculated activity of radioiodine in hyperthyroidism. Design Systematic review and meta-analysis. We searched the databases Medline, EMBASE, Web of Science, and Cochrane Library for randomized and nonrandomized studies, comparing the effect of activity estimation methods with dosimetry for hyperthyroidism. The main outcome measure was the frequency of treatment success, defined as persistent euthyroidism after radioiodine treatment at the end of follow-up in the dose estimated and calculated dosimetry group. Furthermore, we assessed the cure rates of hyperthyroidism. Three randomized and five nonrandomized studies, comparing the effect of estimated versus calculated activity of radioiodine on clinical outcomes for the treatment of hyperthyroidism, were included. The weighted mean relative frequency of successful treatment outcome (euthyroidism) was 1.03 (95% confidence interval (CI) 0.91-1.16) for estimated versus calculated activity; the weighted mean relative frequency of cure of hyperthyroidism (eu- or hypothyroidism) was 1.03 (95% CI 0.96-1.10). Subgroup analysis showed a relative frequency of euthyroidism of 1.03 (95% CI 0.84-1.26) for Graves' disease and of 1.05 (95% CI 0.91-1.19) for toxic multinodular goiter. The two main methods used to determine the activity in the treatment of hyperthyroidism with radioiodine, estimated and calculated, resulted in an equally successful treatment outcome. However, the heterogeneity of the included studies is a strong limitation that prevents a definitive conclusion from this meta-analysis.

Scintigraphic Profile of Thyrotoxicosis Patients and Correlation with Biochemical and Sonological Findings.

Science.gov (United States)

Avs, Anil Kumar; Mohan, Abhish; Kumar, P G; Puri, Pankaj

2017-05-01

Thyrotoxicosis is a spectrum of disorder with a rather common clinical presentation with different aetiologies. The aetiological diagnosis is important as the management differs. It is essential to accurately diagnose the cause before starting treatment. Scintigraphy of thyroid helps in differentiating accurately the various causes. USG is routinely being advocated and T3/T4 ratio has also been used. This study aims to evaluate the scintigraphic profile of thyrotoxicosis patients and to correlate biochemical and USG findings with scintigraphy. A total of 60 newly diagnosed thyrotoxicosis patients based on biochemical reports were included in the study. They underwent further evaluation with ultrasonography and 99mTc scintigraphy. Of 60 patients of thyrotoxicosis, 45 cases were of Grave's disease, 10 cases were of thyroiditis and five cases were of Toxic Multinodular Goiter (MNG). The clinical characteristics were helpful in establishing the diagnosis in only six (10%) patients who presented with classic features of Grave's disease with ophthalmopathy. T3/T4 ratio greater than 20 was seen only in 29 (66%) patients of Grave's disease and also in three (33.33%) of thyroiditis patients. USG had a sensitivity and specificity of 81.82% and 93.75% in diagnosing Graves' disease and 100% and 82.4% in diagnosing thyroiditis respectively. Clinical findings do not help in accurately delineating aetiological diagnosis of thyrotoxicosis. Serum T3/T4 ratio when used as a criterion has marked overlap between the various conditions causing thyrotoxicosis. USG has reasonable sensitivity however, misses many cases of early Grave's disease. Follow up scintigraphy helps in a small population with resolving thyroiditis or early Grave's disease where the initial scintiscan is normal or inconclusive.

Radioiodine therapy of hyperthyroidism at 25 years experience in Vietnam

International Nuclear Information System (INIS)

Mai Trong Khoa; Phan Sy An; Phan Van Duyet; Tran Dinh Ha

2004-01-01

In Vietnam, hyperthyroidism is a common problem with a local prevalence of 1.48%, higher in females (1.78%) and 1.19% in males. Radioiodine (I-131) is used successfully since more than 60 years in the world and more than 20 years in Vietnam for treatment of hyperthyroidism. Hyperthyroidism can be due to Graves' disease (diffuse toxic goiter); toxic multinodular goiter and solitary toxic nodule; thyroiditis; iodine - induced hyperthyroidism (Job-Basedow's disease)... In Vietnam, the most common cause of hyperthyroidism is toxic diffuse goiter. There are 3 main Methods for treatment of hyperthyroidism: antithyroid drug; surgery; radioiodine. In our country, less than half of the patients with hyperthyroidism are treated primarily with radioiodine in recent years. Since 1978, 13226 patients with hyperthyroidism (1784 males and 11442 females) have been treated and have been followed-up at the Nuclear Medicine Departments in other parts of Vietnam (North, Middle, South Vietnam). After treatment with I-131, these patients were followed up at 3 to 4 months interval for the first year and 6 to 12 monthly henceforth. The average dose of I-131 was 6.8 ± 1.9 mCi. Out of the 13226 patients, 5216 (39.4%) became clinically hypothyroid, 7841 (59.3 %) were euthyroid and 169 (1.3%) remained hyperthyroidism.Administration of a single dose resulted in control of thyrotoxicosis in 9911 (74.9%) patients. 2581 (19.5%) patients required 2 doses and a further 734 (5.5%) needed 3 doses of 1-131.At the end of the first year, 511 (3.9%) of patients were clinically hypothyroid. From the second to tenth year, there was a 2.2% annual increase in incidence of hypothyroidism. From the eleventh year on wards, the incidence of hypothyroidism was 1% per year. There was no significant difference in prevalence of hypothyroidism at the time of review in patients treated with a single dose and those requiring repeated treatment (p>0.05). There was no statistically significant difference in the

In vitro measurement of antithyroid compounds and environmental goitrogens.

Science.gov (United States)

Gaitan, E; Cooksey, R C; Matthews, D; Presson, R

1983-04-01

A specific, sensitive, and reproducible in vitro assay for antithyroid compounds and environmental goitrogens has been used to investigate antithyroid activity (AA) in small samples of water supplying 15 localities in endemic and nonendemic goiter areas of western Colombia. A significant positive correlation was observed between goiter prevalence and AA in water collected from the pipelines of these localities. Samples at the water source showed only borderline significance. No significant correlation was observed in waters between AA and total hardness (ppm) or concentrations of Ca, Mg, sulfates, chlorides, silicates, nitrates, and iodine. AA was also demonstrated by this in vitro assay in well water previously shown experimentally to be goitrogenic and that supplied the endemic goiter district of Candelaria town in western Colombia. In contrast, water from the well supplying the area of lower endemicity was found to possess little AA. These results provide experimental support for epidemiological observations that demonstrate a relationship between the sources of drinking water and goiter prevalence rates, and are consistent with previous findings indicating that organic antithyroid compounds contaminate water supplies in areas where goiter persists despite adequate iodine supplementation.

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

Energy Technology Data Exchange (ETDEWEB)

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

1979-08-01

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.

Iodine deficiency disorders

Energy Technology Data Exchange (ETDEWEB)

Ali, S M [Pakistan Council for Science and Technology, Islamabad (Pakistan)

1994-12-31

Iodine deficiency (IDD) is one of the common problem in the diet. Iodine deficiency as prevalence of goiter in population occurs in the mountainous areas. There is consensus that 800 million people are at risk of IDD from living in iodine deficient area and 190 million from goiter. Very high prevalence of IDD in different parts of the world are striking. It has generally observed that in iodine-deficient areas about 50% are affected with goiter, 1-5% from cretinsim and 20% from impaired mental and/or mortor function. (A.B.).

Mise au point

African Journals Online (AJOL)

Case -repart : We report a case of pregnant women who was admitted for compressive goiter with laryngeal dyspnea, which required emergency total thyroidectomy. Conclusion: Urgent thyroidectomy in pregnant women can be performed if we respect the precautions. Keywords: goiter, pregnancy, thyroidectomy.

La prise en charge d'un goitre compressif chez une femme enceinte ...

African Journals Online (AJOL)

Case -report : We report a case of pregnant women who was admitted for compressive goiter with laryngeal dyspnea, which required emergency total thyroidectomy. Conclusion: Urgent thyroidectomy in pregnant women can be performed if we respect the precautions. Keywords: goiter, pregnancy, thyroidectomy.

Thyroid-specific questions on work ability showed known-groups validity among Danes with thyroid diseases

DEFF Research Database (Denmark)

Nexo, Mette A.; Watt, Torquil; Bonnema, Steen Joop

2014-01-01

and interviews with thyroid patients, 24 work ability items were selected from previous questionnaires, revised, or developed anew. Items were tested among 632 patients with thyroid disease (non-toxic goiter, toxic nodular goiter, Graves' disease (with or without orbitopathy), autoimmune hypothyroidism...

Violations of macro- and micronutrient support in patients with nodular thyroid pathology from regions injured after the Chornobyl accident

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V.I. Kravchenko

2017-09-01

Full Text Available Background. The purpose of our study was to determine the state of macro- and micronutrient support of patients with nodular thyroid pathology from the regions injured after the Chornobyl accident. Materials and methods. 65 habitants of the Chernihiv area were examined: 40 — without thyroid pathology (15 men and 25 women aged 36.62 ± 0.60 years, and 25 (5 men and 20 women — with the diagnosed nodular goiter. Results. Research of urinary iodine excretion showed that a median in the control group was 95.6 µg/l, among patients with nodular goiter — 89.3 µg/l, indicating the presence of moderate iodine deficiency. Blood thyroglobulin level in patients of control group was 9.26 ± 0.99 ng/l, among patients with nodular goiter — 23.03 ± 4.70 ng/l. Thyroid-stimulating hormone level higher than 4.0 mIU/l was in 8.9 % of patients with nodular goiter and in 5.0 % of persons from the control group. The data of ultrasonic researches demonstrated that the average thyroid volume in patients of control group was 10.1 ± 0.3 cm3, among patients with nodular goiter — 18.6 ± 1.7 cm3. In the group of patients with nodular goiter, the decreased (p < 0.0001 level of macronutrients in blood plasma was detected: calcium was 67.26 ± 3.21 µg/l and magnesium — 14.88 ± 0.35 µg/l, as well as of microelements: zinc content was 0.72 ± 0.04 µg/l (p < 0.0001 and iron — 0.54 ± 0.06 µg/l (p < 0.05, in comparison with the results in the control group. Conclusions. The relative risk (χ2 criterion for the four-course table of connectivity with Fisher’s correction of nodular goiter development at subzero content of calcium was 2.24 (95% confidence interval (CI 1.58–2.61, the risk of nodular goiter development at subzero levels of magnesium — 2.56 (95% CI 1.77–3.03.

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

DEFF Research Database (Denmark)

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

2008-01-01

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) Gr...

Clinical, biochemical & cytomorphologic study on Hashimoto′s thyroiditis

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Tina Thomas

2014-01-01

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.

Toxic nodular goiter

Science.gov (United States)

... crisis or storm is an acute worsening of hyperthyroidism symptoms. It may occur with infection or stress . Thyroid ... Call your health care provider if you have symptoms of this disorder. Follow the provider's instructions for follow-up visits.

Antiherpetic Drugs in Equine Medicine.

Science.gov (United States)

Maxwell, Lara K

2017-04-01

Since vaccination may not prevent disease, antiherpetic drugs have been investigated for the therapy of several equine herpesviruses. Drug efficacy has been assessed in horses with disease, but most evidence is in vitro, in other species, or empirical. Oral valacyclovir is most often administered in the therapy of equine herpesvirus type-1 (EHV-1) to protect adult horses from equine herpesvirus myeloencephalopathy, while oral acyclovir is frequently administered for EHV-5 infection in the therapy of equine multinodular pulmonary fibrosis. Other antiherpetic drugs are promising but require further investigation. Several topical drugs are also empirically used in the therapy of equine viral keratitis. Copyright © 2016 Elsevier Inc. All rights reserved.

Cytomorphologic significance of marginal vacuoles in diffuse thyroid enlargements

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Anshu Gupta

2013-01-01

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.

Thyroid albumin originates from blood

NARCIS (Netherlands)

de Vijlder, J. J.; Veenboer, G. J.; van Dijk, J. E.

1992-01-01

Iodoalbumin has been found in the goiter of Dutch goats with a thyroglobulin synthesis defect. Immunohistochemical studies showed that in the goiter the percentage of follicles containing albumin was higher than that in normal thyroid glands. In the albumin-containing follicles of normal and

Scintigraphy and ultrasonography of various thyroid diseases

International Nuclear Information System (INIS)

Ban, Yoshio; Nagakura, Hozumi; Kawauchi, Akihiro; Fukunari, Nobuhiro; Itoh, Kunihiko; Higashi, Tomomitsu.

1987-01-01

We reported the usefulness of scintigraphy and ultrasonography of various thyroid diseases. The scintigraphy were useful information in the determination of functioning adenoma, location of ectopic thyroid glands and appearance of lang and bone metastasis of thyroid carcinoma. As ultrasonography were able to be observation of internal structure of thyroid gland, that maight be used to determined associated nodular lesions in diffuse goiter and differentiation between benign and malignant tumor in nodular goiter. In observation of calcifications of goiter, soft X rays apparatus were usefull tool. US, as initial diagnostic test before scintiscanning, provided useful information and minimized radiation exposure. (author)

Bócio mergulhante – A propósito de um caso de estridor no Serviço de Urgência

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Sónia Martins

2017-12-01

Com este caso salienta-se a importância da rápida integração dos dados da anamnese em conjunto com o exame objetivo na abordagem a um doente na sala de emergência. Substernal goiter is a relatively rare condition and is estimated to correspond to 7% of all cases of goiter. In most cases it is asymptomatic (being accidentally detected, but may produce symptons resulting from the compression of contiguous structures. The authors present the case of a 89 year-old woman, with personal history of goiter, admitted in the Emergency Department (emergency room due to respiratory distress with stridor. The evaluation was compatible with large substernal goiter with deviation and tracheal deformity, presenting an analytical evaluation revealing with hyperthyroidism. The case was discussed with Endocrinologic Surgery medical team and the patient was submitted to total thyroidectomy. This case emphasizes the importance of the rapid integration of data from anamnesis and examination in the approach to a patient in the emergency room.

Subacute thyroiditis at Londrina county, PR, Brazil

International Nuclear Information System (INIS)

Calegaro, J.U.M.; Calegaro, N.Q.M.

During 3,5 years (July 74 - December 77) 130 cases of subacute thyroiditis were observed at Londrina county, North area of Parana State; this disease was considered a peculiar problem of local pathology on thyroid disorders. These cases had the following distribution: 89 in the initial stage, 36 in the transition, 2 in remission and another 3 considered as of delayed and ciclic character. Women predominated by a factor of 5,19; the peak age was 30-40 years and it had a seasonal preference for winter and spring. Factors that mislead the diagnosis are pre-existing goiter (12,3%) and infectious diseases of the upper respiratory tract (35,38%). The goiter was diffuse in 50% of the cases and nodular in 30%; the thyroid had a normal size in the others. Painless gland occurred in 5 cases. The laboratory examinations are so important for diagnosis as for disease staging and evolution. Thyrotoxicosis occurred in 31 cases of the initial stage. Hypothyroidism in the transition state was present in 8 cases: 1 clinical and 7 subclinical. Evidence, for permanent functional impairment was demonstrated for 2 patients. Corticotherapy was the effective treatment, without evidence of good response with analgesic-antiinflammatory association. Thyrotoxicosis of the initial stage showed satisfactory results to the propanalol (β adrenergic blockage). Surgery was restricted to patients with eventual residual nodule. (author) [pt

Evaluation of treatment with 15 mCi of 131I to patients bearing toxic diffuse goiter (graves disease)

International Nuclear Information System (INIS)

Filho, J.A.; Silva, J.M. Ferreira da; Santoro, C.

2008-01-01

Full text: The multiple interferences of the physical and social environment on the people, represented especially for the lack of iodine, the basic chemical element for good functioning of the thyroid, in interior or raised regions; in situations of nutritional deficiency or excess of that chemical element absorbed through foods and or drugs; by stress and inadequate feeding to which they are submitted, when facing assumed social responsibilities; for the rural exodus in search of new chances in the great cities; and especially, the women, for the consequences of the continuous use of contraceptives; for greater sensitivity to the humoral and tumoral answers etc., if it becomes the greater target of the thyroid disease called Toxic Diffuse Goiter or Graves disease, as is verified in this report, the existence of about 4 women for each 1 man. However, the implemented sanitary actions for the treatment that such complex diseases, demand, are not satisfactory. The applied doses, on average, are not satisfying the necessities, according to the study carried out with 180 patients (38 males and 142 females), with an average age of (43.6 ± 12.6) years, varying from 15 to 70 years; an average thyroid mass of (37.4 ± 19.5) g, varying from 19.0 to 89.3 g; an average 24-hour uptake of 131 I of (53.6 ± 20.3) %, varying from 20.5 88.1 %; that they had been submitted to in average radiotherapeutic activity of (15.0 ± 1.4) mCi, varying from 12 to 20 mCi; where the output was (41.1 ± 15.6) % and the rate of desistance reached (52.4 ± 15.3) %. A retrospective study on the radiotherapeutic efficiency, covering dozens of treatments and thousands of patients from dozens of countries, in physical, clinical and biokinetic situations of iodine uptake by he thyroid, on average, similar to ours showed that the most efficient average dose, compared with our averages of dosimetric parameters, was about 30.2-34.5 mCi, that is, 2.0-2.3 times bigger than that the applied here. The data

Pathomorphological study on thorotrast-induced hepatic angiosarcoma

International Nuclear Information System (INIS)

Umezu, Tohru

1984-01-01

Pathomorphological study on 18 cases of hepatic angiosarcoma among 93 cases of Thorotrast deposition was carried out. Macroscopically, hepatic angiosarcoma was classified into 4 types: multinodular, massive and diffuse types in addition to mixed type with massive and multinodular. Histologically, hepatic angiosarcoma consisted of 3 main patterns: cavernous, sinusoidal and solid, and they were coexisted in varying degrees in all cases. Factor VIII related antigen was found positive in normal and/or hyperplastic endothelial cells by a peroxidase-antiperoxidase (PAP) method, but negative in neoplastic cells while lysozyme was also negative in neoplastic cells. Varying degrees of hyperplastic changes of endothelial cells were considered as the precursor changes of angiosarcoma, and peliosis was considered as the secondary change. (author)

Recurrent transient thyrotoxicosis in multinodular goitre.

OpenAIRE

Arem, R.

1990-01-01

A patient initially presented with an autonomously functioning right thyroid nodule and transient hyperthyroidism which lasted for a few months. Several months after resolution of thyrotoxicosis, the patient had a recurrent episode of hyperthyroidism and was found to have a left hot nodule. The right hyperfunctioning nodule had become cold on scintigraphy, and its aspiration revealed haemorrhagic fluid suggesting haemorrhagic infarction as the mechanism of resolution of the first episode of h...

Lipid peroxidation and antioxidants status in human malignant and non-malignant thyroid tumours.

Science.gov (United States)

Stanley, J A; Neelamohan, R; Suthagar, E; Vengatesh, G; Jayakumar, J; Chandrasekaran, M; Banu, S K; Aruldhas, M M

2016-06-01

Thyroid epithelial cells produce moderate amounts of reactive oxygen species that are physiologically required for thyroid hormone synthesis. Nevertheless, when they are produced in excessive amounts, they may become toxic. The present study is aimed to compare the lipid peroxidation (LPO), antioxidant enzymes - superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and non-protein thiols (reduced glutathione (GSH)) in human thyroid tissues with malignant and non-malignant disorders. The study used human thyroid tissues and blood samples from 157 women (147 diseased and 10 normal). Thyroid hormones, oxidative stress markers and antioxidants were estimated by standard methods. LPO significantly increased in most of the papillary thyroid carcinoma (PTC: 82.9%) and follicular thyroid adenoma (FTA: 72.9%) tissues, whilst in a majority of nodular goitre (69.2%) and Hashimoto's thyroiditis (HT: 73.7%) thyroid tissues, it remained unaltered. GSH increased in PTC (55.3%), remained unaltered in FTA (97.3%) and all other goiter samples studied. SOD increased in PTC (51.1%) and all other malignant thyroid tissues studied. CAT remained unaltered in PTC (95.7%), FTA (97.3%) and all other non-malignant samples (HT, MNG, TMNG) studied. GPx increased in PTC (63.8%), all other malignant thyroid tissues and remained unaltered in many of the FTA (91.9%) tissues and all other non-malignant samples (HT, MNG, TMNG) studied. In the case of non-malignant thyroid tumours, the oxidant-antioxidant balance was undisturbed, whilst in malignant tumours the balance was altered, and the change in r value observed in the LPO and SOD pairs between normal and PTC tissues and also in many pairs with multi-nodular goitre (MNG)/toxic MNG tissues may be used as a marker to differentiate/detect different malignant/non-malignant thyroid tumours. © The Author(s) 2015.

Relationship Among Pulmonary Hypertension, Autoimmunity, Thyroid Hormones and Dyspnea in Patients With Hyperthyroidism.

Science.gov (United States)

Zuhur, Sayid Shafi; Baykiz, Derya; Kara, Sonat Pinar; Sahin, Ertan; Kuzu, Idris; Elbuken, Gulsah

2017-04-01

Previous studies have reported conflicting results regarding the mechanisms underlying the pathophysiology of pulmonary hypertension (PHT) in patients with hyperthyroidism. Therefore, in this study, we investigated the association between PHT and thyroid-stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3, fT4 and dyspnea during daily activities in a large population of patients with hyperthyroidism. A total of 129 consecutive patients with hyperthyroidism, 37 with hypothyroidism and 38 euthyroid controls were enrolled in this study. The modified medical research council scale was used for the assessment of dyspnea in daily activities. All the patients and euthyroid controls underwent transthoracic echocardiography for the assessment of PHT. Mild PHT was present in 35%, 36%, 13.5% and 5% of the patients with Graves׳ disease, toxic multinodular goiter, hypothyroidism and euthyroid controls, respectively. Pulmonary vascular resistance (PVR) was higher in hyperthyroid patients with PHT than in those without PHT. Moreover, a significant positive correlation was found between modified medical research council scale and pulmonary artery systolic pressure as well as PVR in patients with hyperthyroidism. No association was found between PHT and serum TSH receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3 and fT4 levels. Mild PHT is present in a significant proportion of patients with hyperthyroidism, regardless of etiology. PVR appears to be the main cause of PHT in patients with hyperthyroidism, and neither autoimmunity nor thyroid hormones are associated with PHT in these patients. Mild dyspnea during daily activities in patients with hyperthyroidism may be related to PHT; however, severe dyspnea requires further evaluation. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Treatment of hyperthyroidism with radioiodine targeted activity: A comparison between two dosimetric methods.

Science.gov (United States)

Amato, Ernesto; Campennì, Alfredo; Leotta, Salvatore; Ruggeri, Rosaria M; Baldari, Sergio

2016-06-01

Radioiodine therapy is an effective and safe treatment of hyperthyroidism due to Graves' disease, toxic adenoma, toxic multinodular goiter. We compared the outcomes of a traditional calculation method based on an analytical fit of the uptake curve and subsequent dose calculation with the MIRD approach, and an alternative computation approach based on a formulation implemented in a public-access website, searching for the best timing of radioiodine uptake measurements in pre-therapeutic dosimetry. We report about sixty-nine hyperthyroid patients that were treated after performing a pre-therapeutic dosimetry calculated by fitting a six-point uptake curve (3-168h). In order to evaluate the results of the radioiodine treatment, patients were followed up to sixty-four months after treatment (mean 47.4±16.9). Patient dosimetry was then retrospectively recalculated with the two above-mentioned methods. Several time schedules for uptake measurements were considered, with different timings and total number of points. Early time schedules, sampling uptake up to 48h, do not allow to set-up an accurate treatment plan, while schedules including the measurement at one week give significantly better results. The analytical fit procedure applied to the three-point time schedule 3(6)-24-168h gave results significantly more accurate than the website approach exploiting either the same schedule, or the single measurement at 168h. Consequently, the best strategy among the ones considered is to sample the uptake at 3(6)-24-168h, and carry out an analytical fit of the curve, while extra measurements at 48 and 72h lead only marginal improvements in the accuracy of therapeutic activity determination. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

CLINICAL STUDY OF HASHIMOTO’S THYROIDITIS & ITS MANAGEMENT

Directory of Open Access Journals (Sweden)

Purnaiah

2016-03-01

Full Text Available INTRODUCTION Hashimoto’s Thyroiditis is a well-known clinical condition affecting the thyroid gland predominantly in women during 4 th decade & is often under diagnosed due its wide spectrum of clinical features. It could present as a multinodular goitre, diffuse goitre, or as a solitary nodule with features of Hypothyroidism, Hyperthyroidism or Euthyroid state. AIMS 1. To detect HT by FNAC, Antibody titers finally by Histopathology of excised Thyroid gland. 2. To know its various clinical features. 3. To study Sex ratio & Age it affects. 4. Management i.e. by conservative or surgical. 5. Complications & malignant transformation including Lymphomas. MATERIALS & METHODS 60 patients were taken for 2 years’ period from March 2014 to Feb 2016 attending Government General Hospital-Nizamabad; Telangana State. OBSERVATIONS  56 case are females, 4 cases are males; common age is 30-39 yrs., >50 yrs.-2 cases.  All cases presented with swelling in front of neck, only 5 had toxicity, 2 had obstructive symptoms. None had voice change.  36 Cases- 60% had MNG, 18 Cases- 30% diffuse goitre and 6 cases- 10%- solitary nodule.  The Hypothyroid, Euthyroid & Hyperthyroid state here are 48%, 44% & 8% comparative to Fenn et al -44%, 47% and 7%,  FNAC- was positive 90% here where as Lakshman Rao et al study has 77%.  We had 80% Anti Thyroid Antibodies positivity, others shown 63% and 84%. MANAGEMENT All are put on Hormone-Thyroxine replacement or suppression therapy and all patients found to be clinically Euthyroid during follow up. All patients showed decrease in size of gland except those with MNG. 8 patients underwent surgery- Subtotal Thyroidectomy. Of these 6 were Colloid goiters, later on diagnosed as HT by final HPE. One case was operated for cosmetic reason and the other for obstructive symptoms which was noticed to be lymphoma after HPE.

Optical biopsy of head and neck cancer using hyperspectral imaging and convolutional neural networks

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Halicek, Martin; Little, James V.; Wang, Xu; Patel, Mihir; Griffith, Christopher C.; El-Deiry, Mark W.; Chen, Amy Y.; Fei, Baowei

2018-02-01

Successful outcomes of surgical cancer resection necessitate negative, cancer-free surgical margins. Currently, tissue samples are sent to pathology for diagnostic confirmation. Hyperspectral imaging (HSI) is an emerging, non-contact optical imaging technique. A reliable optical method could serve to diagnose and biopsy specimens in real-time. Using convolutional neural networks (CNNs) as a tissue classifier, we developed a method to use HSI to perform an optical biopsy of ex-vivo surgical specimens, collected from 21 patients undergoing surgical cancer resection. Training and testing on samples from different patients, the CNN can distinguish squamous cell carcinoma (SCCa) from normal aerodigestive tract tissues with an area under the curve (AUC) of 0.82, 81% accuracy, 81% sensitivity, and 80% specificity. Additionally, normal oral tissues can be sub-classified into epithelium, muscle, and glandular mucosa using a decision tree method, with an average AUC of 0.94, 90% accuracy, 93% sensitivity, and 89% specificity. After separately training on thyroid tissue, the CNN differentiates between thyroid carcinoma and normal thyroid with an AUC of 0.95, 92% accuracy, 92% sensitivity, and 92% specificity. Moreover, the CNN can discriminate medullary thyroid carcinoma from benign multi-nodular goiter (MNG) with an AUC of 0.93, 87% accuracy, 88% sensitivity, and 85% specificity. Classical-type papillary thyroid carcinoma is differentiated from benign MNG with an AUC of 0.91, 86% accuracy, 86% sensitivity, and 86% specificity. Our preliminary results demonstrate that an HSI-based optical biopsy method using CNNs can provide multi-category diagnostic information for normal head-and-neck tissue, SCCa, and thyroid carcinomas. More patient data are needed in order to fully investigate the proposed technique to establish reliability and generalizability of the work.

Juvenile hyperthyroidism: an experience.

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Bhadada, S; Bhansali, A; Velayutham, P; Masoodi, S R

2006-04-01

To analyze the clinical profile of juvenile hyperthyroidism at presentation, their treatment outcome; predictors of remission and relapse. Retrospective analysis of medical records of 56 patients with juvenile hyperthyroidism seen over a period of 16 years. A cohort of 38 females and 18 males with mean (+/-SD) age of 14.9 +/- 3.4 years (range 3 to 18 years) was analyzed. Majority of patients was in the age group of 12-16 years. Common symptoms observed at presentation were weight loss (82.1%), excessive sweating (78.6%), heat intolerance (76.8%), increased appetite (73.2%) and diarrhea in 48.2%. In addition, accelerated linear growth was observed in 7.1% of patients. Goiter was present in 98.2% of children; 94.5% of which was diffuse and 4.8% was multinodular. The mean ((+/-SD) T3 was 4.8 +/- 3.4 ng/mL (N, 0.6-1.6), T4 was 218 +/- 98 ng/mL (N, 60-155) and TSH was 0.44 +/- 0.36 (N, 0.5-5.5 microIU/mL). TMA positivity seen in 36.9% of patients. All patients were treated with carbimazole; subsequently 4 patients required thyroidectomy and one required radioactive iodine ablation. Mean (+/-SD) duration of follow-up in our patients was 4.9 +/- 3 years, ranging between 1.6 to 16 years and mean (+/-SD) duration of treatment was 34.4 +/- 22.6 months (range 12 to 120 months). Mean (+/-SD) duration to achieve euthyroidism was 5.2 +/- 4.7 months, ranging between 1-33 months. On intention to treat analysis, remission with carbimazole was achieved in 47.6%, remaining patients failed to achieve remission with drug treatment. Graves disease is the commonest cause of juvenile hyperthyroidism. Carbimazole is safe, effective, cheap, and easily available form of therapy. It is occasionally associated with serious side effects but requires prolonged follow up.

Evaluation of thyroid function in female subjects living in the high natural background radiation area of Karunagappally, Kerala

International Nuclear Information System (INIS)

Sreekumar, A.; Nair, Raghu Ram K.; Jayalakshmi, P.; Sebastian, P.; Akiba, S.

2010-01-01

Radiation exposure has been reported to cause non cancer thyroid abnormalities like diffuse goiter and thyroid nodules. The present study was undertaken to see if there are any morphological and functional changes taking place in the thyroid due to chronic low level radiation exposure. 257 female subjects living in the four high background radiation panchayats of Chavara, Neendakara, Alappad and Panmana were selected for the study after getting informed consent. 5 ml of blood was drawn from these subjects for assessing thyroid function. The subjects were all staying in the same area since their birth and had not moved out for more than one year at a stretch. The average age of the subjects was 40.5y with a range of 17-66y. The cumulative dose had a mean of 226.3 mGy and a range of 20.6-937.8 mGy. 95 subjects from the low background area of Oachira and Thevalakkara were selected as controls in the age group of 18-63y with a mean age of 47.1y. The mean cumulative dose of this group was 35.9 mGy with a minimum of 5.3 mGy and a maximum of 106.8 mGy. 5 ml blood was collected from these subjects for thyroid function studies. All the subjects underwent ultrasound examination of the thyroid using a 10 MHz frequency linear probe. The following parameters were studied to assess thyroid function: Free T4, TSH, Antithyroglobulin antibody (ATG), Parathyroid hormone. Ultrasound images showed the following common features: Normal - 171, Suggestive of Thyroiditis - 106, Multinodular Goitre - 63, Diffuse Goitre - 5, Solitary Nodule - 31. 73 subjects had elevated TSH and 190 subjects had raised ATG. A significant numbers of subjects had features of thyroiditis. A comparative evaluation with control subjects will be done to assess its significance with reference to cumulative dose

Evaluation of proliferation potential in thyroid normo-/hypofunctioning and hyperfunctioning nodules.

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Cornianu, Marioara; Stan, V; Lazăr, Elena; Dema, Alis; Golu, Ioana; Tăban, Sorina; Vlad, Mihaela; Faur, Alexandra; Vărcuş, F; Babău, F

2011-01-01

Thyroid follicular adenomas (FA) and adenomatous thyroid nodules (AN) - lesions that are frequently found in areas with iodine deficiency, can be normo-/hypofunctioning (scintigraphically cold - SCN) or hyperfunctioning (scintigraphically hot - SHN) nodules. Evaluation of proliferation potential in thyroid nodules on tissue samples obtained at surgery from euthyroid patients clinically diagnosed with SCN and from patients with thyroid hyperfunction and SHN. We investigated the proliferation activity estimated by assessing PCNA and Ki-67 proliferation markers in 20 SCN (eight FA and 12 AN) and 16 toxic nodules (six hyperfunctioning FA and 10 toxic multinodular goiters), on formalin-fixed and paraffin-embedded tissue samples, 4-5 μm thick; we used the immunohistochemical technique in LSAB system (DAB visualization) with anti-PCNA (PC10) and anti-Ki-67 (MIB-1) monoclonal antibodies. For each case, we calculated the proliferation index PI-PCNA and PI-Ki-67. The dates were statistically evaluated using the t-unpaired test. We observed a higher PI-PCNA in thyroid nodules than in the normal surrounding thyroid tissue, with statistically significant values for FA (14.3% vs. 3.8%; pnodules vs. surrounding thyroid tissue was 1.64% vs. 1.10% in FA (p0.05). We also noted: (1) significantly higher PI-PCNA values (p 0.05); (2) increased proliferation rate (pthyroid nodules with aspects of lymphocytic thyroiditis (LT) (PI-Ki-67 was 1.21%) as compared to nodules without LT (PI-Ki-67 was 0.12%); (3) a mean PI-PCNA of 8.5% and PI-Ki-67 of 4.61% in toxic thyroid nodules (TTN) vs. 3.01% and 1.5% in normal surrounding thyroid, respectively. The clinical expression of SCN is the consequence of increased thyrocyte proliferation in the nodules; the increased proliferative potential of TTN thyrocytes is a common feature of nodules, independent of their histopathological characteristics.

Disseminated bone metastases from occult thyroid cancer effectively treated with debulking surgery and a single dosimetry-guided administration of radioiodine.

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Borsò, Elisa; Boni, Giuseppe; Mazzarri, Sara; Cocciaro, Ardico; Gambacciani, Carlo; Traino, Antonio C; Manca, Giampiero; Grosso, Mariano; Scatena, Cristian; Ortenzi, Valerio; Vannozzi, Riccardo; Marzola, Maria Cristina; Rubello, Domenico; Mariani, Giuliano

2015-01-01

In this paper we report on a successful management of multiple bone metastases from differentiated thyroid cancer. In 2007, a 75-year-old female patient, previously referred for thyroidectomy for multinodular goiter, underwent surgical removal of a lumbar mass with histological findings of metastasis from well differentiated thyroid cancer. After surgery, serum thyroglobulin (sTg) was 204.4 ng/mL. A diagnostic/dosimetric (123)I WBS was performed, following stimulation by rTSH. Serial WBSs were acquired, along with SPECT/CT and bone scan for localization of lesions. sTg raised to 3.810 ng/mL, and (123)I WBS showed thyroid remnants and numerous areas with high iodine-uptake corresponding to skeletal sites, the two largest loading on the skull, with osteolytic pattern. Calculated radiation absorbed dose for skull lesions, determined by mean of MIRD methodology, was 63.5 mGy/MBq. The patient underwent surgical removal of the two major skull lesions. Successively, 100 mCi (131)I was administered after stimulation by rTSH, with stimulated sTg 297 ng/mL. After 8 months, diagnostic WBS was negative both for remnants and metastases and rTSH-stimulated Tg was 0.6 ng/mL. To date, the patient has maintained sTg values <1 ng/mL during L-T4 suppressive therapy and after rTSH stimulations. In this unusual case of extensive bone cancerous involvement with high iodine avidity, a multidisciplinary approach based on surgery and dosimetry-guided radiometabolic therapy allowed to accurately assess the patient, execute a small number of treatments and achieve a complete remission of the disease in a very short time, with no additive morbidity. Copyright © 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

Hypocalcaemia following thyroidectomy for treatment of Graves' disease: implications for patient management and cost-effectiveness.

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Hughes, O R; Scott-Coombes, D M

2011-08-01

No consensus exists on optimal treatment for Graves' disease once anti-thyroid medication fails to induce remission. Total thyroidectomy is a more cost-effective treatment than radioactive iodine or life-long anti-thyroid medication, but hypocalcaemia is an important complication, leading to longer hospital admissions and increased prescription costs. This study aimed to compare the relative risk of hypocalcaemia requiring medical treatment for patients with Graves' disease. Prospective cohort study of patients undergoing total thyroidectomy for Graves' disease and for multinodular goitre, calculating serum calcium levels 24-hours post-operatively and prescription rates. Mean corrected calcium concentrations 24 hours post-operatively were 2.05 mmol/l for Graves' disease patients and 2.14 mmol/l for multinodular goitre patients (p = 0.003). Biochemical hypocalcaemia developed in 92 per cent (n = 34) of Graves' disease patients and 71 per cent (n = 43) of multinodular goitre patients (p = 0.012). Graves' disease patients were more likely to be prescribed calcium supplementation pre-discharge (p = 0.037). Total thyroidectomy for Graves' disease carries an increased risk of hypocalcaemia at 24 hours, and of calcium supplementation pre-discharge. Graves' disease patients should be informed of the increased risk of hypocalcaemia associated with total thyroidectomy, and this risk must be factored into future cost-effectiveness analysis.

Outcomes of medical management of thyrotoxicosis in Benin City ...

African Journals Online (AJOL)

The frequency of symptoms were anterior neck mass 68.57%, weight loss 60%, palpitation 60%, heat intolerance 37.14%, bulging eyes 31.43%, hyperdefaecation 31.45%, and tremors of the hands 19.99%. Goiter was found in 27(77.14%), proptosis 16 (45.71%) and onycholysis 3(8.57%). Goiters persisted despite medical ...

The hyperfunctioning nodules of the thyroid

International Nuclear Information System (INIS)

Rosenthal, D.

1975-01-01

Iodine kinetic studies, using a double label ( 131 I - and T 4 -125 I), were performed on 8 patients with hot thyroid nodules, 3 diffuse toxic goiters and one normal control. This investigation was complemented by partial kinetic studies done on 62 other subjetcs, including normal controls and euthyroid or hyperthyroid patients with diffuse or nodular goiter [pt

On the cells of origin of radiogenic thyroid cancer: New studies based on an old idea

International Nuclear Information System (INIS)

Clifton, K.H.; Domann, F.E.; Groch, K.M.

1990-01-01

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

3,3'-Diindolylmethane, a cruciferous vegetable derived synthetic anti-proliferative compound in thyroid disease

International Nuclear Information System (INIS)

Tadi, Kiranmayi; Chang Yushan; Ashok, Badithe T.; Chen, Yuangen; Moscatello, Augustine; Schaefer, Steven D.; Schantz, Stimsom P.; Policastro, Anthony J.; Geliebter, Jan; Tiwari, Raj K.

2005-01-01

Considerable epidemiological evidence exists to link thyroid disease with differing patterns of dietary consumption, in particular, cruciferous vegetables. We have been studying the anti-thyroid cancer (TCa) activity of indole-3-carbinol (I3C) found in cruciferous vegetables and its acid catalyzed dimer, 3,3'-diindolylmethane (DIM). There are no studies as yet to elucidate the effect of these compounds on the altered proliferative patterns in goiter or thyroid neoplasia. In this study, we tested the anti-proliferative effects of I3C and DIM on four different thyroid cancer cell lines representative of papillary (B-CPAP and 8505-C) and follicular carcinoma of the thyroid (CGTH-W-1 and ML-1), and primary human goiter cells. Cell survival and IC 50 values for I3C and DIM were calculated by the XTT assay and cell cycle distribution analysis was done by flow cytometry. DIM was found to be a better anti-proliferative agent than I3C in both papillary and follicular TCa resulting in a greater cytotoxic effect at a concentration over three fold lower than predicted by the molar ratio of DIM and I3C. The anti-proliferative activity of DIM in follicular TCa was mediated by a G1 arrest followed by induction of apoptosis. DIM also inhibited the growth of primary goiter cells by 70% compared to untreated controls. Contrary to traditional belief that cruciferous vegetables are 'goitrogenic,' DIM has anti-proliferative effects in glandular thyroid proliferative disease. Our preclinical studies provide a strong rationale for the clinical exploration of DIM as an adjuvant to surgery in thyroid proliferative disease

Possibilities of 99mTc-MIBI for imaging of the thyroid parenchyma

International Nuclear Information System (INIS)

Mluchkov, N.; Mluchkov, Kh.

1998-01-01

Thyroid parenchyma imaging is very important as an evidence of residual part of the gland in case of thyroidectomy. The determination of the mass of this part and its function is crucial at the substituting hormonal therapy. Also at cases of thyroid carcinomas the differential diagnosis of recurrences of radiation and/or postoperative fibrosis is difficult. The thyroid imaging by 131 I and by 99m Tc-pertechnetates is not always possible because of gland blockage from medicines, thyroid hormones and foods with high iodine content. The aim of this study was to establish if 99m Tc-MIBI could depict the thyroid parenchyma without being influenced by gland blockage giving a real image of it. A comparative scintigraphic study has been carried out at 58 patients with different thyroid diseases using 99m Tc-pertechnetate, 131 I and 99m Tc-MIBI. There were 17 patients with diffuse goiter, 27 with nodules (23 of normal activity and 4 with cold nodules), 3 patients with retrosternal goiter and 11 with thyroid carcinoma after surgery intervention. The visualization of the thyroid parenchyma with 99m Tc-MIBI was better than that with 99 0 m Tc-pertechnetate and no dependent on suppression of the gland. All nodules showed 99m Tc-MIBI uptake with the same intensity as the surrounding normal gland tissue. The scintigraphy with 99m Tc-MIBI was of no value for differential diagnosis of nodules. 99m Tc-MIBI scintigraphy could be successfully applied at patients with retrosternal thyroid goiter and for detecting a thyroid rest at patients with thyroid cancer after surgery intervention. (author)

[Non-autoimmune thyroiditis].

Science.gov (United States)

Rizzo, Leonardo F L; Mana, Daniela L; Bruno, Oscar D

2014-01-01

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.

[AUTOIMMUNE REACTIONS IN PATIENTS WITH DISEASES OF A THYROID GLAND].

Science.gov (United States)

Saidova, F Kh; Shakhsuvarov, O M; Guseynov, R G; Akhmedova, L M; Aslanova, Zh B

2015-11-01

A state of autoimmunity was studied in 25 patients, suffering diffuse toxic goiter (DTG), and in 20--in nodular euthyroid goiter (NEG) before and after the operation. The level of circulating immune complexes, quantity of cytotoxic lymphocytes, the subpopulation index, the apoptosis marker were determined. There was established, that in NEG autoimmune disorders have occurred rarer and were less severe, than in DTG.

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

DEFF Research Database (Denmark)

Fast, Søren; Hegedus, Laszlo; Pacini, Furio

2014-01-01

with 131I-therapy. Methods: In this phase II, single-blinded, placebo-controlled study, 95 patients (57.2±9.6 years old, 85% women, 83% Caucasians) with MNG (median size 96.0 ml (31.9 - 242.2 ml)) were randomized to receive placebo (n=32), 0.01 mg MRrhTSH (n=30) or 0.03 mg MRrhTSH (n=33), 24 hours before...... a calculated 131I activity. Thyroid volume (TV) and smallest cross-sectional area of trachea (SCAT) were measured (by CT-scan) at baseline, month 6 and month 36. Thyroid function and quality of life (QoL) was evaluated at 3 month and yearly intervals, respectively. Results: At 6 months, TV reduction...... was enhanced in the 0.03 mg MRrhTSH group (32.9% versus 23.1% in the placebo group, p=0.03), but not in the 0.01 mg MRrhTSH group. At month 36 the mean percent TV reduction from baseline was 44 ± 12.7% (SD) in the placebo group, 41 ± 21.0% in the 0.01 mg MRrhTSH-group and 53 ± 18.6% in the 0.03 mg MRrh...

The Relative Frequency of Persistent Hyperthyroidism After I131Therapy

International Nuclear Information System (INIS)

Al-EID, M.A.

1998-01-01

517 patients with different types of hyperthyroidism who had treated by I 131 therapy were studied. The study demonstrated that diffuse toxic goiter was the most common type of hyperthyroidism. The relative frequency of persistent hyperthyroidism in all types after the first dose of I 131 utilizing our empirical regimen in estimation of therapy doses was low (9.5%). While high frequency of persistent hyperthyroidism among diffuse toxic goiter patients (14%), probably was due to many factors discussed in this paper. Some of these factors are impossible to be estimated precisely and therefore, can not be avoided. But careful dose estimation for each case with diffuse toxic goiter may reduce the rate of retreatment by I 131 . Antithyroid medication prior to I 131 therapy might be another factor resulted in increasing of retreatment of retreatment rate diffuse toxic goiter cases. Longer time interval (more than 5 days) of ceasing antithyroid medication prior therapy is suggested to avoid the effects of these drugs. Patients with other types of hyperthyroidism were not frequently required more than one dose and the frequency of persistent hyperthyroidism was almost negligible

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

Directory of Open Access Journals (Sweden)

I V Makarov

2013-06-01

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.

Reevaluation of the 131I thyroid uptake in Rio de Janeiro

International Nuclear Information System (INIS)

Rosenthal, D.; Frankenfeld, T.G.P.; Assis Paiva, H.J. de; Fridman, J.

1982-01-01

The values of the 3 and 24 hour thyroid radioiodine uptake were analysed in 919 of the patients examined during 1977-1980. Reference values determined for 95% of the normal population are 2.5 - 17.5% for the 3 hour thyroid uptake values, and 10.5 - 41.2% for the 24 hour values. The non-toxic diffuse goiter group has significantly higher mean values than normals or patients with non-toxic nodular goiters and cold nodules, their upper values reaching 24.7% and 52.9% for 3 and 24 hour uptake. The discriminatory power of the test for non-toxic diffuse goiters may be increased if higher limits than those determined for normals are used in day to day routine. Values of 20% for 3 hour uptake and 45% for the 24 hour uptake improve diagnosis in these patients without seriously reducing the capacity for identification of thyrotoxicosis. A value greater than 0.6 for the ratio between the 3 hour and 24 hour uptake can serve as a coadjuvant factor in the diagnosis of diffuse toxic goiters; values higher than 0.8 were found in less than 0.5% of the non-toxic patients. (Author) [pt

Novel compound heterozygous Thyroglobulin mutations c.745+1G>A/c.7036+2T>A associated with congenital goiter and hypothyroidism in a Vietnamese family. Identification of a new cryptic 5' splice site in the exon 6.

Science.gov (United States)

Citterio, Cintia E; Morales, Cecilia M; Bouhours-Nouet, Natacha; Machiavelli, Gloria A; Bueno, Elena; Gatelais, Frédérique; Coutant, Regis; González-Sarmiento, Rogelio; Rivolta, Carina M; Targovnik, Héctor M

2015-03-15

Several patients were identified with dyshormonogenesis caused by mutations in the thyroglobulin (TG) gene. These defects are inherited in an autosomal recessive manner and affected individuals are either homozygous or compound heterozygous for the mutations. The aim of the present study was to identify new TG mutations in a patient of Vietnamese origin affected by congenital hypothyroidism, goiter and low levels of serum TG. DNA sequencing identified the presence of compound heterozygous mutations in the TG gene: the maternal mutation consists of a novel c.745+1G>A (g.IVS6 + 1G>A), whereas the hypothetical paternal mutation consists of a novel c.7036+2T>A (g.IVS40 + 2T>A). The father was not available for segregation analysis. Ex-vivo splicing assays and subsequent RT-PCR analyses were performed on mRNA isolated from the eukaryotic-cells transfected with normal and mutant expression vectors. Minigene analysis of the c.745+1G>A mutant showed that the exon 6 is skipped during pre-mRNA splicing or partially included by use of a cryptic 5' splice site located to 55 nucleotides upstream of the authentic exon 6/intron 6 junction site. The functional analysis of c.7036+2T>A mutation showed a complete skipping of exon 40. The theoretical consequences of splice site mutations, predicted with the bioinformatics tool NNSplice, Fsplice, SPL, SPLM and MaxEntScan programs were investigated and evaluated in relation with the experimental evidence. These analyses predicted that both mutant alleles would result in the abolition of the authentic splice donor sites. The c.745+1G>A mutation originates two putative truncated proteins of 200 and 1142 amino acids, whereas c.7036+2T>A mutation results in a putative truncated protein of 2277 amino acids. In conclusion, we show that the c.745+1G>A mutation promotes the activation of a new cryptic donor splice site in the exon 6 of the TG gene. The functional consequences of these mutations could be structural changes in the protein

Thyroid imaging in goiter

International Nuclear Information System (INIS)

Maier, R.

1994-01-01

Since Cassen und Taylor and Stewart introduced 131 iodine scans of the thyroid, these have become an integral part of the routine diagnostic procedures for thyroid disease. Today 131 I is no longer used due to its excessive radioactivity; 123 iodine or 99m technetium are now preferred. Pitfalls in the use of 99m Tc are that in some thyroid disorders, such as certain forms of thyroid carcinomas and chronic thyroiditis, a normal iodine trapping (but not organification) may occur. This mechanism can lead to false conclusions. (orig.) [de

Purine Nucleoside Phosphorylase (PNP) Activity of Lymphocytes and T Cell Subsets in Peripheral Blood in Thyroid Tumors

International Nuclear Information System (INIS)

Kim, Dong Soo

1992-01-01

To elucidate alteration of purine nucleoside phosphorylase (PNP) activity of peripheral lymphocytes and helper/inducer and suppressor/cytototxic T cells in patients with thyroid tumors, the author examined PNP activity, and CD4 + and CD8 + cells of peripheral blood in 20 cases of simple goiter, 9 cases of thyroid adenoma and 20 cases of thyroid cancer as well as 11 cases of adult healthy subjects as control. Diagnoses were established on the basis of commonly accepted clinical and biochemical criteria in simple goiter and were confirmed histopathologically in thyroid adenoma and cancer. All blood was obtained from veins of the patients and control subjects in Pusan National University Hospital during the period of January to August, 1991. The results obtained were summarized as follows: 1) The PNP activity was significantly decreased or tended to be decreased in thyroid adenomas and cancers as compared with control subjects and simple goiters. 2) The percentage of CD8 cells was significantly decreased or tended to be decreased in thyroid cancers as compared with simple goiters, thyroid adenomas and control subjects. 3) The CD4/CD8 ratio was significantly increased or tended to be increased in thyroid cancer as compared with simple goiters, thyroid adenomas and control subjects. On the basis of the results, it can be suggested that the immunodysfunction in thyroid cancer may be due to decreased suppressor/cytotoxic T cells, and the estimation of PNP activity of peripheral lymphocyte is a helpful test in detecting the immune status in thyroid tumors.

Electronic and oscillation absorption spectra of blood plamsa at surgical diseases of thyroid gland

Science.gov (United States)

Guminetskiy, S. G.; Motrich, A. V.; Poliansky, I. Y.; Hyrla, Ya. V.

2012-01-01

The results of investigating the absorption spectra of blood plasma in the visible and infrared parts of spectra obtained using the techniques of spherical photometer and spectrophotometric complex "Specord IR75" are presented. The possibility of using these spectra for diagnoses the cases of diffuse toxic goiter and nodular goiter and control of treatment process in postsurgical period in the cases of thyroid gland surgery is estimated.

Incidental cancer in multinodular goitre post thyroidectomy

African Journals Online (AJOL)

of choice to rule out cancer in patients presenting with MNG is fine- ... Method. Records of patients who underwent thyroidectomy between January 2005 and December 2010 at Chris Hani .... each of benign goitre and atypical cells, one Hurthle cell lesion .... 6%) in their retrospective audit of MNG post thyroidectomy. The.

Radioiodine therapy in non-toxic multinodular goitre

DEFF Research Database (Denmark)

Bonnema, Steen J; Nielsen, Viveque E; Hegedüs, Laszlo

2006-01-01

I activity, rhTSH pre-stimulation improves the goitre reduction by 30-50%. However, this is at the expense of a higher rate of hypothyroidism, cervical pain and transient thyrotoxicosis. Of particular concern is the observation made in healthy persons, that rhTSH results in a transient average...

Ultrasound and computed tomographic demonstration of portal vein thrombosis in hepatocellular carcinoma

Energy Technology Data Exchange (ETDEWEB)

Pauls, C H

1981-07-15

Two cases of multinodular hepatocellular carcinoma (HCC) in which ultrasound and computed tomography (CT) revealed portal vein thrombosis are presented. The diagnostic value of determining the presence of portal vein thrombosis in patients with suspected HCC is discussed.

The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism

DEFF Research Database (Denmark)

Biondi, Bernadette; Bartalena, Luigi; Cooper, David S

2015-01-01

Endogenous subclinical hyperthyroidism (SHyper) is caused by Graves' disease, autonomously functioning thyroid nodules and multinodular goitre. Its diagnosis is based on a persistently subnormal serum thyroid-stimulating hormone (TSH) level with free thyroid hormone levels within their respective...

A retrospective assessment of the effectiveness of radioiodine treatment of hyperthyroid patients from 1997 to 2003 in the north-eastern region of Poland

International Nuclear Information System (INIS)

Budlewski, T.; Rogowski, F.; Szumowski, P.; Parfienczyk, A.; Sopotyk, A.; Kociura-Sawicka, A.; Abdelrazek, S.

2005-01-01

results from a specific form of hyperthyroidism in the region: over 80% of hyperthyroidism is caused by unifocal autonomous and multinodular hyperthyroid goiter. The long-term results of RIT in this region will be known once an additional analysis is conducted after a 5 and/or 10 year period. (author)

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

Directory of Open Access Journals (Sweden)

Francisco Ochoa Torres

2004-12-01

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

No evidence of radiation risk for thyroid gland among schoolchildren around Semipalatinsk Nuclear Testing Site.

Science.gov (United States)

Hamada, Aiko; Takamura, Noboru; Meirmanov, Serik; Alipov, Gabit; Mine, Mariko; Ensebaev, Ruslan; Sagandikova, Sagadat; Ohashi, Toshinori; Yamashita, Shunichi

2003-02-01

To assess thyroid status among the schoolchildren around Semipalatinsk Nuclear Testing Site (SNTS), Kazakhstan, and to evaluate the current status of iodine deficiency in this area, we performed medical screening of schoolchildren in two villages, Kaynar and Karaul villages, East Kazakhstan Region, Republic of Kazakhstan, located within 100 km of SNTS. A total of 196 schoolchildren were chosen at random. Control groups comprised 250 schoolchildren from Nagasaki, an iodine-rich area, and 100 schoolchildren from Gomel, an iodine-deficient area contaminated by the Chernobyl Nuclear Power Plant accident. Ultrasound screening of thyroid revealed three cases of benign thyroid disease (two cases of goiter and one single cyst), but no cases suspicious of malignancy. The urinary iodine (UI) concentrations of subjects in Kaynar and Karaul ranged from 21.8 to 735.8 microg/L, 4.3% of whom showed low UI concentrations (tests carried out in SNTS.

A Case of Painful Hashimoto Thyroiditis that Mimicked Subacute Thyroiditis

Science.gov (United States)

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

2012-01-01

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. 99mTc 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. PMID:22570820

EFFICIENCY ON GROUP PROPHYLAXIS OF IODINE DEFICIENCY IN CHILDREN LIVING IN IODINE DEFICIENCY REGION

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V.R. Kuchma

2007-01-01

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.

Detection of erythrovirus B19 in thyroidectomy specimens from Graves' disease patients: a case-control study.

Science.gov (United States)

Page, Cyril; Hoffmann, Thomas Walter; Benzerdjeb, Nassim; Duverlie, Gilles; Sevestre, Henri; Desailloud, Rachel

2013-08-01

Environmental factors, such as viruses, are thought to contribute to the development of thyroid autoimmunity. Erythrovirus B19 (EVB19) is suspected to be involved in Hashimoto's thyroiditis, but no direct evidence is available concerning the role of EVB19 infection in Graves' disease. The objective of this study was to investigate whether the presence of EVB19 is more frequent in thyroidectomy specimens of patients undergoing thyroidectomy for Graves' disease (cases) than for multinodular thyroid (controls). Serum and thyroidectomy specimens were prospectively collected from 64 patients referred for total thyroidectomy over a 5-year period (2007-2011) and were investigated retrospectively and blindly for circulating EVB19 DNA by q-PCR (Qiagen), and for EVB19 thyrocyte infection by immunochemistry (VP2-Antibody, Dako). EVB19 serology was also determined. General clinical and laboratory data were collected. Twenty patients were referred for Graves' disease and 44 patients were referred for non-autoimmune multinodular thyroid. Patients with thyroid cancer were excluded. Ten percent of Graves' disease patients and 27.7% of control patients had positive staining of thyrocytes for EVB19 antibodies (ns). EVB19-positive and EVB19-negative cases did not differ. EVB19-positive controls were older than EVB19-negative controls (mean age: 57.5 [35-74] vs. 45 [28-80] years, P=0.03) No case of acute EVB19 infection was identified. EVB19-positive serology was more frequent in controls than in Graves' disease patients (88% vs. 45%, PGraves' disease patients than in controls. Further studies are needed to determine the role of EVB19 infection in thyroid diseases. Copyright © 2013 Wiley Periodicals, Inc.

Clinical Investigation and Treatment of Thyroid Disease with Radioactive Iodine (131I)

International Nuclear Information System (INIS)

Lee, Mun Ho; Koh, Chang Soon; Ro, Heung Kyu; Koo, In Seu; Suh, Whan Jo; Lee, Kyung Ja; Lee, Hong Kyu; Lee, Chung Sang

1970-01-01

A summary of the clinical data of the 131 I-thyroid function tests and the therapeutic results of 131 I among the 2,658 patients of various thyroid diseases treated over the past 10 years from May 1960 to Oct. 1969 at the Radioisotope Clinic and Laboratory, SNUH were presented and discussed. 1) The patients examined consisted of 929 cases (34.9%) of diffuse toxic goiter, 762 cases (28.7%) of diffuse nontoxic goiter, 699 cases (26.3%) of nodular nontoxic goiter, 58 cases (2.2%) of nodular toxic goiter and 210 cases (7.9%) of hypothyroidism. 2) There were 300 (11.4%) male and 2358 (88.6%) female, showing a ratio of 1 : 8. 3) The majority of patients (79.1%) were in the 3rd-5th decade of their lives. 3) The normal ranges, diagnostic values of 131 I uptake test, 48 hrs serum activity, BMR and main subjective symptoms of various thyroid diseases were discussed. 5) In the 579 patients among 867 cases with hyperthyroidism treated with 131 I, 47.8% were confirmed to be cured completely after single therapeutic doses. 6) The complications of 131 I therapy were discussed and myxedema had developed in 6.75% of our patients. 7) The results of 131 I thyroid function tests were analysed among the 160 cases of thyroid diseases which were confirmed the diagnosis with histopathological measures.

Epidemiology of thyroid disorders and valuation of effects of iodide administration in the Sejny community (Poland) after Chernobyl accident

International Nuclear Information System (INIS)

Zimnicki, P.

1993-01-01

The epidemiology of thyroid disorders was studied and the effect of potassium iodide administration was evaluated in citizens of Sejny (Poland) community four years after Chernobyl accident. The endemic goiter was observed in this area. The elevated levels of anti-human thyroid membrane antibodies and anti-human thereoglobuline antibody were found in 5.5% of children that had undergone iodide administration after Chernobyl accident. It may result from iodide administration or from endemic goiter. (author). 127 refs, 9 figs, 16 tabs

Hyperfunctioning thyroid nodules

DEFF Research Database (Denmark)

Laurberg, P; Pedersen, K M; Vestergaard, P

1991-01-01

The authors describe the principal clinical and pathological aspects of the solitary hyperfunctioning adenoma or the multifocal hyperfunction of a multinodular goitre. Successively they report the incidence of these conditions in countries with different iodine intake as well as the age distribut...

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

Energy Technology Data Exchange (ETDEWEB)

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

2007-07-01

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.)

Guideline for radioiodine therapy for benign thyroid diseases (version 4)

International Nuclear Information System (INIS)

Dietlein, M.; Schicha, H.; Moser, E.; Reiners, C.; Schneider, P.; Schober, O.

2007-01-01

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.)

Assessment of iodine deficiency in school going children in Abbottabad - Pakistan

International Nuclear Information System (INIS)

Iqbal, N.; Shah, S.M.; Bano, S.

1999-01-01

A bout 1628 school going children were surveyed for the assessment of iodine deficiency in school going children in Abbottabad city, The purpose of this survey was to find out prevalence of goiter, severity of iodine deficiency and iodine content of the salts used by the people of the area. It was found that total goiter rate (TGR) was 23.9%. Among males 176 (23.1%) and among females 214 (24.7) were suffering from goiter, On the basis of urinary iodine (UI) 5.2% children were facing severe. Analysis of salts provided by students showed that 58.8% families were using salts with recommended level of iodine while the remaining 41-2% families were using salts with inadequate quantity of iodine. It is clear iodine deficiency is still a major public health problem in the area and most of the people in the area do not use iodized salt with recommended level of iodine. (A.B.)

Postoperative Outcomes in Graves' Disease Patients: Results from the Nationwide Inpatient Sample Database.

Science.gov (United States)

Rubio, Gustavo A; Koru-Sengul, Tulay; Vaghaiwalla, Tanaz M; Parikh, Punam P; Farra, Josefina C; Lew, John I

2017-06-01

Current surgical indications for Graves' disease include intractability to medical and/or radioablative therapy, compressive symptoms, and worsening ophthalmopathy. Total thyroidectomy for Graves' disease may be technically challenging and lead to untoward perioperative outcomes. This study examines outcomes in patients with Graves' disease who underwent total thyroidectomy and assesses its safety for this patient population. A retrospective cross-sectional analysis was performed using the Nationwide Inpatient Sample database from 2006 to 2011. Total thyroidectomy performed in patients with Graves' disease, benign multinodular goiter (MNG), and thyroid cancer was identified. Demographic factors, comorbidities, and postoperative complications were evaluated. Chi-square, one-way analysis of variance, and risk-adjusted multivariable logistic regression were performed. Of 215,068 patients who underwent total thyroidectomy during the study period, 11,205 (5.2%) had Graves' disease, 110,124 (51.2%) MNG, and 93,739 (43.6%) thyroid malignancy. Patients with Graves' disease were younger than MNG and thyroid cancer patients (M age  = 42.8 years vs. 55.5 and 51.0 years; p Graves' disease group included a higher proportion of women (p Graves' disease was independently associated with a higher risk of vocal-cord paralysis (odds ratio [OR] = 1.36 [confidence interval (CI) 1.08-1.69]), tracheostomy (OR = 1.35 [CI 1.1-1.67]), postoperative hypocalcemia (OR = 1.65 [CI 1.54-1.77]), and hematoma requiring reoperation (OR = 2.79 [CI 2.16-3.62]) compared to MNG patients. High-volume centers for total thyroidectomy were independently associated with lower risk of postoperative complications, including in patients with Graves' disease. Despite low overall morbidity following total thyroidectomy, Graves' disease patients are at increased risk of postoperative complications, including bleeding, vocal-cord paralysis, tracheostomy, and hypocalcemia. These risks appear

Incidentally detected thyrotoxicosis-etiology and natural course: A study from Central Kerala

Directory of Open Access Journals (Sweden)

Rajeev Philip

2016-01-01

Full Text Available Context: Thyrotoxicosis is a common clinical problem, and the most common cause of thyrotoxicosis is Graves′ disease and is 4 times more common than the other causes combined. Of late, the number of people incidentally detected to have biochemical thyrotoxicosis is increasing, and most patients are detected during health checkups, pregnancy planning, and surgical fitness. There are no data on the etiology and natural course of such cases and no guidelines for evaluation of such patients. Aims: The aim of this study is to evaluate the cause of thyrotoxicosis in patients incidentally detected to have biochemical thyrotoxicosis and to study the natural course of illness of these patients. Subjects and Methods: All patients who were incidentally detected to have biochemical thyrotoxicosis (during health checkups, pregnancy planning, and surgical fitness were included and studied. Patients who had symptoms of thyrotoxicosis, or patients in whom thyrotoxicosis was suspected by the treating doctor were excluded from the study. All patients underwent an ultrasound thyroid and thyroid scan, and treatment was decided based on the results. All patients were followed up for a minimum period of 3 months. Results: A total of 57 patients were studied. The average age of the study population was 32.8 years, with male:female ratio of 1:3.3. Of 57 patients, 52 (91% had subacute thyroiditis as the cause of thyrotoxicosis while Graves′ disease was seen in 9%. None had toxic adenoma or toxic multinodular goiter. In the patients with subacute thyroiditis, 47 became euthyroid and 5 became subclinically hypothyroid (Stage b. Conclusions: The majority of patients with incidentally detected thyrotoxicosis had thyroiditis as the cause, which reverted to euthyroid state in most of the cases. Based on the study, it seems prudent to wait and follow up this group of patients rather than start antithyroid drugs, especially if facilities for uptake scan are not available or

The clinical analysis of the TNF-α1 and IL-2 levels in patients with hyperthyroidism

International Nuclear Information System (INIS)

Huang Chunling; Zha Jinshun; Jiang Tingyin

2012-01-01

Objective: To explore the characters of plasma levels of the tumor necrosis factor-α1 (TNF-α1) and interleukin-2 (IL-2) in patients with hyperthyroidism due to multiple etiologies such as Graves disease (GD) and Hashimoto disease (HD) etc. Methods: Two hundred and fifty hyperthyroidism patients were divided into three groups,including GD group (n=109), HD group (n=80) and other causes of hyperthyroidism group (n=61). Ninety-eight healthy individuals served as control group.The TNF-α1 and IL-2 levels in plasma were measured by radioimmunoassay. Results: The TNF-α1 level in plasma of GD group and HD group were significantly higher than that of other causes of hyperthyroidism group (d TNF-α1 =17.638 and 19.248, both P<0.01) and normal group (d TNF-α1 =24.460 and 26.070, both P<0.01). The IL-2 level in plasma of GD group and HD group were significantly lower than that of other causes of hyperthyroidism group (d IL-2 =2.668 and 2.975, both P<0.01) and normal group (d IL-2 =2.649 and 2.955, both P<0.01).There were no significant differences of the TNF-α1 and IL-2 levels in plasma between other causes of hyperthyroidism group and normal group (d TNF-α1 =0.821, d IL-2 =0.194, both P>0.05). Conclusions: Hyperthyroidism due to autoimmune disease such as GD and HD accompanied with changes of TNF-α1 and IL-2 levels in plasma, while hyperthyroidism due to high iodine uptake, toxic multinodular goiter, and toxic adenoma did not accompany with changes of TNF-α1 and IL-2 levels in plasma. The plasma levels of TNF-α1 and IL-2 may play an important role in differential diagnosis and therapeutic effect evaluation in GD and HD. (authors)

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

Directory of Open Access Journals (Sweden)

Constanza Díaz González

1991-02-01

Full Text Available

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 antithyroid antibodies. It was found that neither criteria was satisfactory in terms of sensitivity or specificity when compared with the result of the aspiration cytology. Ac. cordingly, we favor the use of the latter provided that adequate material is obtained and that an expert reading is performed.

Se hicieron estudios clínico y de laboratorio y biopsia tiroidea por aspiración a 133 mujeres y 8 hombres con bocio difuso, de la Consulta Externa del Instituto de Seguros Sociales de Medellín, con el fin de comparar el valor diagnóstico de cuatro de los cinco criterios de Fisher con el de dicha biopsia, en la tiroiditis de Hashimoto. El diagnóstico citológico fue bocio simple (nodular, multinodular O coloide en 130 casos (92.2% y tiroiditis de Hashimoto en 11 (7.8%. Se aplicó la prueba tamiz a los criterios de Fisher, aisladamente O en grupos, con resultados deficientes en cuanto a sensibilidad y especificidad. Los criterios analizados fueron: a glándula moderadamente crecida, difusa y firme; b captación tiroidea Irregular; c TSH plasmática elevada; y d anticuerpos antitiroideos positivos a muy altas diluciones (≥:1 :25.000. La captación tiroidea Irregular tuvo la mayor sensibilidad (90% pero su especificidad fue sólo 11 %. En contraste, la sensibilidad y la especificidad de los títulos altos de anticuerpos antimicrosomales fueron 78% 71 %, respectivamente.

Cytometric evaluation of intracellular IFN-γ and IL-4 levels in thyroid follicular cells from patients with autoimmune thyroid diseases

Directory of Open Access Journals (Sweden)

Bossowski Artur

2011-09-01

Full Text Available Abstract Background In recent few years is underlined that altered balance of pro- and anti-inflammatory cytokines play an important role in the pathogenesis of AITD. The aim of this study was to estimate intracellular INF-γ and IL-4 levels in thyroid-infiltrating lymphocytes and thyrocytes isolated from thyroid tissues in 54 adolescent patients aged 8-21 years, with Graves' disease (GD; n = 18, Hashimoto's thyroiditis (HT; n = 18 and non-toxic multinodular goiter (NTMG; n = 18. Methods Fresh thyroid tissues were taken on culture medium RPMI -1640, it was mechanically prepared. In next step were added cell activators -12- myristate 13- the acetate (PMA and Ionomycin as well as the inhibitor of transportation of proteins - Breferdin A. They were cultured 24 hours in 50 ml flasks at 37°C in a 5-95% CO2-air water-saturated atmosphere. After that, thyrocytes were identified by mouse mAb directed against human TPO epitope 64 conjugated with rabbit anti-mouse antibodies IgG (Fab'2 labeled by FITC. After incubation at room temperature to each of samples added reagent A fixative the cellular membrane. In next step into the cell suspensions were added reagent B to permeabilization of cellular membrane and specific anti-IL-4-PE or anti-IFN-γ-PE mAbs. Identification of intracellular cytokines in T lymphocytes was performed in the same procedure with application of anti-CD4-PerCP and anti-CD8-PerCP mAbs specific for T lymphocytes. The cells were analyzed in a flow cytometry (Coulter EPICS XL. Results In examined group of patients with GD we observed statistically significant higher mean percentage of cells with phenotype CD4+IL-4 (p Conclusions We conclude that human thyrocytes in autoimmune thyroid disorders could be a source of cytokine production and that their activation influences local interaction with T lymphocytes inflowing to the thyroid gland.

Sonographic evaluation of thyroiditis with color flow study.

Science.gov (United States)

Sultana, N; Rima, S; Rahman, S; Azad, S A; Karim, M E; Shawkat, S; Ahsan, M; Kamal, M M; Begum, M

2014-01-01

This cross sectional study was carried out in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Bangladesh in collaboration with the Department of Endocrinology and Department of Histopathology of the same hospital during the period of March 2007 to February 2008 to determine efficacy of ultrasonogram in the evaluation of thyroiditis and to compare its results with color flow Doppler study. For this purpose, a total of 50 patients having clinical suspicion of thyroiditis were enrolled in this study. Ultrasound and color Doppler were done in all these patients. Then all patients underwent for FNAC in the Histopathology department. Correlation between sonographic diagnosis and histopathological diagnosis were observed. Out of these 50 patients 10(20%) were male and 40 (80%) were female with age ranging from 12 to 50 years, highest between 21 to 30 years. The mean age of the patients was 30.42±9.57 years. On unltrasonographic findings of thyroid gland 42.0% patients had regular and 58.0% had irregular margin. Seventy percent had fibrosis, 14.0% had feature of necrosis, 48.0% had lymphadenopathy. Out of all patients 6.0% had normal echogenic feature, 16.0% had increased and 78.0% decreased echogeneic feature. Twelve percent (12.0%) patients had homogeneous and 88.0% had heterogeneous pattern of echogenecity. Thirty eight percent (38%) patients had focal nodules. Sixty percent (60.0%) patients had focal swelling and 40.0% had diffuse swelling. On color flow Doppler 28.0% had normal, 38.0% had increased and 34.0% decreased vascular flow pattern. USG reports revealed that 48.0% had thyromegaly, 36.0% had thyroid nodule, 10.0% had multinodular goiter and 6.0% had thyroid abscess. FNAC diagnosis revealed that 34.0% patients had Hashimoto's thyroiditis, 24.0% had lymphocytic thyroiditis, 18.0% had granulomatous thyroiditis, 6.0% had abscess, 8.0% had goitre and 10.0% nonspecific. USG and CFD are recommended modalities for the diagnosis of

Teenage hyperthyroidism and radioiodine therapy

International Nuclear Information System (INIS)

Hussain, F.A.; Nisa, L.; Hoque, M.; Jehan, A.H.

2007-01-01

Full text: Objective: To assess the efficacy of radioiodine therapy in teenage patients with hyperthyroidism. Method: The medical records of 28 patients (age range 16 -18 years) were purposely selected from a pool of 3637 hyperthyroid patients treated with radioiodine during the period January 1982 to December 2006. Data for analysis included the age, sex, clinical symptoms, type of hyperthyroidism, antithyroid medications received, doses of radioiodine therapy given and the outcome of the therapy after one and five years. Results: The mean age of the patients treated for hyperthyroidism was 17.60 ± 0.73 years and 82 % were females. The most common type of hyperthyroidism was Graves' disease (75%). All patients were pre-treated with antithyroid drugs for variable duration periods (6 months to 2 years). The mean administered dose of radioiodine was 10.69 ± 2.77 mCi. The dose of I-131 was calculated on the basis of gland size and morphology (assessment by palpation and scintigraphy) and percentage of radioactive iodine uptake. Effective control of hyperthyroidism after radioiodine treatment occurred in 60.72% patients with a single dose, 35.71% required a second dose and 3.57% required more than two doses. Frequency of early hypothyroidism within one year was 38.09 % in Graves' disease and 33.33% in toxic multinodular goiter. Most patients (66.66%) in the toxic nodule group remained euthyroid up to one year after I-131 therapy. Overall incidence rates of hypothyroidism after 1 year and 5 years of radioiodine therapy were 32.14% and 75%, respectively. Conclusion: Hyperthyroidism in the teen group of patients was effectively controlled with radioiodine. There were no early side effects. The only long-term effect was hypothyroidism. Appearance of early/late hypothyroidism showed a direct relationship with the type of hyperthyroidism and the dose of radioiodine administered. In general, patients with Graves' disease showed a greater tendency in the evolution of early

Intra ovaries thyroid cancer with intraperitoneal, osseous and pulmonary metastases fixing iodine 131; Cancer thyroidien intra-ovarien avec metastases intraperitoneale, osseuse et pulmonaires fixant l'iode 131

Energy Technology Data Exchange (ETDEWEB)

Bernard, A.M.; Barge, M.L.; Le Dortz, L.; Herry, J.; Devillers, A. [Centre Eugene-Marquis, Service de medecine nucleaire, 35 - Rennes (France); Vauleon, E.; Kerbrat, P. [Centre Eugene-Marquis, service d' oncologie medicale, 35 - Rennes (France)

2010-07-01

Purpose: Intra ovaries localizations of differentiated thyroid cancer are rare. A few metastatic localizations were described. The presented file is this one of bone and lung metastases localizations discovered 14 years after a bilateral ovaries surgery for a mature teratoma with double epidermic and thyroid compound, taking aspect of an ovaries goiter, with changes. Conclusions: In front of the discovery of an ovary goiter, a careful histopathologic examination is necessary, in search of malignant lesions that may be treated by ira-therapy. (N.C.)

Nodular goiter (epidemiology and diagnostics

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R A Chernikov

2013-06-01

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.

Goiter and Multiple Food Allergies

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Stefanie Leniszewski

2009-01-01

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.

Incidence of thyroid cancer in women in relation to previous exposure to radiation therapy and history of thyroid disease

International Nuclear Information System (INIS)

McTiernan, A.M.; Weiss, N.S.; Daling, J.R.

1984-01-01

Female residents of 13 counties of Western Washington, in whom papillary, follicular, or mixed papillary-follicular thyroid carcinomas had been diagnosed between 1974 and 1979 were interviewed regarding their medical and reproductive histories and past exposure to radiation treatments. For comparison, a random sample of women from the same population was interviewed. Women who had received radiation treatments to the head or neck prior to 5 years before interview were 16.5 times (95% confidence interval . 8.1-33.5) more likely than unexposed women to develop cancer. The relative risk (RR) was highest for papillary cancer (19.4) but also was elevated substantially for follicular and mixed papillary-follicular tumors. Women first irradiated at age 19 years or younger had a much higher RR than did women irradiated at age 20 or older. Regardless of prior radiation exposure, women who ever had had a goiter were at increased risk of developing thyroid cancer. Women who had ever developed a goiter had 17 times the risk of developing follicular cancer and almost 7 times the risk of developing papillary cancer as compared with women who never had had a goiter. Risk of thyroid cancer was elevated even among women who had had a history of goiter many years prior to diagnosis. A history of thyroid nodules was also a risk factor for papillary and mixed thyroid cancer. Neither a history of hypothyroidism nor hyperthyroidism was found to increase the risk of thyroid cancer

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

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Farzad Morad Haseli

2009-02-01

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.

Clinical relevancy of a sensitive TSH-RIA

International Nuclear Information System (INIS)

Seidel, C.; Ziegelitz, D.; Weber, A.; Dittmer, T.; Gerl, H.; Knappe, G.; Correns, H.J.

1982-01-01

Based on a sensitive TSH-RIA (measuring range 0.2-25 mU/l, 50%-intercept 2 mU/l, coefficients of between-assay-variation 5-10%) and on nearly 1200 cases, it is demonstrated that clinical results can be received by determination of basal serum TSH alone. Values above 0.5 mU TSH/l indicate positive TRH tests in a good correlation between increasing basal concentrations and pituitary TSH reserve. TSH levels below 0.3 mU/l proceed with negative TRH tests. In selected healthy subjects, we found all TSH values between 0.7 and nearly 5 mU/l (x-bar = 1.99). In euthyroid goiters TSH levels are normally in the same range, but in nodular goiters, subnormal values were found accumulated. TSH levels below 0.3 mU/l are helpful to discover non-suppressibility. Hormone treatment of goiters is successful above all in case of high-normal pretherapeutic TSH values. 'Fine-tuning' of hormone dosage (goiter treatment, postoperative prophylaxis, suppression therapy in thyroid carcinoma) as well as monitoring of thyrotoxicosis treatment is recommended to be performed by means of basal TSH determination. In pituitary disorders, thyroid hormone treatment seems to be necessary only at TSH levels below 0.5 mU/l. Combination of basal TSH and total T 3 is economical and describes nearly all functional situations in diagnosis and treatment of thyroid diseases. (author)

The impact of voice impairment after thyroidectomy on quality of life. A prospective cohort study

DEFF Research Database (Denmark)

Sørensen, Jesper Roed; Døssing, Helle; Bonnema, Steen Joop

Introduction: To assess the impact of voice and vocal fold changes (VVFC) after thyroidectomy on disease specific quality of life (QoL). Methods: Prospective cohort study (inclusion period: 18 months, ending April-2016) with six months follow-up of patients with nodular goiter undergoing thyroide......Introduction: To assess the impact of voice and vocal fold changes (VVFC) after thyroidectomy on disease specific quality of life (QoL). Methods: Prospective cohort study (inclusion period: 18 months, ending April-2016) with six months follow-up of patients with nodular goiter undergoing...

Medical Surveillance Monthly Report (MSMR). Volume 21, Number 4, April 2014

Science.gov (United States)

2014-04-01

Disorders of fl uid electrolyte/acid-base balance 178 33.5 Other cellulitis and abscess 1,031 70.7 Diabetes mellitus 156 29.4 Pilonidal cyst 100 6.9...Nontoxic nodular goiter 39 7.3 Cellulitis and abscess of fi nger and toe 98 6.7 Thyrotoxicosis with or without goiter 29 5.5 Other disorders of skin...31 34.1 Other cellulitis and abscess 109 58.9 Other and unspecifi ed anemias 21 23.1 Pilonidal cyst 21 11.4 Diseases of white blood cells 21 23.1

Evaluation of /sup 201/TlCl and delayed scan for thyroid imaging agent

Energy Technology Data Exchange (ETDEWEB)

Taniguchi, Tatsuyoshi; Harada, Taneichi; Takahashi, Tatsuo; Senoo, Tsuneaki; Ohtsuka, Nobuaki; Ito, Yasuhiko [Kawasaki Medical School, Kurashiki, Okayama (Japan)

1982-11-01

The results of 189 patients with nodular goiter by imaging with /sup 201/TlCl following with sup(99m)TcO/sub 4//sup -/ was presented. Accumulation of /sup 201/TlCl to the corresponding area was observed in 85.5% of cancer, 62.2% of adenoma, 42.5% of adenomatous goiter, and the usefulness of /sup 201/TlCl (early scan) for thyroid imaging agent was recognized. On the other hand, delayed scan for purpose of differentiation from benign to malignant was also performed. However, no significant differences were obtained.

Cotyledonoid Leiomyoma

African Journals Online (AJOL)

Cotyledonoid leiomyoma is a very rare tumor among the ever expanding repertoire of growth variants described in benign uterine leiomyoma. We report a case of cotyledonoid leiomyoma in a 39-year-old (unmarried) women presented with lump in abdomen. On laparotomy, a large multinodular, tan colored, exophytic, ...

Thyroid cancers in nodular goitres in Northwestern Nigeria

African Journals Online (AJOL)

BACKGROUND: Cancer is an occasional incidental finding in nodular goitres, but there has been no formal study on this disease in our centre which is located in an endemic goitrous region. AIMS AND OBJECTIVES: To determine the prevalence and pattern of malignant growths in multinodular goitres. METHODOLOGY: ...

Post partum lymphocytic thyroiditis in North Indian population: a spectrum of thyroid dysfunction

International Nuclear Information System (INIS)

Sharma, Rajnish; Mondal, Anupam; Taneja, Vijay; Bansal, J.K.; Khanna, C.M.; Sharma, Manisha

1999-01-01

Two hundred and sixty one Indian women from Delhi and surrounding territory were prospectively evaluated to determine the frequency of post-partum thyroiditis upto 12 weeks of postpartum. Thirty one (11.8%) of the 261 cases included in our study developed thyroid disease. Twenty four (77%) of the patients who developed thyroiditis were found to have high titres of thyroid antibodies. Of these 24 patients, 21 (67.7%) tested positive for antimicrosomal antibodies and 17 (54.8%) tested positive for antithyroglobulin antibodies. Patients were found to have a spectrum of thyroid dysfunction. Transient hypothyroidism developed in 17 patients, I patient developed persistent hypothyroidism, 7 had transient thyrotoxicosis and 6 developed euthyroid goiters. Twenty two patients had goiters ranging from grade OB to grade II. Fine needle aspiration cytology showed chronic lymphocytic thyroiditis in 20 patients, while 2 had colloid goiter. It is concluded from our study that there is a significant incidence of post partum thyroid disease in the female population representative of North India, and most of the patients (93.5%) develop transient thyroid disorder. (author)

A case report of thyroid storm induced by acute sepsis

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Chiu-Yin Yeh

2016-03-01

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.

Differential diagnosis of hyperthyroidism

Energy Technology Data Exchange (ETDEWEB)

Emrich, D.

1984-04-23

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.

Differential diagnosis of hyperthyroidism

International Nuclear Information System (INIS)

Emrich, D.

1984-01-01

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. (orig.) [de

Radionuclide study of thyroid function in pediatrics, using sup(99m)Tc, 123I or 131I: 150 case-reports

International Nuclear Information System (INIS)

Guillet, J.; Basse-Cathalinat, B.; Soubiran, G.; Blanquet, P.; Guillet, G.

1981-01-01

THe best radioisotope for in vivo thyroid investigations is the one which provides the highest quality scintigrams with the least radiation exposure. The choice of 131 I, 123 I or sup(99m)Tc in 150 children is discussed. Cases included 25 dysgenesis, 4 goiters with hypothyroidism, 56 goiters without thyroid dysfunction, 3 thyroiditis, and 11 cold nodules. When thyroid scanning is performed with 131 I, the gland's radiation exposure is high. 123 I is preferable since a fairly high activity can be obtained without delivering an excessive radiation dose. (approximately 2 rad to the thyroid for 50 microCi/m 2 ). sup(99m)Tc which is readily available is not a true iodine analog. It does not give a true picture of iodine metabolism. 123 I was generally used in cases of hypothyroidism, goiter (whenever a defect in thyroid hormone synthesis was suspected) and hyperthyroidism. sup(99m)Tc was generally used in other cases. The low radiation doses delivered by these radioisotopes allows study of thyroid function in the neonate [fr

Radionuclide study of thyroid function in pediatrics, using sup(99m)Tc, /sup 123/I or /sup 131/I: 150 case-reports

Energy Technology Data Exchange (ETDEWEB)

Guillet, J.; Basse-Cathalinat, B.; Soubiran, G.; Blanquet, P. (Hopital Pellegrin, 33 - Bordeaux (France)); Guillet, G. (Johns Hopkins Medical Institutions, Baltimore, MD (USA). Div. of Nuclear Medicine)

1981-11-01

THe best radioisotope for in vivo thyroid investigations is the one which provides the highest quality scintigrams with the least radiation exposure. The choice of /sup 131/I, /sup 123/I or sup(99m)Tc in 150 children is discussed. Cases included 25 dysgenesis, 4 goiters with hypothyroidism, 56 goiters without thyroid dysfunction, 3 thyroiditis, and 11 cold nodules. When thyroid scanning is performed with /sup 131/I, the gland's radiation exposure is high. /sup 123/I is preferable since a fairly high activity can be obtained without delivering an excessive radiation dose. (approximately 2 rad to the thyroid for 50 microCi/m/sup 2/). sup(99m)Tc which is readily available is not a true iodine analog. It does not give a true picture of iodine metabolism. /sup 123/I was generally used in cases of hypothyroidism, goiter (whenever a defect in thyroid hormone synthesis was suspected) and hyperthyroidism. sup(99m)Tc was generally used in other cases. The low radiation doses delivered by these radioisotopes allows study of thyroid function in the neonate.

A fifteen year experience of total thyroidectomy for the management ...

African Journals Online (AJOL)

Tracheostomy was required in 35 (5.8%) patients but none was permanent. Conclusion: Total thyroidectomy is a relatively safe treatment option for patients who have simple multinodular goitre. It provides a permanent cure with a low postoperative morbidity risk. The burden of replacement l-thyroxine needs to be discussed ...

An unusual case of the Capgras syndrome.

Science.gov (United States)

Fialkov, M J; Robins, A H

1978-04-01

A variant of the Capgras syndrome is described in a 43-year-old woman who had vitiligo and multinodular goitre. The unusual feature of the case was that the patient not only misidentified members of her own family but also claimed that she herself had been replaced by a double.

Ectopic Intratracheal Thyroid: A Rare Cause of Airway Obstruction

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Waheed Rahman

2018-01-01

Full Text Available Ectopic intratracheal thyroid tissue (EITT is a rare abnormality with only limited cases reported so far. The presenting symptoms can be very similar to those of bronchial asthma. We discuss the case of a 29-year-old man with subglottic ectopic thyroid, with a history of thyroid surgery for goiter, which has been managed with laser-assisted endoscopic approach. We have also included presenting symptoms, pathophysiology, diagnosis, and management of EITT. We aim to include EITT in the differentials of airway obstruction, particularly in those patients who have goiter or previous thyroid surgeries.

Clinical classification of supressed and low normal basal serum TSH concentrations in euthyroidism

International Nuclear Information System (INIS)

Seidel, C.; Ziegelitz, D.; Correns, H.J.

1981-01-01

By use of highly sensitive and accurate TSH radioimmunoassay it can be shown up that beginnung with suppressed TSH-levels in serum during increasing TSH-levels TSH response after TRH injection increases concomitantly, i.e. there is positive correlation between basal TSH and TSH response after TRH. TRH mediated TSH-increase shows positive correlation to thyroidal suppressibility with thyroid hormones. The results demonstrate the importance of a highly sensitive and accurate TSH radioimmunoassay for clinical work especially for exclusion of hyperthyroidism or thyroidal autonomy for therapeutics of goiter, prevention of reoccurring goiter and control of thyroidal suppression. (orig.) [de

Clinical classification of suppressed and low normal basal serum TSH concentrations in euthyroidism

Energy Technology Data Exchange (ETDEWEB)

Seidel, C.; Ziegelitz, D.; Correns, H.J.

1981-02-01

By use of highly sensitive and accurate TSH radioimmunoassay it can be shown that beginning with suppressed TSH-levels in serum during increasing TSH-levels TSH response after TRH injection increases concomitantly, i.e. there is positive correlation between basal TSH and TSH response after TRH. TRH mediated TSH-increase shows positive correlation to thyroidal suppressibility with thyroid hormones. The results demonstrate the importance of a highly sensitive and accurate TSH radioimmunoassay for clinical work especially for exclusion of hyperthyroidism or thyroidal autonomy for therapeutics of goiter, prevention of reoccurring goiter and control of thyroidal suppression.

Iodine deficiency disorders (IDD) in regions of Russia affected by Chernobyl

International Nuclear Information System (INIS)

Gerasimov, G.; Alexandrova, G.; Arbuzova, M.

1996-01-01

The present article provides an update on IDD in the Western regions of Russia (Bryansk, Kaluga, Tula and Orel) which were contaminated by radioactive fallout after the Chernobyl accident in 1986. These surveyed areas meet the criteria of ICCIDD/UNICEF/WHO for mild and moderate IDD. Higher iodine excretion and smaller goiter prevalence (mild level of IDD) were more typical for urban sites, while lower iodine levels and higher goiter endemicity (moderate level of IDD) were found in rural areas. IDD control programmes should be developed and implemented in Chernobyl areas and iodine excretion should be monitored continuously to minimize future thyroid abnormalities

Chronic thyroiditis (Hashimoto disease)

Science.gov (United States)

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

The frequency of carcinoma in solitary thyroid nodules and in ...

African Journals Online (AJOL)

Muhimbili Medical Centre, Dar es Salaam was made to determine the frequency of malignancy in patients with solitary non-toxic thyroid nodule (STN) and in those with multinodular goitre (MNG). There were 60 cases of STN and. 178 with MNG. Nodular goitre was found to be predominantly a disease of females with sex.

[Constant or break? On the relations between human genetics and eugenics in the Twentieth Century].

Science.gov (United States)

Germann, Pascal

2015-07-01

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.

Evident?

DEFF Research Database (Denmark)

Plant, Peter

2012-01-01

Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind......Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind...

Thyrotoxicosis Associated with a Hypopharyngeal Toxic Nodular Thyroid

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S. Ali Imran

2017-01-01

Full Text Available Ectopic thyroid is a rare developmental anomaly which may be either asymptomatic or present with thyroid dysfunction as well as pressure symptoms. Here we present a novel case of thyrotoxicosis associated with a hypopharyngeal multinodular thyroid in a female. Removal of the ectopic thyroid led to normalization of the thyroid status.

Hyperthyroidism

OpenAIRE

Sharma, Mala; Aronow, Wilbert S.; Patel, Laxesh; Gandhi, Kaushang; Desai, Harit

2011-01-01

Summary Hyperthyroidism is a pathological syndrome in which tissue is exposed to excessive amounts of circulating thyroid hormone. The most common cause of this syndrome is Graves? disease, followed by toxic multinodular goitre, and solitary hyperfunctioning nodules. Autoimmune postpartum and subacute thyroiditis, tumors that secrete thyrotropin, and drug-induced thyroid dysfunction, are also important causes.

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

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Mark E Peterson

2015-11-01

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.

CLINICAL CONCEPTS ON THYROID EMERGENCIES

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Alfredo ePontecorvi

2014-07-01

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.

Somatostatin reduces 3H-thymidine incorporation and c-myc, but not thyroglobulin ribonucleic acid levels in human thyroid follicular cells in vitro

International Nuclear Information System (INIS)

degli Uberti, E.C.; Hanau, S.; Rossi, R.; Piva, R.; Margutti, A.; Trasforini, G.; Pansini, G.; del Senno, L.

1991-01-01

The action of somatostatin (SRIH) on 3 H-thymidine (thy) incorporation and on c-myc and thyroglobulin RNA levels in a suspension of follicles from normal and goitrous human thyroid was examined. SRIH, at 10 - 7 M concentration, inhibited basal thy incorporation (maximally by 4 h lasting for up 24 h), which effect was greater in goiter than in normal thyroid and was also detected in growing adherent epithelial cells. Moreover, in a follicle suspension SRIH prevented TSH-stimulated thy incorporation, both in normal and in goitrous thyroid. Basal expression of c-myc RNA was not affected by SRIH in either tissue, whereas the TSH-stimulated c-myc RNA level was significantly reduced in goiter. No effect of SRIH was observed on basal or TSH-stimulated thyroglobulin RNA levels. SRIH did not alter basal cAMP concentrations in normal or goitrous follicles, but it significantly reduced TSH-stimulated cAMP accumulation both in normal thyroid and in goiter. Overall, our data indicate a direct inhibitory action of SRIH on growth, but not on differentiation, of human thyroid, probably by a mechanism not entirely cAMP dependent

[Prevention and multimodal therapy of hyperthyroidism].

Science.gov (United States)

Palitzsch, K-D

2008-12-01

Subclinical and overt hyperthyroidism have been associated with various negative clinical outcomes as for example an increased risk of atrial fibrillation or increased cardiovascular mortality, especially in old age. In order to avoid hyperthyroidism it is strongly recommended not to start any iodine containing drug therapy or to avoid application of contrast agents unless the patient presents with an unremarkable clinical course. TSH suppressive therapy for the treatment of endemic goiter or differentiated low risk thyroid carcinoma is unnecessary, since it favours the development of subclinical hyperthyroidism. Overt hyperthyroidism is treated with antithyroid drugs and/or radioiodine therapy or surgery according to the underlying disease (toxic nodular goiter, Graves' disease).

Hyperthyroidism (primary)

DEFF Research Database (Denmark)

Nygaard, Birte

2010-01-01

Hyperthyroidism is characterised by high levels of serum thyroxine and triiodothyronine, and low levels of thyroid-stimulating hormone. The main causes of hyperthyroidism are Graves' disease, toxic multinodular goitre, and toxic adenoma. About 20 times more women than men have hyperthyroidism. ME...... Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA)....

Therapy of endemic goiter and hypothyroidism

Energy Technology Data Exchange (ETDEWEB)

Luft, D.

1983-09-12

Successful treatment of endemic goitre depends on the correct diagnosis and the comprehension of the pathophysiologic changes as well. Several criteria, e.g. anamnestic data, general clinical condition, local symptoms and signs, certainty of diagnosis, contraindications, rates of success, and side effects, determine the particular form of therapy (suppression with thyroid hormones, surgical resection, radio-iodine). The decision criteria are discussed. Prophylaxis of recurrent goitre with either thyroid hormones or iodine salts is necessary after successful treatment. Some endemic goitres behave like either hyper- or hypothyroidism. Treatment with thyroid hormones of patients with latent hyperthyroidism is senseless and dangerous, whereas other methods of treatment may be applied. An unequivocal indication for treatment exists in patients with latent hypothyroidism accompanied by goitre, but not in all patients without goitre. Hormonal replacement therapy of manifest hypothydroidism is simple, but long term success is not achieved in all patients.

Therapy of endemic goiter and hypothyroidism

International Nuclear Information System (INIS)

Luft, D.

1983-01-01

Successful treatment of endemic goitre depends on the correct diagnosis and the comprehension of the pathophysiologic changes as well. Several criteria, e.g. anamnestic data, general clinical condition, local symptoms and signs, certainty of diagnosis, contraindications, rates of success, and side effects, determine the particular form of therapy (suppression with thyroid hormones, surgical resection, radio-iodine). The decision criteria are discussed. Prophylaxis of recurrent goitre with either thyroid hormones or iodine salts is necessary after successful treatment. Some endemic goitres behave like either hyper- or hypothyroidism. Treatment with thyroid hormones of patients with latent hyperthyroidism is senseless and dangerous, whereas other methods of treatment may be applied. An unequivocal indication for treatment exists in patients with laent hypothyroidism accompanied by goitre, but not in all patients without goitre. Hormonal replacement therapy of manifest hypothydroidism is simple, but long term success is not achieved in all patients. (orig.) [de

Evidence logics with relational evidence

DEFF Research Database (Denmark)

Baltag, Alexandru; Occhipinti, Andrés

2017-01-01

We introduce a family of logics for reasoning about relational evidence: evidence that involves an ordering of states in terms of their relative plausibility. We provide sound and complete axiomatizations for the logics. We also present several evidential actions and prove soundness...

Thyroid gland removal

Science.gov (United States)

... thyroidectomy; Thyroidectomy; Subtotal thyroidectomy; Thyroid cancer - thyroidectomy; Papillary cancer - thyroidectomy; Goiter - thyroidectomy; Thyroid nodules - ... Kaplan EL, Angelos P, James BC, Nagar S, Grogan RH. Surgery ...

[Evidence and Evidence Gaps - an Introduction].

Science.gov (United States)

Dreier, G; Löhler, J

2016-04-01

Treating patients requires the inclusion of existing evidence in any health care decision, to be able to choose the best diagnosis or treatment measure or to make valid prognosis statements for a particular patient in consideration of the physician's own expertise.The basis are clinical trials, the results of which are ideally gathered in systematic reviews, rated, summarized and published. In addition to the GCP (Good Clinical Practice)-compliant planning, conducting and analysis of clinical studies it is essential, that all study results are made publicly available, in order to avoid publication bias. This includes the public registration of planned and discontinued trials. In the last 25 years, the evidence-based medicine (EbM) has increasingly found its way into clinical practice and research. Here EbM is closely associated with the names Archibald Cochrane and David Sackett. In Germany, both the German Cochrane Centre (DCZ) and the network of evidence-based medicine (DNEbM) were established approximately 15 years ago. In the international Cochrane Collaboration clinicians and other scientists like statisticians interdisciplinary work side by side to develop the methods of evidence-based medicine and to address the topics of evidence generation and processing as well as the transfer of knowledge. Challenge: Existing evidence primarily serves doctors to support their decision-making, but is also the basis for providing scientific proof for a health care intervention's benefit to patients and ultimately payers/health insurances. The closure of existing evidence gaps requires substantial human and financial resources, a complex organizational structure and can only succeed with the involvement of clinical and methodological expertise and specific knowledge in the field of clinical research. In addition, the knowledge must be transferred into practice, using journals, guidelines, conferences, databases, information portals with processed evidence and not least the

Refractory Cushing's disease caused by multinodular ACTH-cell hyperplasia.

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McKeever, P E; Koppelman, M C; Metcalf, D; Quindlen, E; Kornblith, P L; Strott, C A; Howard, R; Smith, B H

1982-09-01

A patient with pituitary-dependent hypercortisolism, unresponsive to resection of nodules in the anterior lobe, is described. Histochemical stains of the nodules showed multiple, focal, cellular expansions of the fibrovascular stroma. Transitions between normal and expanded adenohypophysial acini were present. Immunoperoxidase stains for ACTH and other pituitary hormones revealed that these multiple foci contained an excess of ACTH-positive cells. Less than 10% of the cells in these foci were negative for ACTH and positive for other hormones. Serial sections showed that these foci of predominantly ACTH-producing acini were not connected. Clinical, morphological, and immunohistochemical data indicated that ACTH-cell hyperplasia caused Crushing's disease in this patient. Pathologic study of individual cases should concentrate on determining whether hyperplasia or adenoma exist at the time of surgical exploration of the pituitary gland, since this determination is important to proper treatment. Tentative criteria to recognize ACTH-cell hyperplasia are: 1. Multiple foci of ACTH laden cells. 2. A minor subpopulation of cells of alternate hormone series. 3. Expansion without destruction of acini in the adenohypophysis.

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

DEFF Research Database (Denmark)

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

2013-01-01

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......Context: Nodular thyroid disease is very common. Most nodules are asymptomatic, are benign by fine-needle aspiration, remain stable, and can be followed by observation alone in the majority of the patients. Occasionally, nodules grow or cause symptoms requiring treatment. So far, surgery has been...... our main option for treatment. Objective: In this review, we discuss nonsurgical, minimally invasive approaches for small thyroid masses, including indications, efficacy, side effects, and costs. Evidence Acquisition: We selected recent publications related to minimally invasive thyroid techniques...

Clinical outcome during the peri-operative (thyroidectomy) period of severely hyperthyroid patients with normalized pre-operative free-T4 levels: Importance of I-131 therapy as a part of pre-operative preparation

International Nuclear Information System (INIS)

Siguan-Crisaldo, M.A.L.; Mercado-Asis, L.B.

2005-01-01

Thyroidectomy is performed for hyperthyroidism on patients who do not respond to or are not compliant with medical therapy and in patients with very large goiters causing compressive symptoms. All thyrotoxic patients undergoing thyroidectomy usually are first treated with anti-thyroid drugs to normalize free thyroid hormone levels and render them euthyroid before surgery in order to prevent complications particularly thyroid storm and circulatory collapse. In this case series, we describe the clinical outcome during the perioperative (thyroidectomy) period of three severely hyperthyroid patients, two females and one male, with ages ranging from 13 to 38 years. All patients had grade III goiter, and only one had exophthalmos. The mean duration of goiter was 3.6 years. All of them were given preoperative treatment consisting of propylthiouracil (PTU) at 450-600 mg/day; iodone, 3 tablets daily and propranolol at 30-120 mg/day for one month. All of them had normalized preoperative thyroid function tests. In addition to the preoperative medications mentioned above, all three patients received radioactive iodine therapy before surgery. The first two patients received relatively low doses of 8.0 and 7.5 mCi of I-131 respectively. Unfortunately the first patient had supraventricular tachycardia (SVT), post skin cutting and the other one went into thyroid storm. The third patient who received a cumulative dose of 23.5 mCi of I-131 before surgery had an uneventful postoperative course. It is concluded that normalization of thyroid hormone parameters, especially free T4 is not sufficient for an uneventful and uncomplicated peri-thyroidectomy period in severely hyperthyroid patients with large goiters. Effective radioactive iodine therapy might prove to be helpful in inducing thyroid tissue fibrosis, thus leading to true clinical euthyroidism and excellent clinical course postoperatively. (author)

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

Energy Technology Data Exchange (ETDEWEB)

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

2016-01-15

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.

Endocrine glands

Science.gov (United States)

... 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 ...

Differentiation between malignant and benign thyroid tumors by X-ray fluorescent analysis-comparison of cases from Russia and Albany, New York

International Nuclear Information System (INIS)

Tomashevsky, I.; Gerasimov, G.; Troshina, K.; Alexandrova, G.; Serpukhovitin, S.; Bronstein, M.; Figge, J.

1996-01-01

Intra thyroid iodine level in different types of thyroid neoplasms in Russia (126 cases) and USA (37 cases) were investigated by X-ray fluorescent analysis in vitro. A decrease in intra thyroid iodine concentration is associated with the stepwise loss of differentiation in thyroid tumors. In colloid goiter tissue from Russia, the intra thyroid iodine level is increased. The intra thyroid iodine level was markedly increased in micro follicular adenomas and colloid goiters from American patients which may reflect a higher iodine supply in the USA. X-ray fluorescent analysis together with careful clinical appraisal can be used for management of thyroid patients with suspicious nodules which should be treated by surgery

Radioiodine treatment of hyperthyroidism

International Nuclear Information System (INIS)

Becker, D.V.; Hurley, J.R.

1988-01-01

Hyperthyroidism is a clinical symptom complex caused by elevated thyroid hormone levels. Of the disorders in which it appears, the most common is Graves' disease; toxic nodular goiter (Plummer's disease) is considerably less frequent. Recent studies suggest that Graves' disease is autoimmune in origin and is probably caused by a genetic defect in immunoserveillance in which thyroid-stimulating antibodies interact with thyroid-stimulating hormone (TSH) receptor sites on thyroid follicular cell membranes to increase synthesis and secretion of thyroid hormones. Toxic nodular goiter is characterized by the secretion of increased amounts of thyroid hormone by localized autonomous areas of increased function within the thyroid gland. Other forms of hyperthyroidism are discussed. Radioiodine treatment of hyperthyroidism is described

Radioiodotherapy: dosimetry planning

International Nuclear Information System (INIS)

Apyan, A.; Mileshin, O.; Klyopov, A.; Shishkanov, N.; Matusevich, E.; Roziev, A.

2001-01-01

The results of treatment of 142 case histories of 125 patients who had been treated with radioactive iodine at the Medical Radiological Research Center of Russian Academy of Medicine Sciences from 1983 to 1999 are given in the presentation. Among the patients, 35 cases of diffuse toxic goiter with signs of thyrotoxicosis of a mild degree, 25 cases of Diffuse toxic goiter with severe thyrotoxicosis, 6 cases of differentiated thyroid cancer with metastases to lymph-nodes of the neck, 30 cases of thyroid cancer with metastases to lymph-nodes of the neck and lung and 1 case of thyroid cancer with metastases to bones were diagnosed. This paper gives recommendations for individual dosimetry planning for radioiodine-therapy. (authors)

Impact of Ecologically Unfriendly Environment on the Formation of Thyroid Pathology in Children Against Iodine Deficiency

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N.S. Kosmynina

2014-02-01

Full Text Available By prevalence among thyroid pathological conditions in Ukraine, the diffuse nontoxic goiter is dominated, the frequency of which, in addition to iodine deficiency, is influenced by anthropogenic pollution of environment. The article evaluated the role of the negative impact of polluted environment on the formation of thyroid disease in children from ecologically unfriendly region on the background of endemic iodine deficiency compared with children from ecologically friendly area of iodine deficiency. It has been determined the frequency of diffuse endemic goiter in children from studied groups according to palpation and ultrasonography. The functional state of the pituitary-thyroid system in children living in iodine deficiency environmentally unfriendly and ecologically friendly areas has been researched.

Misdiagnosis of thyroid nodules by ultrasonography: report of a large series

International Nuclear Information System (INIS)

Ruan Jianqiu; Xu Huixiong; Xie Xiaoyan; Lv Mingde

2010-01-01

Objective: To analyze the common factors of ultrasonographic misdiagnosis of thyroid nodules. Methods: From 2006 to 2009, the pre-operative ultrasonographic diagnosis on 1933 patients with pathologically confirmed thyroid nodules were reviewed. Results: Of 2011 sonograms, ultrasonic diagnosis was corxect in 1575. The 436 diagnostic errors included false negative malignancy (133), false positive malignancy (37), and misdiagnosis between benign lesions (266). Conclusion: There were three main reasons of misdiagnosis including insufficient understanding of the high morbidity of nodular goiter and the relatively low incidence of thyroid adenoma; low awareness of the ultrasonographic diversity of nodular goiter and the sonographic characteristics of the thyroid adenoma and thyroid carcinoma; coexistence of underlying thyroid disease and multifocal nodules. (authors)

Clinical evaluation of echography in diagnosis of thyroid disease

International Nuclear Information System (INIS)

Fritzsche, H.; Braendle, J.

1983-01-01

In 63 patients echography of thyroid was performed additionally to case history, palpation, scintigraphy and hormone tests for evaluating clinical significance of this method. The benefit of this technique is rapid measurement of thyroid size, demonstration of nodules in palpable diffuse goiters and differentiating of solid or cystic nodules of the thyroid. For diagnosis of autonomous areas in the thyroid scintigrahy remains the method of choice. Also there is no correlation of ultrasound findings and thyroid function. In routine diagnostic procedure of thyroid disease echography may replace scintigraphy only in diffuse goiter and if radionuclide imaging is not possible. Nevertheless ultrasonic evaluation of the thyroid is an important additional method in diagnostic of thyroid diseases. (Author)

Study on serum thyroid peroxidase antibody levels in autoimmune thyroid disease

International Nuclear Information System (INIS)

Zhang Zhixiang; Zheng Lan; Xu Shujin; Guan Jinghua

2008-01-01

Objective: To investigate the clinical significance of changes of serum thyroid peroxidase antibody (TPO-Ab) in patients with hyperthyroidism, hypothyroidism and simple goiter. Methods: Serum TPO-Ab, TMA,TGA and FT 3 , FT 4 , TSH levels were measured with radioimmunoassay(RIA) in 69 patients with hyperthyroidism, 53 patients with hypothyroidism, 45 patients with simple goiter and 20 controls. Results: The positive rate of thyroid peroxidase antibody (TPO-Ab) (82%-92.5%) was higher than that of thyroidglobulim antibody(TGA) (44.2%) and thyroid microsome antibody(TMA) (60.4-69.8%) in all patients with AICD. Conclusion: TPO-Ab could be taken as an important indicator in assessment of treatment and prognosis in patients with auto- immune thyroid diseases. (authors)

Hyperthyroidism (primary)

OpenAIRE

Nygaard, Birte

2010-01-01

Hyperthyroidism is characterised by high levels of serum thyroxine and triiodothyronine, and low levels of thyroid-stimulating hormone (TSH). Thyrotoxicosis is the clinical effect of high levels of thyroid hormones, whether or not the thyroid gland is the primary source.The main causes of hyperthyroidism are Graves' disease, toxic multinodular goitre, and toxic adenoma.About 20 times more women than men have hyperthyroidism.

Mesotelioma pleural com metástase renal em gato Pleural mesothelioma with renal metastasis in a cat

Directory of Open Access Journals (Sweden)

A.M. Piacenti

2004-08-01

Full Text Available It has been described the anatomopathological and immunohistochemical characteristics of a multinodular neoplasm distributed in the parietal and visceral pleurae, pericardium, thoracic portion of the diaphragm and renal cortex of an eight year-old, female, mixed breed, cat. Based on the anatomopathological and immunohistochemical findings it was firmed the diagnosis of biphasic pleural mesotelioma with renal metastasis.

Evidence and evidence gaps in tinnitus therapy

Science.gov (United States)

Hesse, Gerhard

2016-01-01

A nearly endless number of procedures has been tried and in particular sold for the treatment of tinnitus, unfortunately they have not been evaluated appropriately in an evidence-based way. A causal therapy, omitting the tinnitus still does not exist, actually it cannot exist because of the various mechanisms of its origin. However or perhaps because of that, medical interventions appear and reappear like fashion trends that can never be proven by stable and reliable treatment success. This contribution will discuss and acknowledge all current therapeutic procedures and the existing or non-existing evidence will be assessed. Beside external evidence, the term of evidence also encompasses the internal evidence, i.e. the experience of the treating physician and the patient’s needs shall be included. While there is no evidence for nearly all direct procedures that intend modulating or stimulating either the cochlea or specific cervical regions such as the auditory cortex, there are therapeutic procedures that are acknowledged in clinical practice and have achieved at least a certain degree of evidence and generate measurable effect sizes. Those are in particular habituation therapy and psychotherapeutic measures, especially if they are combined with concrete measures for improved audio perception (hearing aids, CI, hearing therapies). PMID:28025604

Thyroid Diseases

Science.gov (United States)

... beats. All of these activities are your body's metabolism. Thyroid problems include Goiter - enlargement of the thyroid gland Hyperthyroidism - when your thyroid gland makes more thyroid hormones ...

Experience of 1166 Thyroidectomy without Use of Prophylactic Antibiotic

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Qiang Lu

2014-01-01

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.

The Prevalence of Thyroid Disease in the Children and Teenagers in Iodine-Deficient Region

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A V Kiyaev

2007-06-01

Full Text Available To indicate iodine intake and the prevalence of thyroid disease in the iodine-deficient area we perform complex investigation of 2332 children and teenagers in 23 settlements of Sverdlovsk region. Studying population consisted of1153 7—8 years old children (599 girls and 554 boys and 1179 14—15 years old teenagers (637 girls and 542 boys. Study protocol includes thyroid ultrasound for all children and urinary iodine excretion for younger group and, serum TSH, AT-TG and AT-TPO in older group. The incidence of diffuse goiter was 22.8% and median of urinary iodine excretion was 53 μg/l. We found that Sverdlovsk region is a mild iodine-deficient area. The incidence of significant thyroid diseases is relatively low (thyroid cancer, functional autonomy and overt hypothyroidism — in 0.04%, nodular goiter — 0.26%, autoimmune thyroiditis with subclinical hypothyroidism — 0.6%. There is no significant difference in the prevalence of thyroid disease among children and teenagers. We found that thyroid ultrasound is not a reasonable screening strategy for thyroid cancer and nodular goiter in pediatric population of the iodine-deficient region. We consider that the most reasonable screening strategy is the palpation technique.

Evidence and evidence gaps - an introduction.

Science.gov (United States)

Dreier, Gabriele; Löhler, Jan

2016-01-01

Background: Medical treatment requires the implementation of existing evidence in the decision making process in order to be able to find the best possible diagnostic, therapeutic or prognostic measure for the individual patient based on the physician's own expertise. Clinical trials form the evidence base and ideally, their results are assembled, analyzed, summarized, and made available in systematic review articles. Beside planning, conducting, and evaluating clinical trials in conformity with GCP (good clinical practice), it is essential that all results of conducted studies are publicly available in order to avoid publication bias. This includes also the public registration of planned and cancelled trials. History: During the last 25 years, evidence-based medicine became increasingly important in medical care and research. It is closely associated with the names of Archibald Cochrane and David Sackett. About 15 years ago, the Deutsche Cochrane Zentrum (Cochrane Germany) and the Deutsche Netzwerk Evidenzbasierte Medizin e.V. (German Network for Evidence-based Medicine, DNEbM) were founded in Germany. In the International Cochrane Collaboration, clinicians and methodologists come together on an interdisciplinary level to further develop methods of evidence-based medicine and to discuss the topics of evidence generation and processing as well as knowledge transfer. Problem: Evidence is particularly important for physicians in the process of decision making, however, at the same time it is the base of a scientific proof of benefit for the patient and finally for the payers in health care. The closure of evidence gaps requires enormously high staff and financial resources, significant organizational efforts, and it is only successful when clinical and methodical expertise as well as specific knowledge in the field of clinical research are included. On the other hand, the knowledge has to be transferred into practice. For this purpose, practice guidelines, meetings

Indicators of physical and sexual development of adolescent boys, depending on the functional state of the thyroid gland

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K. G. Kamalov

2015-01-01

Full Text Available Republic of Dagestan is a region with medium and severe iodine deficiency, which is associated with the development of endemic goiter and subclinical hypothyroidism. Children with goiter with or without it with SG had the worst indicators of physical, psychological and sexual development, tended to chronic somatic pathology.Objective. To examine the connection between the elevated TSH level with indicators of physical and sexual health of boys.Material and methodThere were examined 297 adolescents aged 11-13 years (76 persons in the beginning of puberty and 14-17 years (221 people in the middle and the end of puberty. The anthropometric studies of height, weight were conducted, body mass index BMI was calculated, the degree of sexual development: R - pubic body hair, G-degree sexual development, testicular volume by Prader and the size of the penis, index of virilization, level tireotroponogo hormone (TSH were assessed.Results showed that physical development of boys already in the early stages of dysfunction of the thyroid gland tends to lag behind. This is more evident in the mid to completion of puberty (boys and adolescents 14-17 years of age, secondary sexual characteristics in boys 11-13 years more marked in those with a TSH level of 0.5 to 2.6 IU/l compared with peers with TSH levels from 4.2 to 10.0 IU/l In the subgroup of 14-17 year old boys and teenagers, there is a tendency to the phenomenon of "macroorchidism" beginning at the stage of subclinical hypothyroidism.

Psiquiatria baseada em evidências Evidence-based psychiatry

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Maurício S de Lima

2000-09-01

Full Text Available Em psiquiatria, observa-se grande variabilidade de práticas clínicas, muitas vezes desnecessária. Essas variações podem estar relacionadas à ausência de evidência científica confiável ou ao desconhecimento das evidências de boa qualidade disponíveis. A medicina baseada em evidências (MBE é uma combinação de estratégias que busca assegurar que o cuidado individual do paciente seja baseado na melhor informação disponível, a qual deve ser incorporada à prática clínica. Neste artigo, conceitos de MBE são discutidos com relação a aspectos e desafios no tratamento de pacientes com distimia, bulimia nervosa e esquizofrenia. A partir de resultados de três revisões sistemáticas recentemente publicadas, conclui-se que a prática de psiquiatria baseada em evidências acrescenta qualidade à prática psiquiátrica tradicional.The unnecessary variability often seen in the clinical practice can be related to both the absence of reliable evidence and unawareness of the existence of good quality evidence. Evidence-Based Medicine (EBM is a set of linked strategies designed to assist clinicians in keeping themselves up-to-date with the best available evidence. Such evidence must be incorporated into the clinical practice. EBM concepts are discussed here through common aspects and challenges doctors face when treating patients with dysthymia, bulimia nervosa, and schizophrenia. In the light of some results from three systematic reviews it is concluded that Evidence-Based Psychiatry strategies, rather than replacing the traditional ones, may be a valuable tool to improving quality in a good clinical practice.

Evidence-based librarianship: searching for the needed EBL evidence.

Science.gov (United States)

Eldredge, J D

2000-01-01

This paper discusses the challenges of finding evidence needed to implement Evidence-Based Librarianship (EBL). Focusing first on database coverage for three health sciences librarianship journals, the article examines the information contents of different databases. Strategies are needed to search for relevant evidence in the library literature via these databases, and the problems associated with searching the grey literature of librarianship. Database coverage, plausible search strategies, and the grey literature of library science all pose challenges to finding the needed research evidence for practicing EBL. Health sciences librarians need to ensure that systems are designed that can track and provide access to needed research evidence to support Evidence-Based Librarianship (EBL).

Synthesizing Quantitative Evidence for Evidence-based Nursing: Systematic Review.

Science.gov (United States)

Oh, Eui Geum

2016-06-01

As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR), a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings. Copyright © 2016. Published by Elsevier B.V.

Synthesizing Quantitative Evidence for Evidence-based Nursing: Systematic Review

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Eui Geum Oh, PhD, RN

2016-06-01

Full Text Available As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR, a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings.

Thyroid Disease and Teens

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... become enlarged and may result in a goiter. Hypothyroidism is usually easily diagnosed with a physical examination and blood tests, and treatment with thyroid hormone replacement pills can restore normal ...

Intraparenchymal schwannoma of the frontal lobe.

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Deogaonkar M

1994-10-01

Full Text Available A 45 year old woman with bifrontal headaches and progressive diminution in vision over 6 months was found to have bilateral papilloedema. CT scan showed large right frontal lesion with surrounding oedema. Right basal frontotemporal craniotomy was performed to excise the multinodular, intraparenchymatous tumor. Hispathology confirmed the diagnosis of schwannoma. Post-operative course was uneventful with disappearance of pre-operative signs and symptoms.

Profile of Hashimoto's Thyroiditis in Sri Lankans: Is There an Increased Risk of Ancillary Pathologies in Hashimoto's Thyroiditis?

OpenAIRE

Siriweera, Eranga Himalee; Ratnatunga, Neelakanthi Vajira Illangakoon

2010-01-01

Hashimoto's thyroiditis has been reported to be associated with many neoplastic and nonneoplastic thyroid pathologies. This retrospective study aims to determine the demographic profile of Hashimoto's thyroiditis in Sri Lankans, document ancillary pathologies in Hashimoto's thyroiditis, and determine whether there is an increased risk of occurrence of malignancies, benign neoplasms, and nonneoplastic benign lesions in Hashimoto's thyroiditis by comparing with thyroids showing multinodular goi...