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PubMedDate not supplied

Nodular goiter and thyroid carcinoma in children and adolescents in a moderate endemic area (lower Silesia-Sudeten endemia) in the last twelve years.

Although thyroid carcinoma is more common in the adult population, the risk of a nodule being malignant is greater in children. The aim of our present investigation was to ascertain the percentage of malignancy in nodular goiter observed in patients from the Lower Silesia region in the last 12 years. The examination included 60 children (12 boys and 48 girls) treated in our clinic from 1987 to June 1998. Age varied from 7 to 18 years (mean 14.8 +/- 2.4), most of them in the age group between 13 and 18 years. The following investigations were performed: TSH, T3, T4, thyroid ultrasonography, fine needle aspiration biopsy and Tc99 scintigraphy of the thyroid. Most of the patients were euthyroid; two children demonstrated pressure symptoms. All the patients were treated by operation. Histological examinations revealed the following: nodular goiter in 19 patients, cystic nodular goiter in 5, follicular adenoma in 20, fetal adenoma in 3, nodular goiter and follicular adenoma in 6, papillary carcinoma in 6, and follicular carcinoma in 1 patient. We concluded that an increased incidence of thyroid cancer has been noted in children with nodular goiter in Lower Silesia during the last 12 years. Thyroid cancer was observed mostly in patients with single nodules and was associated with a high risk of malignancy.

Adolescent↗
PubMed1978

Morphologic and functional substrate of thyrotoxicosis caused by nodular goiters.

The pathogenesis of nonimmunogenic thyrotoxicosis caused by nodular goiters--with the exception of true toxic adenoma--was investigated in 11 patients by means of scintigraphic, morphologic and autoradiographic technics. The basic event is the appearance, for unknown reasons, of autonomously functioning follicles which are morphologically indistinguishable from normal follicles. Four basic patterns of intrathyroidal distribution of autonomously functioning follicles are individualized: Type I = multiple individual autonomously functioning follicles scattered throughout the goiter. Type II = clustered autonomous follicles without demarcation from less active parenchyma. Type III = multiple microadenomas. Type IV = autonomous function of the majority of all follicles. In all four types, the autonomous follicles occur without recognizable relation to nodule boundaries. Scintiscans cannot predict the microstructure of these types of goiters. More than one pattern of distribution of autonomously functioning follicles may occur within a single goiter. The growth of thyroid nodules is independent of, and certainly not a prerequisite to, thyrotoxicosis. Rather, the appearance of thyrotoxicosis in this type of multinodular goiter depends on (1) the number of autonomous follicles throughout the gland and (2) their mean hormone-producing capacity per unit of time.

Autoradiography↗
PubMed2002

[Percutaneous ethanol sclerotherapy of non-toxic nodular goiters--a clinical study of 76 patients].

INTRODUCTION: Ultrasonography-guided percutaneous ethanol injection (PEI) therapy is a new method for treating nodular goiters. PATIENTS AND METHODS: 76 patients with nontoxic nodular goiter (65 women, 11 men, mean age 49 years) underwent PEI in order to avoid surgery. In the first 14 patients with cystic nodule one session, while in the remaining 36 patients 3-8 sessions were performed. In each session after evacuation of the cysts half volume of absolute alcohol was injected into the nodule. In the cases of the 26 solid nodules each patient received a mean total dose of 0.98 ml (range 0.34-1.77 ml) ethanol per ml nodular volume. Ethanol was injected in a mean of 3.9 (range 2-8) sessions for solid nodules. Success was defined as shrinkage of the nodule to half or less compared to the pretreatment volume on 4.5 months and every later follow-up occasion. RESULTS: No serious side effects occurred. 2 previously operated patients became hypothyroid. In the case of cystic nodules treated on one session, in 4 of 14 cases the therapy was unsuccessful. In patients treated on multiple occasions the success rate was significantly (p = 0.02, chi 2(1) = 5.06) higher; in 34 of 36 cases. PEI was successful in 25 of 26 patients with solid nodules. A continuous shrinkage of the nodule was observed in those 25 patients who were followed for at least 2 years: the volume of the nodule was 35% at 1.5 month, 29% at 4.5 month, 21% at 1 year and 17% of pretreatment volume at 2 years follow-up. CONCLUSIONS: PEI should be reserved for patients who cannot or will not undergo surgery. On the other hand, patients with recurrent nodular goiter requiring surgery form a subset where PEI can be proposed.

Adult↗
PubMed2007

Analysis of the sodium iodide symporter expression in histological slides from a nodular goiter.

BACKGROUND: The aim of the study was analysis at both the level and the cell site of the sodium/iodide symporter (NIS) in histological slides from hot, warm, and cold nodules and extranodular parenchyma according to scintigraphy. METHODS: The study population consisted of 97 people who underwent surgery for a toxic nodular goiter (26 patients) or a non-toxic nodular goiter (71 patients). Immunohistochemical study was performed with 198 histological slides from hot, warm, and cold nodules (study slides) and the extranodular parenchyma (control slides). The level of NIS expression was estimated objectively using the computerized image analysis system, Quantimet 600S (Leica, Cambridge, UK). RESULTS: We found significantly higher NIS expression in hot nodules than in cold nodules and in warm nodules than in cold ones. We found significantly higher NIS expression in hot and warm nodules than in the surrounding parenchyma. The level of NIS expression did not differ significantly between cold nodules and the collateral tissues. CONCLUSIONS: Our data indicate that NIS protein participates in the development of hyperthyroidism in the course of a nodular goiter. We confirm that the functional state of a nodular goiter is determined by NIS expression in nodules, not in collateral parenchyma. The low metabolism of cold nodules does not simply result from decreased level of NIS protein or its defective targeting to the cell membrane. The observation of NIS in the cell cytoplasm of hot nodules seems to indicate that the intracellular localization of NIS does not determine loss of its activity.

Female↗
PubMed2002

[Early results after minimal lobectomy for benign nodular goiter].

Following traditional operations (enucleation and subtotal resection) for benign nodular goiters recurrences may develop. Reoperations for this condition can cause complications, such as hypoparathyroidism and damage of the recurrent laryngeal nerve. That is why total thyroidectomy is recommended by many specialists in benign thyroid disease. We performed lobectomy on one side, and, if necessary, partial resection on the other side. Lobectomy was performed on one side in 31 cases, with partial resections on the other side in 73 patients. We tried to identify the parathyroid glands and both recurrent laryngeal nerves. Postoperative complications were evaluated. Temporary dysfunction of the recurrent laryngeal nerve was detected in 2.3%, permanent damage in 1.1%. Temporary hypocalcaemia developed in 16.4%, permanent hypocalcemia in 1.9%. Two reoperations were necessary for bleeding. Because of the low postoperative complication rate we recommend this method as an alternative to thyroidectomy for benign nodular goiters. We know that our favourable results can be compared with traditional subtotal resection and thyroidectomy when long term results of thyroid function and data about nodular recurrences will be collected.

Adult↗
PubMed1999

Suppressive therapy with levothyroxine for euthyroid diffuse and nodular goiter.

In this study, 35 patients with euthyroid diffuse goiter and 35 patients with euthyroid nodular goiter were treated with Levothyroxine (L-T4) for six months. The aim was to evaluate the efficacy of treatment on thyroid and nodule volumes and to evaluate the correlation between volume changes and thyroglobulin levels. Serum thyroid hormones, TSH, thyroglobulin, thyroid and nodule volumes were measured at the initial visit and after 6 months. Radioactive iodine uptakes of the thyroid gland were evaluated before treatment. The mean decrease of thyroid volume at six months was about 20% (20.4 +/- 8.8 ml vs. 16 +/- 7.9 ml, P<0.001) in patients with diffuse goiter. All patients with diffuse goiter showed some decrement in their goiter sizes. Thyroid nodules, in response to thyroid hormone treatment, showed a variable behavior. A reduction of 50% or more in volume was detected in 31% (11/35) of the patients. 54% of the patients (19/35) showed a 10-49% decrease in nodule volume. Five of the patients were found to be insensitive to the therapy. Their nodule volumes either increased or did not change during therapy. Free T4 and free T3 levels increased and TSH levels decreased with L-T4 treatment in all patient groups. Patients with higher TSH levels (within normal limits) showed more volume reduction in the diffuse goiter group. No uniform correlation was found between volume changes and thyroglobulin levels in either of the patient groups. In conclusion, suppressive thyroxine treatment is effective in reducing the size of the goiter, and nodules and thyroglobulin levels cannot be taken as an indicator of the efficacy of L-T4 therapy.

Female↗
PubMed1989

Simple nodular goiter. Treatment of 58 cases.

The treatment of 58 cases of simple nodular goiter, over a three-year period, is reported. This study was done in the Asella Regional Hospital, situated in the Arssi Region, in the central highland of Ethiopia. This is a frequent disease in this Region, and two provinces at high risk have been identified. Simple nodular goiter masked a carcinoma in 15.4% of cases. The treatment and results are discussed in details.

Adolescent↗
PubMed2001

Pretreatment with recombinant human TSH changes the regional distribution of radioiodine on thyroid scintigrams of nodular goiters.

In a recent study, we demonstrated that pretreatment with a single, low dose of recombinant human TSH (rhTSH) doubles 24-h thyroid radioactive iodine uptake in patients with nodular goiter. The purpose of the present study was to investigate whether rhTSH pretreatment induces changes in the regional distribution of radioiodine as visualized on thyroid scintigrams in these patients. Anterior planar thyroid 123I scintigrams were obtained in 26 patients with a nodular goiter (23 women and 3 men; age, 62 +/- 9 yr, mean +/- SD; thyroid weight, 165 +/- 72 g) 24 h after administration of a diagnostic dose of radioiodine. All patients were studied twice: first, without rhTSH pretreatment (baseline study), and second, after an im injection of 0.01 mg (n = 10) or 0.03 mg rhTSH (n = 16), given 24 h before radioiodine administration (rhTSH study). For quantification of regional differences in radioiodine uptake, a region of interest method was used. Upon visual inspection, baseline scintigrams showed a heterogeneous uptake of radioiodine. In general, rhTSH scintigrams also showed heterogeneous radioiodine uptake. In some patients, the distribution of radioiodine in the rhTSH scintigram was considerably more homogeneous than in the baseline scintigram. In a few patients, originally "cold" areas had changed into "hot" ones, whereas originally hot areas had changed into cold ones. Quantification of regional radioiodine uptake showed that pretreatment with rhTSH caused a larger increase in radioiodine uptake in relatively cold areas and a smaller increase in radioiodine uptake in relatively hot areas, compared with the increase in radioiodine uptake in the entire thyroid. In patients with a baseline serum TSH level of 0.5 mU/liter or lower, the increase in radioiodine uptake in relatively cold areas was significantly larger than in patients with a baseline serum TSH level higher than 0.5 mU/liter. In conclusion, a single, low dose of rhTSH not only doubled 24-h radioactive iodine uptake but also caused a more homogeneous distribution of radioiodine within the thyroid gland in patients with a nodular goiter by stimulating radioiodine uptake in relatively cold areas more than in relatively hot areas. This was most marked in patients with a low baseline serum TSH level. Our data suggest that pretreatment with rhTSH may improve the efficacy of radioiodine treatment for volume reduction of nodular goiters, especially in patients with a low baseline serum TSH level.

Aged↗
PubMed1989

Thyroid peroxidase activity in human nodular goiters.

1. Thyroid peroxidase (TPO, iodide-oxidation) activity was evaluated in nodular and paranodular tissue samples from 27 patients with nodular goiter (19 "cold" and 8 "hot" nodules), and compared to 11 diffuse toxic goiter and 9 normal thyroid tissue samples. 2. In terms of U/g digitonin solubilized protein, TPO activity was increased in hot nodules (P less than 0.05), although not as much as in diffuse toxic goiters (P less than 0.01). 3. The mean TPO activity of tissues paranodular to a cold nodule was not different from that of normal thyroids. 4. Both the highest and the lowest TPO activities were found in cold nodules, but their mean value did not differ from those of their paranodular tissues or normal thyroids. 5. Inter-tissue variability was significantly increased (P less than 0.01) in cold nodules and in tissues paranodular to a hot nodule. 6. These data show that heterogeneity both within and among tissues contributes to the wide range of TPO activity detected in nodular goiters.

Adult↗