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PubMed1976

[Secretion of TSH and stimulation-ability of the hypophysis after long-term suppression therapy in euthyroid nodular goiter and residual thyroid gland after subtotal resection of goiter].

In 51 patients, 33 with euthyroid goiter and 18 after subtotal thyroidectomy, plasma concentrations of T4, T3, and TSH before and after stimulation with TRF were determined under long term suppression with thyroid hormone and 1,2, and 4 weeks after stopping it. Even after complete suppression (delta TSH less than 0, 5 muU/ml) resumption of TSH secretion occurred within 4 weeks in all but two. A significantly higher increase of TSH and somewhat lower thyroid-hormone concentrations turned out in operated patients. An excessive decrease of T3 (and T4) concentrations within the 1st (and 2nd) week after therapy, dependent on the degree of previous TSH suppression, could be due to transitory thyrotropic insufficiency.

Goiter, Nodular↗
PubMed1993

[The value of cytological studies in nodular goiter: results in 495 patients].

The accuracy of clinical diagnosis and fine-needle aspiration biopsy (FNAB) was evaluated in a total of 495 patients of whom 183 were operated upon within 6 months after FNAB and 312 were not. Operated patients were divided into three subgroups with high, moderate or low suspicion of malignant neoplasms on clinical grounds. Histological examination revealed an overall malignant neoplasm rate of 23%. The rate, i.e. the positive predictive value, was 74% for the subgroup with high clinical suspicion, vs 14% and 10% respectively for the subgroups with moderate and low clinical suspicion. The sensitivity of a high clinical suspicion was 60% and the specificity 93%. The overall sensitivity of FNAB was 93% in the operated group and probably not less than 87% in all patients studied; specificity was 71% and 84% respectively for these groups. The overall positive predictive value of a positive cytology result (malignant or uncertain) was 48%. In the subgroups with moderate or low clinical suspicion which are more representative of a non-university setting, the average predictive value was 27%. In our opinion all patients in the group with high clinical suspicion need surgical treatment, regardless of the FNAB result; those with lower degrees of clinical suspicion and malignant or uncertain FNAB result should also undergo diagnostic surgical exploration.

Adolescent↗
PubMed1997

[Management of suspected malignant nodular goiter in pregnancy].

Guidelines for the management of thyroid nodules supposed to be malignant during pregnancy have not yet been established. We recommend performance of fine needle biopsy in thyroid nodules having developed during pregnancy, and in preexisting thyroid nodules suspicious of being malignant, respectively. According to literature, surgical intervention in case of papillary carcinoma can be postponed to a timepoint soon after delivery. Regarding the management of follicular or medullary cancer, sufficient data are not available. In threatening cases, i.e. in case of rapid growth of the nodule(s) or suspected high malignancy, surgery can be done at any time. Nevertheless, pregnancy itself neither seems to promote growth of thyroid cancer nor to have any impact on the dignity of cancer.

Adenocarcinoma, Follicular↗
PubMed1997

Reduced serum T3 level in a patient with nodular goiter and cardiac myxoma.

We report the unusual case of an 87-year-old woman with cardiac myxoma and adenomatous goiter. She exhibited slight elevations of serum interleukin-6 (IL-6), but levels of thyroid hormones such as T3, free T3 and free T4 were all abnormally low. Interleukin-6 may potentiate the alteration of thyroid metabolism.

Aged↗
PubMed1992

[Efficacy of L-thyroxine (L-T4) therapy on the volume of the thyroid gland and nodules in patients with euthyroid nodular goiter (ENG)].

The efficacy of treatment with TSH suppressive doses of L-thyroxine was evaluated by echography in 35 patients with euthyroid nodular goiter. Patients have been subdivided in two groups comparable for sex age and size of the goiter. Sixteen patients were treated for nine months with suppressive doses of thyroxine and nineteen were followed without therapy as control. Patients in treatment were then followed up for additional 9 months without therapy. The mean decrease of thyroid volume at nine months was 25% (27 +/- 10 ml vs 20 +/- 8 ml; p < 0.01). After discontinuation of treatment thyroid volume increased and had returned to base line values after nine months of follow up. In the control group mean thyroid volume had increased by 17.7% at nine months (28 +/- 17 vs 33 +/- 19 ml; p < 0.001). Thyroid nodules in response to thyroid hormone treatment showed a variable behaviour: 30.7% (4/13) of the nodules responded to the therapy with a reduction > to 25% at the ninth month; the remaining nodules were insensitive to the therapy. In conclusion suppressive thyroxine treatment is effective in reducing the goiter, nodules instead are only in part sensitive to the treatment. Thyroxine therapy of euthyroid nodular goiter must be followed for long term since upon thyroxine discontinuation there is a prompt reappearance of the goiter.

Adult↗
PubMed2003

[Development of Basedow disease after radioiodine therapy for nodular goiter].

It has been observed in the past few years, that radioiodine therapy triggers autoimmune thyrotoxicosis. The possible mechanism of this phenomenon is that protein fragments enter the circulation after thyroid cell damage induced by radiation. TSH-receptor autoantibodies are produced in genetically susceptible patients after radiotherapy. In treating nodular goiter--a non-immune thyroid disease--with 131I, an immunogenic disorder--Basedow-Graves' disease--may develop. The authors present this phenomenon in a case of a 67 year-old woman with a history of operation for euthyroid nodular goiter in 1977. In November 2001, she was admitted to the hospital with local signs and symptoms of relapse of euthyroid nodular goiter (TSH-receptor antibodies were not detected). She was treated with oral doses of 320 MBq of radioiodine to reduce the thyroid volume. Four months after radioiodine therapy the patient had developed signs of thyrotoxicosis. At that time TSH-receptor antibodies were found to be positive. Thyreostatic therapy was administered and still being in use till today. The authors draw the attention to the fact that, when a hyperthyrosis develops after radioiodine therapy of a non-immune thyroid disease, the possibility of Graves-Basedow disease should be raised, especially in a patient with a positive family history.

Aged↗
PubMed1994

[Nodular goiter from the oncologic viewpoint].

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

Adolescent↗
PubMedDate not supplied

[Clinical study of residual function and recurrences in patients after partial thyroidectomy for non-toxic nodular goiter].

The different surgical chances for the treatment of non toxic nodular goiter led the Authors to study the residual function after partial thyroidectomy. A variable rate of recurrences and hormone deficiency was shown in patients who underwent sub-total thyroidectomy, lobectomy and enucleation. It depended on the amount of residual gland and the different methods they used. Recurrences occurred more in patients studied by ultrasonography. After sub-total thyroidectomy the Authors noted a more reduced number of recurrences than after lobectomy and enucleation. There was a meaningless connection between high plasmatic levels of TSH and recurrences. Subclinical hypothyroidism was higher in patients who underwent subtotal thyroidectomy than in patients treated with lobectomy and enucleation. These clinical data show that recurrences could depend on growth factors (EGF, IGF) in thyroid tissues and not only on TSH action. Therefore the surgical attitude of the authors in the treatment of nodular goiter consists in total thyroidectomy.

Aged↗
PubMed1984

[Pre- and postoperative thyroglobulin secretion into the blood in nodular goiter].

Serum thyroglobulin was measured in patients with a euthyroid, preclinically hyperthyroid or toxic uni- or multinodular goiter (n = 72) prior to and/or 3-12 months following selective resection of the nodular goiter tissue. A sharp decrease in the mean and individually elevated serum thyroglobulin values was observed postoperatively, with normal or undetectable values in 92% of the patients. The pre- and postoperative thyroglobulin levels in multinodular goiter patients with hyperthyroidism, preclinical hyperthyroidism and euthyroidism were 102 +/- 79 micrograms/l vs. 10 +/- 7 micrograms/l; 77 +/- 62 micrograms/l vs. 16 +/- 22 micrograms/l; and 76 +/- 82 micrograms/1 vs. 18 +/- 26 micrograms/1 respectively. The pre- and postoperative values in uninodular goiter patients with TRH-TSH unresponsiveness and with a normal TSH response were 84 +/- 60 micrograms/l vs. 10 +/- 8 micrograms/l, and 105 +/- 115 micrograms/1 vs. less than 6 micrograms/1 respectively. Thus, the elevation of serum thyroglobulin proved to be unrelated to TRH-TSH responsiveness and to thyroid hormone secretion, but to be related to the presence of nodular goiter tissue. Follicular nodules lack normal TSH dependence with respect to goiter maintenance and growth. The results suggest that serum thyroglobulin may represent a marker of autonomous thyroid growth.

Goiter, Nodular↗
PubMed2004

Dosimetry of radioiodine therapy in patients with nodular goiter after pretreatment with a single, low dose of recombinant human thyroid-stimulating hormone.

UNLABELLED: A single, low dose of recombinant human thyroid-stimulating hormone (rhTSH) doubles 24-h RAIU and causes a more homogeneous distribution of radioiodine on thyroid scintigrams of patients with nodular goiter. Pretreatment with rhTSH allows the therapeutic dose of (131)I to be reduced by 50%-60% without compromising the result of thyroid volume reduction. The present study focused on the dosimetric aspects of therapy with a reduced dose of (131)I after pretreatment with rhTSH in patients with nodular goiter. METHODS: Thirty-six patients were treated with (131)I to reduce thyroid volume. Nine patients were pretreated with a single dose of 0.01 mg of rhTSH, and 9 patients, with 0.03 mg of rhTSH. Two control groups of 9 patients, matched for thyroid weight and 24-h radioactive iodide uptake, were not pretreated with rhTSH. The therapeutic dose of (131)I was aimed at being sufficient to result in retention of 3.7 MBq of (131)I per gram of thyroid tissue at 24 h. Thyroid radioactivity after (131)I administration was measured every 24 h for 3 d and on days 7, 10, 14, 21, and 28. A model of iodine biokinetics was used to estimate absorbed doses in organs. Protein-bound (131)I activity was measured at 1, 2, 3, 7, and 10 d and at 2, 3, and 4 wk after (131)I therapy. RESULTS: The administered activities were 1.5 times lower in the 0.01-mg rhTSH group and 1.9 times lower in the 0.03-mg rhTSH group than in the control groups. The absorbed dose in the thyroid was similar in the rhTSH-pretreated groups and in the control groups. In the organs of excretion (bladder) and uptake (stomach) of inorganic iodide, the absorbed doses were 2- to 3-fold lower in the pretreated groups than in the control groups. The effective dose equivalent outside the thyroid was considerably lower in the rhTSH-pretreated groups than in their respective control groups (1.6-fold in the 0.01-mg rhTSH group and 2.3-fold in the 0.03-mg rhTSH group). The time course of protein-bound (131)I activity in serum and the cumulated protein-bound (131)I activity in serum did not differ significantly between rhTSH-pretreated and control groups. CONCLUSION: (131)I therapy after pretreatment with a single, low dose of rhTSH, with the dose reduced according to the rhTSH-induced increase in 24-h radioactive iodide uptake, caused lower radiation-absorbed doses in extrathyroidal organs and tissues, especially bladder and stomach, and no significant increase in the release of (131)I-labeled thyroid hormones into the circulation of patients with nodular goiter. Thus, this mode of therapy can be recommended, especially when the dose of radioiodine to be administered without rhTSH pretreatment is high.

Aged↗