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

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.

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A study to determine the incidence of carcinoma of the thyroid gland in patients treated for multinodular goiter

International Surgery Journal ◽

10.18203/2349-2902.isj20194067 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3289

Author(s):

Vikram Yogish ◽

Challa Teja ◽

Himanshi Grover

Keyword(s):

Thyroid Gland ◽

Multinodular Goiter ◽

Tamil Nadu ◽

Complete Blood Count ◽

Histopathological Examination ◽

Nodular Goiter ◽

Needle Aspiration ◽

Thyroid Function Tests ◽

College Hospital ◽

Detailed History

Background: In the population today, the presence of multi nodular goiter (MNG) is found in quite a few people and this may be due to various reasons. The patients should be thoroughly evaluated and a detailed history must be collected. Surgical treatment is offered to patients for various reasons. The objective of this research article is, to determine the incidence and the type of carcinoma of the thyroid gland in patients treated for multinodular goiter.Methods: A total of 105 patients who had multinodular goiter were studied. The study was carried out at SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu, India, from March 2016 to February 2019, for a period of three years. A detailed history was obtained and a thorough clinical evaluation was done. Investigations such as, complete blood count, thyroid function tests, ultrasound of the neck, and fine needle aspiration cytology were done. The patients then underwent total thyroidectomy and the operated specimens were subjected to histopathological examination (HPE). Out of the total of 105 patients that were studied, 21 patients were found to have carcinoma of the thyroid gland. The statistics were analysed using SPSS package 16.0.Results: From the results it was seen that papillary carcinoma of the thyroid gland was most commonly found in the operated specimens. The findings were compared with other studies.Conclusions: In patients with multinodulargoiter, a thorough evaluation and a detailed histopathological examination of the operated specimens must be done.

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Risk factors for recurrent laryngeal nerve palsy after thyroidectomy

Open Medicine ◽

10.2478/s11536-011-0018-0 ◽

2011 ◽

Vol 6 (3) ◽

pp. 279-283 ◽

Cited By ~ 3

Author(s):

Petr Čelakovský ◽

Jan Vokurka ◽

Lukáš Školoudík ◽

Petr Kordač ◽

Eva Čermáková

Keyword(s):

Risk Factors ◽

Thyroid Cancer ◽

Thyroid Gland ◽

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Multinodular Goitre ◽

Laryngeal Nerve Palsy ◽

Hashimoto's Disease

AbstractThis study investigates the incidence of temporary and permanent recurrent laryngeal nerve palsy (RLNP) and possible risk factors for patients with different types of thyroid gland diseases. 1224 consecutive patients who underwent thyroidectomy for treatment of various thyroid diseases between the years 2001–2005. The rates of RLNP were evaluated. The surgeon and type of thyroid gland disorder were recognised as possible risk factors for RLNP. The incidence of temporary/permanent RLNP for the whole group was 4.5/0.8%. The rates of temporary RLNP for groups, classified as multinodular goitre, Graves’ disease, thyroid cancer or Hashimoto’s disease were 4.3%, 4.3%, 5.2% and 5.7%, respectively. The rates of permanent RLNP for the same groups were 0.4%, 0.9%, 1.6% and 1.9%, respectively. The frequency of temporary RLNP for individual surgeons ranges from 2.8 to 7.0% and the rates of permanent RLNP is between 0–3.1%. There was no relationship between the surgeon’s experience (the number of procedures performed) and RLNP rates. Total thyroidectomy is a safe procedure associated with a low incidence of RLNP not only for benign multinodular goitre, but also for Graves’disease, thyroid cancer and Hashimoto’s disease. The rates of RLNP among individual surgeons are acceptable with small inter-individual differences.

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Strumos chirurginio gydymo pavojai: pooperacinis balso klosčių paralyžius

Lietuvos chirurgija ◽

10.15388/lietchirur.2006.2.2275 ◽

2006 ◽

Vol 4 (2) ◽

pp. 0-0

Author(s):

Algimantas Žindžius ◽

Virgilijus KKrasauskas ◽

Jelena Jončiauskienė

Keyword(s):

Surgical Treatment ◽

Thyroid Gland ◽

Recurrent Laryngeal Nerve ◽

Vocal Cord ◽

Vocal Cord Paralysis ◽

Recurrent Laryngeal Nerve Palsy ◽

Vocal Cord Palsy ◽

Early Postoperative Period ◽

Laryngeal Nerve ◽

Vocal Cords

Algimantas Žindžius, Virgilijus kKrasauskas, Jelena JončiauskienėKauno medicinos universiteto Chirurgijos klinikaEivenių g. 2, LT-50009 Kaunas Tikslas Retrospektyviuoju tyrimu, remiantis medicininės dokumentacijos duomenų analize, įvertinti toksinės ir netoksinės strumos chirurginio gydymo pavojus, pooperacinio balso klosčių paralyžiaus rizikos veiksnius, nustatyti ir palyginti šios komplikacijos dažnumą, atsižvelgiant į operacijos indikacijas, apimtį ir metodiką. Ligoniai ir metodai Išnagrinėtos ligos istorijos 5555 pacientų, operuotų Kauno medicinos universiteto klinikų Chirurgijos klinikoje 1998–2004 metais. Skydliaukės operacijos atliktos subfascine ir atvirąja metodika, neidentifikuojant arba identifikuojant grįžtamuosius gerklų nervus. Rezultatai Pooperacinis balso klosčių paralyžius ištiko 127 (2,29%) pacientus: vienos balso klostės klostės – 104 (1,87%), abipusis – 23 (0,41%) pacientus. Po 350 operacijų nuo strumos recidyvo balso klosčių paralyžius pasireiškė 25 (7,14%) pacientams: 16 (4,57%) – vienpusis, 9 (2,57%) – abipusis. Nustatyta, kad chirurginis gydymas pritaikytas įvairioms strumos klinikinėms formoms, skyrėsi tik laikotarpiu, kai į gydymą įsitraukė chirurgai. Išvados Dažniausia skydliaukės operacija yra tiroidektomija (42,11%), dažniausia komplikacija – pooperacinis balso klosčių paralyžius (2,29%). Grįžtamojo gerklų nervo sužalojimus lemia įvairūs veiksniai – strumos patologinė morfologija, ligos recidyvas, ilgalaikis medikamentinis gydymas, nepalankūs skydliaukės ir gretimų struktūrų anatomijos variantai, operacijos apimtis, operacijos metodas. Dėl abipusio balso klosčių paralyžiaus ankstyvuoju pooperaciniu laikotarpiu 4 pacientams kilus kvėpavimo nepakankamumui, tracheostomijos buvo išvengta atlikus vienos balso klostės šoninę fiksaciją. . Reikšminiai žodžiai: struma, chirurginis gydymas, grįžtamojo gerklų nervo pažeidimas, balso klosčių paralyžius Dangers of thyroid surgery: postoperative paralysis of vocal cords Algimantas Žindžius, Virgilijus kKrasauskas, Jelena JončiauskienėKaunas University of Medicine, Surgery Clinic,Eivenių g. 2, LT-50009 Kaunas, Lithuania Objective The aim of this article is to evaluate retrospectively dangers of the surgical treatment of toxic and nontoxic goiter. We also analyzed the risk factors of postoperative vocal cord paralysis, evaluated and compared the frequency of this complication depending on the indications, extent and methods of surgery. Patients and methods Three thousand eight hundred ninety seven operations on the thyroid were performed at the Clinic of Surgery of Kaunas University of Medicine Hospital during the period 1998–2002. The operations on the thyroid gland have been performed by subfascial and open methods, identifying the recurrent laryngeal nerves. Results Postoperative vocal cord paralysis developed in 97 (2.49%) cases. One-sided vocal cord palsy developed in 81 (2.08%) patients and bilateral in 16 (0.41%) patients. There were 19 (7.49%) cases of vocal cord palsy after 256 operations performed due to recurrent goiter, 13 being one-sided and 6 bilateral. It has been found that surgical treatment is suitable for all clinical forms of goiter, the only difference being the time the surgeons enter the process of treatment. Conclusions The most frequent thyroid gland operation is thyroidectomy (35.69%) and the most frequent complication is postoperative vocal cord paralysis (2.49%). The injuries to the recurrent laryngeal nerve are determined by both objective (thyroid gland pathology, thyroid cancer, recurrence of goiter, long-lasting medical treatment, unfavorable variants of thyroid gland and adjacent anatomic structures and the extent of operation) and subjective factors (methods of operation, surgeon’s experience, operative technique). Individual selection of open or subfascial methods of thyroid operation gives hope to reduce the complications of the surgical treatment. The respiratory insufficiency developing in the early postoperative period due to bilateral vocal cord paralysis can be cured by performing vocal cord laterofixation instead of tracheostomy. Key words: goiter, surgical treatment, recurrent laryngeal nerve palsy, paralysis of vocal cords

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Surgical treatment of a patient with multiple endocrine neoplasia type 2A

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2020-179-4-79-86 ◽

2020 ◽

Vol 179 (4) ◽

pp. 79-86

Author(s):

T. A. Britvin ◽

E. V. Bondarenko ◽

A. V. Krivosheev ◽

O. A. Nechaeva ◽

T. S. Tamazyan ◽

...

Keyword(s):

Surgical Treatment ◽

Multiple Endocrine Neoplasia ◽

Multiple Endocrine Neoplasia Type ◽

Clinical Laboratory ◽

Histopathological Examination ◽

Endocrine Neoplasia ◽

Endocrine Neoplasia Type ◽

Comprehensive Examination ◽

Abdominal Ct Scan ◽

High Level

The diagnosis and treatment of multiple endocrine neoplasia type 2A syndrome or Sipple’s syndrome, as well as other endocrine hereditary syndromes, presents certain difficulties for several reasons. One of them is the rarity of this pathology and, as a result, the lack of awareness of physicians. In addition, the diagnosis requires a comprehensive examination and a high level of clinical, laboratory, radiation and morphological diagnostics. And finally, surgical treatment, which is essentially the only method, involves an individual approach to each patient. We present the clinical case of Sipple's syndrome in a 39-year-old man. The diagnosis was carried out of medical history, clinical examination, laboratory tests (24-hour urine excretion of metanephrines and normetanephrines; serum calcium, calcitonin and parathyroid hormone levels), neck ultrasound and abdominal CT scan and was confirmed by histopathological examination and genetic testing for RET mutation. The achievement of the endpoint in the form of normalization of blood pressure and the absence of adrenal insufficiency was due to radical surgical treatment.

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Late Simultaneous Metastasis of Renal Cell Carcinoma to the Submandibular and Thyroid Glands Seven Years after Radical Nephrectomy

International Journal of Otolaryngology ◽

10.1155/2010/698014 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 11

Author(s):

Mohammed S. Miah ◽

Sharon J. White ◽

George Oommen ◽

Esther Birney ◽

Samit Majumdar

Keyword(s):

Renal Cell Carcinoma ◽

Thyroid Gland ◽

Cell Carcinoma ◽

Salivary Glands ◽

Metastatic Disease ◽

Renal Cell ◽

Previous History ◽

Surgical Excision ◽

First Case ◽

Thyroid Glands

Background. Renal cell carcinoma (RCC) metastasis to the salivary glands is extremely rare. Most cases reported previously have involved the parotid gland and only six cases involving the submandibular gland exist in the current literature. Metastasis of RCC to thyroid gland is also rare but appears to be more common than to salivary glands.Methods and Results. We present the first case of simultaneous metastasis to the submandibular and thyroid glands from clear cell RCC in a 61-year-old woman who presented seven years after the primary treatment. The submandibular and thyroid glands were excised completely with preservation of the marginal mandibular and recurrent laryngeal nerves, respectively.Conclusion. Metastatic disease should always be considered in the differential diagnosis for patients who present with painless salivary or thyroid gland swelling with a previous history of RCC. If metastatic disease is confined only to these glands, prompt surgical excision can be curative.

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Epidemiology and results of surgical treatment of euthyroid and toxic goiter depending on the peculiarities of clinical course, tracheal compression and comorbidity

Problems of Endocrinology ◽

10.14341/probl12233 ◽

2020 ◽

Vol 66 (1) ◽

pp. 87-92

Author(s):

Elena A. Ilyicheva ◽

Gleb A. Bersenev ◽

Valeriy N. Makhutov ◽

Gennadiy Yu. Aldaranov ◽

Eugene G. Grigoryev

Keyword(s):

Pulmonary Hypertension ◽

Surgical Treatment ◽

Thyroid Gland ◽

Multinodular Goiter ◽

Thyroid Diseases ◽

External Respiration ◽

Tracheal Compression ◽

Toxic Goiter ◽

Endocrine Surgeon ◽

Benign Thyroid

BACKGROUND: At the time of seeking medical help, some patients have nodular/multinodular goiter of large and gigantic sizes, which leads to compression of the neck organs. In the structure of benign diseases, neck compression is diagnosed in 10% of cases, and tracheal narrowing is found in 84% of patients in this group. It was experimentally established that narrowing of the trachea leads to the development of hypertension in the pulmonary circulation. Patients with nodular/multinodular goiter with compression of the neck organs belong to the age group of 50 years and older, the peculiarity of which is comorbidity of varying severity. Cardiopulmonary syndromes may mask compression of the organs of the neck by the thyroid gland. As a rule, patients come and/or go to a cardiologist, pulmonologist, gastroenterologist and other specialists, as a result of which the timelines for timely surgical treatment are missed. Often, patients are delivered to the endocrine surgeon urgently due to the development of asphyxiation. The symptoms of impaired external respiration and the initial manifestations of pulmonary hypertension, as a result of compression syndrome, preceding this condition are evaluated only retrospectively. AIMS: To study the frequency of tracheal compression and symptoms of chronic hypoxia in the structure of benign thyroid diseases requiring surgical treatment, as well as an assessment of the nature of comorbid pathology and the results of surgical treatment. METHODS: A retrospective analysis of the results of surgical treatment of benign thyroid diseases for the period from March to August 2019 was carried out (100 observations). RESULTS: Toxic goiter prevailed in the structure of benign thyroid diseases (74%). Tracheal compression was observed in 69% of cases. When trachea was compressed, arterial hypertension statistically significantly prevailed (2, p0.01). The appearance of wheezing on inhalation/exhalation and an increase in its frequency were detected when the trachea narrowed to the thyroid gland to 10 mm or less in 10 cases (10%) with a statistically significant prevalence of pulmonary hypertension (2, p0.01). Thyroidectomy prevailed in the structure of operations (80%). There was no statistically significant increase in surgical complications depending on the severity of tracheal compression, age, and concomitant pathology. There were no fatal outcomes. CONCLUSIONS: Surgical treatment of patients with benign thyroid diseases complicated by compression of the neck organs is also shown safely regardless of age and associated pathology.

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Is it Necessary to Perform a Histopathological Examination of Pilonidal Sinus Excision Material?

The American Surgeon ◽

10.1177/0003134821991974 ◽

2021 ◽

pp. 000313482199197

Author(s):

Tezcan Akin ◽

Merve Akin ◽

Serhat Ocakli ◽

Birkan Birben ◽

Sadettin Er ◽

...

Keyword(s):

Surgical Treatment ◽

Pilonidal Sinus ◽

Histopathological Examination ◽

Surgical Excision ◽

Pilonidal Sinus Disease ◽

Sinus Disease ◽

Associated Malignancy

Background Although pilonidal sinus disease is common, development of associated malignancy is very rare. After surgical treatment, most surgeons send the excision material for a histopathological examination. The aim of this study was to examine whether it is necessary to routinely send the pilonidal sinus surgical excision material for this examination. Method The data of 3146 patients were retrospectively screened, and 2486 patients with available histopathological reports of the excision material were included in the study. Results Of the 2486 patients included in the study, 2165 were men and 321 were women, and 94.7% of the patients were under the age of 50 years while 5.3% were 50 years or above. The rate of patients who underwent surgery due to recurrence was 1.2%. No malignancy was detected in any patient after the histopathological examination. Discussion In this study, none of the pathology results was reported as malignant. This confirms that it is necessary to ask the question whether we should routinely send the surgical excision material for a histopathological examination.

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Histological Study of Human Thyroid Gland Relative Proportion of Parenchyma and Stroma in Thyroid Glands of Bangladeshi People

Update Dental College Journal ◽

10.3329/updcj.v1i2.13981 ◽

2013 ◽

Vol 1 (2) ◽

pp. 17-20

Author(s):

Md Enayet Ullah ◽

Hasna Hena ◽

Rubina Qasim

Keyword(s):

Thyroid Gland ◽

Histological Study ◽

Relative Proportion ◽

Age Groups ◽

Human Thyroid ◽

Structural Units ◽

Thyroid Glands ◽

Group A ◽

Group B ◽

Connective Tissue Sheath

Deep cervical fascia forms a connective tissue sheath around the thyroid gland. Delicate trabeculae and septa penetrate the gland indistinctly dividing the gland into lobes and lobules which in turn composed of follicles.1,2,3 These follicles are structural units of thyroid gland which varies greatly in size and shape.4 The number of follicles varies in different age groups. The study was carried out to see the percentage of area occupied by follicles in the stained section of thyroid glands in different age groups. The collected samples were grouped as A (3.5 20yrs), B (21- 40yrs) & C (41 78yrs). Percentage of area occupied by follicles was (58.55±10.72) in group A, (63.79±12.35) in group B + (63.39±8.29) in group C.DOI: http://dx.doi.org/10.3329/updcj.v1i2.13981 Update Dent. Coll. j. 2011: 1(2): 17-20

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INHIBITION OF THYROGLOBULIN BIOSYNTHESIS AND DEGRADATION BY EXCESS IODIDE. SYNERGISM WITH LITHIUM

Acta Endocrinologica ◽

10.1530/acta.0.0810495 ◽

1976 ◽

Vol 81 (2) ◽

pp. 495-506 ◽

Cited By ~ 9

Author(s):

A. Radvila ◽

R. Roost ◽

H. Bürgi ◽

H. Kohler ◽

H. Studer

Keyword(s):

Protein Synthesis ◽

Thyroid Gland ◽

Inhibitory Action ◽

Inhibit Protein Synthesis ◽

Thyrotrophic Hormone ◽

Thyroid Glands ◽

Pre Treatment ◽

Excess Iodide ◽

Kidney Liver

ABSTRACT Lithium and excess iodide inhibit the release of thyroid hormone from preformed stores. We thus tested the hypothesis that this was due to an inhibition of thyroglobulin breakdown. Rats were pre-treated with propylthiouracil (PTU) for 3 weeks in order to deplete their thyroids of thyroglobulin. While the PTU was continued, lithium chloride (0.25 mEq./100 g weight) or potassium iodide (3 mg per rat) were injected every 12 h for 3 days. Thereafter the thyroglobulin content in thyroid gland homogenates was measured. PTU pre-treatment lowered the thyroglobulin content from 4.21 to 0.22 mg/100 mg gland. Lithium caused a marked re-accumulation of thyroglobulin to 0.60 mg/100 mg within 3 days. While iodide alone had only a borderline effect, it markedly potentiated the action of lithium and a combination of the two drugs increased the thyroglobulin content to 1.04 mg/100 mg. Thyroxine was injected into similarly pre-treated animals to suppress secretion of thyrotrophic hormone. This markedly inhibited the proteolysis of thyroglobulin and 1.3 mg/100 mg gland accumulated after 3 days. Excess iodide, given in addition to thyroxine, decreased the amount of thyroglobulin accumulated to 0.75 mg/100 mg gland. To study whether this could be explained by an inhibitory action of iodide on thyroglobulin biosynthesis, thyroid glands from animals treated with excess iodide were incubated in vitro in the presence of 0.2 mm iodide for 3 h. Iodide decreased the incorporation of radioactive leucine into total thyroidal protein and into thyroglobulin by 25 and 35 % respectively. Iodide did not inhibit protein synthesis in the kidney, liver or muscle tissue. Thus, large doses of iodide selectively inhibit thyroglobulin biosynthesis.

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Treatment Methods Conditioned by the Gravity of Drug-Induced Gingival Hyperplasias

Revista de Chimie ◽

10.37358/rc.17.11.5941 ◽

2017 ◽

Vol 68 (11) ◽

pp. 2618-2622

Author(s):

Alina Mihaela Calin ◽

Mihaela Debita ◽

Raluca Dragomir ◽

Ovidiu Mihail Stefanescu ◽

Cristian Budacu ◽

...

Keyword(s):

Dental Treatment ◽

Histopathological Examination ◽

Transplant Rejection ◽

Surgical Excision ◽

Channel Blockers ◽

Gingival Hyperplasia ◽

Drug Induced ◽

Treatment Methods ◽

Systemic Medication ◽

Bacterial Plaque

The first drug discovered to be involved in the development of gingival hyperplasia is phenytoin, which is indicated in the treatment of epileptic patients. The other drugs are calcium channel blockers with vasodilating effect. The most important one is Nifedipine, while Ciclosporin A, which is used as an immunosuppressant in the prevention of transplant rejection, causes gingival hyperplasia as a secondary effect. Gingival hyperplasia can reach an impressive volume, completely covering the dental crown and affecting the masticatory and physiognomic functions. The elucidation of the mechanism, by which drug-induced gingival hyperplasia occurs, favoring factors and the choice of conservative or surgical treatment methods, emphasizing the prophylactic treatment. The study batch was subject to intraoral and extraoral clinical examinations and the data were included in the dental treatment sheet of each patient, 11 patients aged over 60 years, who came to the Clinic ... in the period 2014-2016. The diagnosis was based on the anamnesis, the clinical aspect of the lesions and the histopathological examination. After the surgical excision of the hyperplasia affected area, recurrence was prevented by dispensarizing the patients and controlling the bacterial plaque through rigorous oral hygiene. Treatment depends on the severity of the lesions, as well as on the physionomic and masticatory functions. Conservative etiological therapy is attempted, by removing the bacterial plaque and local irritant factors, by reducing the dose of drugs, or by changing the systemic medication.

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