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PubMedDate not supplied

Lack of response of peripheral blood mononuclear cells to thyroid microsomal antigen in nontoxic nodular goiters.

The production of interferon gamma (IFN gamma) by peripheral blood mononuclear cells (PBMC) from patients with nontoxic nodular goiter (NTNG), autoimmune thyroid disease (AITD), and normal persons (NL) has been studied in vitro, with the express object of comparing NTNG and AITD. PBMC were cultured with thyroid microsomal antigen (TMc), thyroglobulin (Tg), and liver microsomal antigen (LMc) at concentrations of 0, 1, 10, 100, and 1000 ng/ml for two days. IFN gamma was measured by a spot-ELISA technique which determines the number of cells secreting IFN gamma. There were no significant differences in the basal numbers of IFN gamma secreting cells between NL, AITD, and NTNG PBMC in this study. In AITD PBMC, TMc antigen caused a significant increase in the number of IFN gamma secreting cells, compared with the numbers in unstimulated AITD PBMC (percent IFN gamma secreting cells), whereas Tg and LMc antigen caused a significant decrease in all groups. The maximal percentage change in IFN gamma secreting cells (i.e., compared to unstimulated PBMC) did not increase significantly in NTNG in response to TMc antigen, in contrast to the AITD PBMC. Based on these findings, it is concluded that NTNG PBMC are not sensitized to the thyroid antigens tested; this is unlike the findings from AITD PBMC.

Adolescent↗

PubMed2002

Smoking as a risk factor for Graves' disease, toxic nodular goiter, and autoimmune hypothyroidism.

To study the association between smoking and thyroid disease (Graves' disease [E05.0], nodular toxic goiter [E05.2], and autoimmune hypothyroidism [E03.9]) in a low-iodine intake area a case-control study was undertaken. A self-administered questionnaire was issued to 864 consecutive patients with hyperthyroidism and 628 patients with autoimmune hypothyroidism treated at five university or regional endocrinologic clinics in Denmark between January 1, 1990 and December 31, 1998. Each respondent was compared to an age- (+/- 5 years) and gender-matched normal control person randomly drawn from the background population. A total of 621 patients with hyperthyroidism (72%) and 411 patients with autoimmune hypothyroidism (66%) responded. Of these, 617 (542 females) and 408 (364 females) could be analyzed, respectively. There was an increased risk of both Graves' disease (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.8-3.5), toxic nodular goiter (OR = 1.7, 95% CI: 1.1-2.5), and autoimmune hypothyroidism (OR = 1.5, 95% CI: 1.1-2.1) with ever smoking compared to never smoking in women, but not in men. With the high proportion of ever-smokers among women (56%), the attributable risk of smoking in women was 45% in Graves' disease, 28% in toxic nodular goiter, and 23% in autoimmune hypothyroidism. Ever use of oral contraceptives was associated with a slightly lower risk of Graves' disease in women, but not of toxic nodular goiter or autoimmune hypothyroidism. In conclusion, smoking is a powerful risk factor for thyroid disease, especially in populations with a high smoking frequency. Oral contraceptive use is associated with a slightly lower frequency of Graves' disease.

Adult↗

PubMed1987

Changes of the blood lymphocyte population following 131I treatment for nodular goiter.

The blood lymphocyte population was examined in 34 patients who were treated with 131I for toxic or atoxic nodular goiter. The patients received one to three doses of 300-550 MBq of 131I administered at 1 week intervals. Lymphocyte counts were significantly reduced both 1 and 6 weeks after treatment. This reduction was accompanied by a changed composition of the lymphocyte population. The frequency of lymphocytes expressing membrane receptors for C'3 (EAC-rosette forming) was significantly reduced 1 and 6 weeks after 131I-administration. At 6 weeks there was a slight but statistically significant increase of the frequency of T-cells as identified by Leu 1 monoclonal antibodies. This was largely caused by an increased proportion of helper/induced T-cells as identified by Leu 3a monoclonals. 131I-treatment also reduced the capacity of lymphocytes to secrete immunoglobulins (Ig) upon PWM-stimulation. The most pronounced effect was observed for IgM. Secretion of IgG and IgA were less reduced. Mitogenic stimulations of lymphocytes with PHA and ConA were not significantly changed. We conclude that these changes observed, with the exception of mitogen reactivity, are essentially similar to those occurring after external radiation therapy for cancer. We speculate that blood lymphocytes passing through the continuously irradiated gland are damaged mainly by emitted beta-particles.

Adult↗

PubMed1990

Physiopathology of thyroid cysts in euthyroid nodular goiter.

Following the introduction of echography it has became evident that a large proportion of nodules (15-37%) in euthyroid nodular goiter is entirely or partially cystic (20% in the A. experience). It is thought that cystic areas are subsequent to hemorrhagic necrosis occurring during goitrogenesis and therefore the term "pseudocysts" seems to be preferred. The article summarizes some hypothetical mechanisms of pseudocyst formation. In pseudocysts of recent onset a direct or indirect viral or bacterial etiology is suggested; in longstanding pseudocysts a deficient angiogenesis or immunotoxic mechanisms are proposed.

Cysts↗

PubMed1989

[Surgical tactics in non-toxic nodular goiter].

Surgical policy in 246 cases of nodular euthyroid goiter was reviewed. Urgent histological examination of operative biopsy specimens of the removed thyroid tissue has disclosed subclinical thyroid cancer in 6.6% of the patients. The authors hold that surgical intervention is an effective measure in prophylaxis and early detection of thyroid cancer in clinical cases of nodular nontoxic goiter.

Adult↗

PubMed2004

Uses for recombinant human TSH in patients with thyroid cancer and nodular goiter.

Recombinant human TSH (rhTSH) has revolutionized the care of patients with differentiated thyroid cancer. Since its approval for clinical use in 2001 in Europe (1998 in the USA), rhTSH has greatly enhanced the surveillance of these patients by allowing the avoidance of hypothyroidism for TSH stimulation. Previously, a hypothyroid state was required for TSH stimulated diagnostic whole-body radio-iodine scans (DxWBS) and thyroglobulin (Tg) levels. Patients generally prefer rhTSH as a mechanism for TSH stimulation because symptoms of hypothyroidism can be completely avoided. Currently, rhTSH is only approved for diagnostic monitoring of differentiated thyroid cancer patients. There are many other potential uses for rhTSH, including facilitation of treatment of patients with thyroid cancer and nodular goiter. The diagnostic and therapeutic role of rhTSH in patients with differentiated thyroid cancer and nodular goiter will be discussed in this review.

Adjuvants, Pharmaceutic↗

PubMed1986

Further data supporting episodic degenerative discharge of thyroid hormone from nodular goiters.

To elucidate the features of thyroid hormone secretion under conditions of impaired circulation, blood samples were withdrawn at operation from thyroid and peripheral veins of 23 patients with thyroidal and non-thyroidal diseases. They were taken from the respective veins simultaneously, when the arterial supply to the thyroid tissue was partially occluded by surgical manipulation. It was found that triiodothyronine was preferentially, as compared with thyroxine, secreted from the thyroid, irrespective of the disease. Serum levels of thyroglobulin were also markedly elevated in the thyroid vein. These results suggest that episodic degenerative discharge of thyroid hormone from nodular goiters may be a cause of impaired or blunted TSH response to TRH, frequently observed in patients with common nontoxic nodular goiters.

Goiter, Nodular↗

PubMed2005

Effects on bone mineral density by treatment of benign nodular goiter with mildly suppressive doses of L-thyroxine in a cohort women study.

OBJECTIVES: Thyroid diseases and their treatment may influence the osseous system. The influence that prolonged suppressive L-thyroxine (LT4) therapy may have on inducing subclinical hyperthyroidism on bone metabolism is still a matter of debate. The aim of the present study was to assess the effects of chronic LT4 treatment at mildly inhibiting serum thyroid-stimulating hormone (TSH) doses on bone mineral density (BMD) and biochemical bone remodeling markers in a cohort of women with benign nodular goiter, and to verify the efficacy of the treatment on nodule size. SUBJECTS AND STUDY DESIGN: A total of 200 euthyroid Caucasian women with nodular goiter (age 52.1 +/- 9; 80 pre- and 120 postmenopausal) were enrolled: 96 had been treated with LT4 for at least 3 years and a matched group of 104 had untreated goiter. LT4 therapy was given at a dose sufficient to reduce TSH under the lower limit of the normal range (0.27-4.20 microIU/ml) without suppressing it below the limit of assay sensitivity (0.005 microIU/ml) and maintaining normal serum values of free triiodothyronine (FT3) and free thyroxine (FT4). The adequacy of the dose was evaluated on the basis of serum TSH levels. The osteopenic effect of LT4 treatment was evaluated directly by total body and lumbar spine dual-energy X-ray absorptiometry (DEXA) and indirectly by biochemical parameters (alkaline phosphatase, osteocalcin, calcium, parathyroid hormone) at the baseline and throughout the follow-up. The efficacy of LT4 schedule on thyroid nodule size was assessed on the basis of the ultrasonographic evaluation. RESULTS: Mineralometric data showed no significant difference between BMD values for treated and untreated patients in both pre- and postmenopausal status. In all patients, serum markers of bone turnover were in the normal range, with no differences in the treated and control groups. The TSH concentrations were significantly lower in treated than in untreated patients (p < 0.0001); FT3 and FT4 were in the normal range for all patients. Evaluation of nodule size during follow-up showed a reduction of > or = 30% in 32 of 96 treated patients (33.3%) versus none in those untreated, whilst nodule size remained unmodified in 60 treated patients (62.5%) versus 35 (33.6%) in those untreated, and an increase in nodule size and/or development of new nodules was found in 4 treated patients (4.2%) versus 69 of the 104 untreated patients (66.3%). CONCLUSIONS: This study suggests that at slightly suppressing TSH doses, LT4 therapy has no adverse effects on BMD in both pre- and postmenopausal women, while having an efficacy on nodule size comparable with that reported using an LT4 schedule able to maintain TSH near or below the assay sensitivity limit.

Absorptiometry, Photon↗

PubMed2000

[Recurrent nodular goiter. Characteristic features and surgical management].

Purpose of the study was to investigate the frequency of the thyroid carcinoma in the recurrent nodular goiter, to analyse the applied operative methods, the observed complications and the obtained early and distant postoperative results. For the period 1985-1996 in the Clinic of Endocrine Surgery were performed 588 reoperations by 577 patients with nodular recurrent goiter, distributed as following: 539 females, aged 14-81 and 49 males, aged 11-69. In 431 cases (73%) was applied medial approach and in 157 cases (27%)--lateral operative approach by the mobilizing of the thyroid recurrence. In the early postoperative period were established the following complications: clinical hypoparathyroidism in 10 patients (1.7%) with calcium level from 1.44-2.01 mmol/l and recurrent nerve paralysis in 28 patients (4.76%), including: in 13 cases unilateral paralysis on the right side, in 9 cases unilateral--on the left side and in 6 cases--bilateral paralysis. The established in 28 patients (4.76%) thyroid carcinoma and the appeared in 59 cases (10%) new recurrence of the basic thyroid disease supported our tactic for radical operative treatment in all patients with nodular recurrent goiter.

Adolescent↗

PubMed2003

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

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.

Carcinoma↗

PubMed1985

Comparison of serum angiotensin-converting enzyme in Graves' disease, toxic nodular goiter, and other thyroid conditions.

Angiotensin-converting enzyme (ACE) was measured in plasma of patients with Graves' disease and with toxic nodular goiter, as well as in their treated counterparts and in normal controls. A significant elevation of ACE levels and a positive correlation between ACE, thyroxine, and triiodothyronine levels was found in both groups of thyrotoxicosis. Parallel fluctuations of triiodothyronine and ACE levels, albeit with a certain lag of the latter, was observed in patients in whom multiple measurements were taken. ACE levels, which were also determined in hypothyroid patients and in patients with euthyroid goiter on suppression therapy, were in the same range as normal controls and as in treated thyrotoxic patients. We conclude that the pathogenesis of thyrotoxicosis does not play a role in ACE elevation but that increased thyroid hormone seems to induce elevation of ACE. ACE elevation in thyrotoxicosis may constitute an integral part of the renin-angiotensin axis.

Adolescent↗

PubMedDate not supplied

Multinucleated giant cells in fine needle aspirates. Can they help differentiate papillary thyroid cancer from benign nodular goiter?

OBJECTIVE: To determine whether multinucleated giant cells (MGCs) in fine needle aspirates can help differentiate papillary thyroid carcinoma (PTC) from benign nodular goiter (BNG). STUDY DESIGN: Specimens from 100 cases of PTC and 100 cases of BNG with surgical and pathologic proof were randomly retrieved. The morphologic characteristics and frequency distribution of the maximal size and number of MGC nuclei were analyzed. A retrospective review of medical records was also undertaken. RESULTS: MGCs were twice as frequent (40%) in PTC than in BNG (26%) (odds ratio = 1.90). Most MGCs in BNG tended to be smaller and ovoid, with foamy cytoplasm, and had fewer nuclei. No MGC in BNG was > 116 microns in diameter or had > 27 nuclei. In contrast, MGCs in PTC were more diverse in size, shape, cytoplasm and number of nuclei. No significant association was found between the presence or nature of MGCs and disease extent in PTC. CONCLUSION: The presence of large MGCs with dense cytoplasm in a thyroid nodule without clinical evidence of thyroiditis should prompt careful exclusion of associated PTC.

Biopsy, Needle↗

PubMed1989

[Role of surgery in the treatment of simple nodular goiter].

On the basis of the pathophysiological data and their experience, the Authors believe that the medical treatment of non-toxic nodular goiter has many limitations. Furthermore, thyroid nodules may progress uncontrollably till to cancer. Surgery is safe in skilled hands, but in many cases it is necessary to remove the gland extensively. Thus, the best treatment is both medical and surgical, because prevention and cure are associated that way.

Female↗

PubMed2005

[The LISA trial-a- randomized, double-blind, placebo-controlled four-arm study of 1,000 patients with nodular goiter in Germany. Study Design and first results of feasibility].

BACKGROUND: Although levothyroxine is the mostly prescribed medicament in Germany, its therapeutic effectiveness in nodular goiter was never studied in a randomized, double-blind trial with sufficient power. Thus, in May 2004 a TSH-adapted (TSH: thyroid-stimulating hormone), randomized, doubleblind, placebo-controlled four-arm (placebo [P] vs. levothyroxine [T] vs. iodine [I] vs. levothyroxine + iodine [TI]) multicenter study was started in Germany (LISA study). PATIENTS AND METHODS: Based on former retrospective and prospective studies, it was calculated that a sufficient statistical power (> 80%) would be achieved with 250 patients in each arm. The primary endpoint of the trial is the 1-year change of ultrasonographically measured total volume of all nodules. Secondary criteria are volume of goiter, number of nodules, and echogenic structure of nodules. While the study is kept strictly double-blind, the dose of levothyroxine in the T and TI groups is adapted once according to 3-month TSH measurements (target range 0.2-0.8 mU/l). RESULTS: Up to now (1 year after beginning), 305 patients have been included. TSH adaptation could be performed without compromising the double-blind character of the study with good results: about 90% of the patients reached the TSH target range. CONCLUSION: Unblinded results are to be expected in 2007.

Adolescent↗

PubMed2001

Retrospective analysis of the association of nodular goiter with primary and secondary hyperparathyroidism.

BACKGROUND: The association of hyperparathyroidism (HPT) with thyroid disease has long been known, but the mechanisms underlying such an association have not yet been clarified. OBJECTIVE: To elucidate the main factors determining this combination of endocrine diseases, in a retrospective multicenter study. METHODS: We retrospectively reviewed all patients referred for parathyroid scintigraphy in the period 1990-1999. A total of 487 patients in the age range 17-65 years were selected for the analysis (339 women and 148 men); group A included 241 patients with primary and group B 246 patients with secondary HPT. RESULTS: A total of 124/241 patients in group A (51.5%), but only 92/246 patients in group B (38.2%) had thyroid disorders (notably nodular goiter) associated with HPT (P=0.0035). Thyroid disorders were evenly distributed throughout the entire 17-65 years age range in group A, but 17-40-year-old patients in group B had significantly fewer thyroid disorders than the older patients of the same group (15.5% compared with 43.3%, P<0.002), as expected in a general population. In patients with primary HPT there was no difference in the prevalence of thyroid disease between women and men, whereas the ratio of women to men in secondary HPT patients with thyroid disease was about 3:1. CONCLUSIONS: These results demonstrate an increased prevalence of nodular goiter in patients with primary rather than secondary HPT, and are consistent with a possible role of increased endogenous calcium concentrations (a hallmark of primary, but not of secondary, HPT) as a goitrogenic factor in patients with HPT.

Adolescent↗

PubMed1992

[The surgical treatment of autonomous nodular goiter. Prospective long-term study].

In a prospective study 287 patients with a nodular goiter and preclinical or overt hyperthyroidism (TRH-TSH unresponsiveness) underwent selective excision of the nodular goitrous tissue to prevent continuing growth and goiter recurrence and reduce concomitantly the autonomously functioning follicular tissue. Depending on the topographic location of the nodes, hilar dissection (hemithyroidectomy or extrathyroidal excision) was carried out in 44% of the patients instead of classic subtotal resection. The operative mortality was nil and the rate of recurrent nerve palsy was 2.1% of cases and 1.3% of nerves at risk respectively; in no instance did bilateral palsy or permanent hypoparathyroidism occur. Thyroid function was investigated one or more times during a period lasting from 3 months to 18 years postoperatively. One patient (0.6%) developed recurrent hyperthyroidism, and in 5 subjects euthyroid TRH-TSH unresponsiveness persisted during an observation period lasting 8-13 years postoperatively. Preclinical or overt hypothyroidism occurred depending upon the extension of goiter resection, i.e. upon the extension of nodular goitrous transformation: hypothyroidism occurred in none of the patients with unifocal (uninodular) autonomy. In 58% of patients with less than or equal to 10 g of residual thyroid tissue, and in 19% of patients with a greater than 10 g thyroid remnant, substitution with thyroxine was necessary. In 2 (2.4%) of the patients followed up for 5-18 (x = 10 +/- 3) years a goiter recurrence (euthyroid) necessitating resection developed 9 and 12 years respectively after resection of a toxic uninodular goiter.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1998

[Surgery of nodular goiter: postoperative hypocalcemia in relation to extent of resection and manipulation of the parathyroid glands].

In a series of 579 consecutive first operations for bilateral benign nodular goiter, the incidence of hypocalcemia was analyzed related to the extent of the bilateral operative procedure and manipulation of the parathyroid glands (identification, mobilization, non-identification). The incidence of early hypocalcemia increased with the extent of the operation and with increasing manipulation of the parathyroid glands. However, permanent hypocalcemia was exclusively found after identification of less than three parathyroid glands (1.5% vs 0%), most evidently after bilateral conventional subtotal resection (3.5%). As a rule, the parathyroid glands should be identified routinely, especially in conventional subtotal resections, if possible without further mobilizing manipulations.

Goiter, Nodular↗

PubMed1988

Sequential changes in serum thyroglobulin, triiodothyronine, and thyroxine following partial thyroidectomy for nontoxic nodular goiter.

The sequential changes in serum thyroglobulin (Tg), thyroxine (T4), free thyroxine (FT4), triiodothyronine (T3) and thyrotropin (TSH) were evaluated in ten patients on whom partial thyroidectomy for nontoxic nodular goiter had been performed. These changes were compared with those in ten patients who underwent upper abdominal surgery (cholecystectomy) under similar anesthesia, and whose calorie and fluid intake was similar until at least 48 hours after surgery. In agreement with previous reports, marked elevations in serum Tg that reached peak concentration (660 to 1350 ng/mL) at one or two hours after the thyroid incision (mean +/- SD; 787 +/- 304.0 ng/mL and 839 +/- 345.7 ng/mL, respectively) were observed. On the other hand, the significant but minimal increases in serum T4 and FT4 were observed at 24 hours (P less than .001 and P less than .001, respectively), 48 hours (P less than .01 and P less than .001, respectively), and 72 hours (P less than .01 and P less than .01, respectively) after the thyroid incision compared with the level just prior to the thyroid incision. Similarly, serum T3 also increased significantly at 6 to 168 hours after the thyroid incision (P less than .01, P less than .05, P less than .05, P less than .05, and P less than .05, respectively). These increases in serum T4, FT4 and T3 were not observed in the cholecystectomy patients. The mean serum TSH levels at 24 to 72 hours after thyroid incision and those at 6 to 48 hours after the abdominal incision were significantly decreased compared with those before thyroid and abdominal incision, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗