scholarly journals GAMBARAN EUTIROID PADA PASIEN STRUMA MULTINODUSA NON-TOKSIK DI BAGIAN BEDAH RSUP PROF. DR. R. D. KANDOU MANADO PERIODE JULI 2012 – JULI 2014

e-CliniC ◽  
2015 ◽  
Vol 3 (3) ◽  
Author(s):  
Syaugi M. Assagaf ◽  
Nico Lumintang ◽  
Harsali Lampus
Keyword(s):  
Retrospective Study ◽  
Thyroid Gland ◽  
Total Thyroidectomy ◽  
Thyroid Tissue ◽  
Subtotal Thyroidectomy ◽  
Nodular Goitre ◽  
Thyroid Glands ◽  
Surgery Department ◽  
Euthyroid Goitre ◽  
Gland Enlargement

Abstract: Goitre is a thyroid gland enlargement due to the increase of thyroid tissue. Goitre can be classified from several aspects: physiological (euthyroidsm, hypothyroidsm, and hyperthyroidism), morphological (diffuse and nodular goitre), and clinical (toxic and non toxic goitre) aspects. Patients with euthyroid goitre have no symptoms because there is no abnormality with the thyroid function. This study aimed to obtain the profile of the non toxic multinodosa goitre patients with euthyroidism in Surgery Department Prof. Dr. R. D. Kandou Hospital Manado period from July 2012 to July 2014. This was a descriptive retrospective study using the medical record of the Surgery Department Prof. Dr. R. D. Kandou Hospital Manado. Of 25 non toxic goitre multinodosa patients, there were 21 (84%) female patient and 4 (16%) male patient. Patients with euthyroidism were 21 cases (84%) and with hypothyroidism 4 cases (16%). Therapy of euthyroid goitre was surgery. The types of surgery for this 25 patient were as follows: 14 (56%) total thyroidectomy, 9 (36%) isthmolobectomy, 1 (4%) nearly total thyroidectomy, and 1 case (4%) subtotal thyroidectomy. Patients with enlargements in the neck should be checked for their thyroid glands and hormones even if they do not have any symptoms, especially if they come from iodine deficiency endemic area.Keywords: goitre, euthyroidAbstrak: Struma adalah pembesaran kelenjar tiroid karena terjadi penambahan jaringan kelenjar tiroid. Struma dapat diklasifikasikan berdasarkan fisiologis (eutirodisme, hipotiroidisme, dan hipertiroidisme), morfologi (struma difus dan nodular) serta berdasarkan klinis (struma toksik dan non toksik). Penderita struma yang eutiroid tidak mempunyai keluhan karena tidak terdapat gangguan fungsi tiroid. Penelitian ini bertujuan untuk mengetahui gambaran pasien struma multinodusa non-toksik yag eutiroid di Bagian Bedah RSUP Prof. Dr. R. D. Kandou Manado periode Juli 2012 – Juli 2014. Penelitian ini bersifat deskriptif retrospektif dengan memanfaatkan catatan medik di Bagian Bedah RSUP Prof. Dr. R. D. Kandou Manado. Dari 25 pasien struma multinodusa non-toksik ditemukan bahwa jenis kelamin perempuan sebanyak 21 pasien (84%) dan jenis kelamin laki-laki 4 pasien (16%). Jumlah pasien yang eutiroid sebanyak 21 kasus (84%) dan hipotiroid 4 kasus (16%). Terapi struma eutiroid ialah pembedahan. Dari 25 kasus struma multinodusa non-toksik didapatkan 14 kasus (56%) tiroidektomi total, 9 kasus (36%) istmolobektomi, 1 kasus (4%) tiroidektomi hampir total, dan 1 kasus (4%) tiroidektomi subtotal. Pasien dengan pembesaran di daerah leher sebaiknya langsung dilakukan pemeriksaan kelenjar dan hormon tiroid walaupun tanpa gejala apapun, terutama yang berasal dari daerah endemis kekurangan yodium.Kata kunci: struma, eutiroid

Infants Diagnosed with Athyreosis on Scintigraphy May Have a Gland Present on Ultrasound and Have Transient Congenital Hypothyroidism

2021 ◽  
pp. 1-8
Author(s):  
Niamh McGrath ◽  
Colin Patrick Hawkes ◽  
Stephanie Ryan ◽  
Philip Mayne ◽  
Nuala Murphy
Keyword(s):  
Thyroid Gland ◽  
Congenital Hypothyroidism ◽  
Thyroid Tissue ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Ultrasound ◽  
Free T4 ◽  
Median Serum ◽  
Thyroid Glands ◽  
Rule Out

Scintigraphy using technetium-99m (<sup>99m</sup>Tc) is the gold standard for imaging the thyroid gland in infants with congenital hypothyroidism (CHT) and is the most reliable method of diagnosing an ectopic thyroid gland. One of the limitations of scintigraphy is the possibility that no uptake is detected despite the presence of thyroid tissue, leading to the spurious diagnosis of athyreosis. Thyroid ultrasound is a useful adjunct to detect thyroid tissue in the absence of <sup>99m</sup>Tc uptake. <b><i>Aims:</i></b> We aimed to describe the incidence of sonographically detectable in situ thyroid glands in infants scintigraphically diagnosed with athyreosis using <sup>99m</sup>Tc and to describe the clinical characteristics and natural history in these infants. <b><i>Methods:</i></b> The newborn screening records of all infants diagnosed with CHT between 2007 and 2016 were reviewed. Those diagnosed with CHT and athyreosis confirmed on scintigraphy were invited to attend a thyroid ultrasound. <b><i>Results:</i></b> Of the 488 infants diagnosed with CHT during the study period, 18/73 (24.6%) infants with absent uptake on scintigraphy had thyroid tissue visualised on ultrasound (3 hypoplastic thyroid glands and 15 eutopic glands). The median serum thyroid-stimulating hormone (TSH) concentration at diagnosis was significantly lower than that in infants with confirmed athyreosis (no gland on ultrasound and no uptake on scintigraphy) (74 vs. 270 mU/L), and median free T4 concentration at diagnosis was higher (11.9 vs. 3.9 pmol/L). Six of 10 (60%) infants with no uptake on scintigraphy but a eutopic gland on ultrasound had transient CHT. <b><i>Conclusion:</i></b> Absent uptake on scintigraphy in infants with CHT does not rule out a eutopic gland, especially in infants with less elevated TSH concentrations. Clinically, adding thyroid ultrasound to the diagnostic evaluation of infants who have athyreosis on scintigraphy may avoid committing some infants with presumed athyreosis to lifelong levothyroxine treatment.

scholarly journals Developing anterior mediastinum mass after orthotopic thyroidectomy: a case report

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Rita Meira Soares Camelo ◽  
José Maria Barros
Keyword(s):  
Thyroid Gland ◽  
Total Thyroidectomy ◽  
Thyroid Tissue ◽  
Anterior Mediastinum ◽  
Ectopic Thyroid ◽  
Ectopic Thyroid Tissue ◽  
Ectopic Tissue ◽  
Thyroid Scan ◽  
Imaging Results ◽  
Adjacent Structures

Abstract Background Ectopic thyroid tissue is a rare embryological aberration described by the occurrence of thyroid tissue at a site other than in its normal pretracheal location. Depending on the time of the disruption during embryogenesis, ectopic thyroid may occur at several positions from the base of the tongue to the thyroglossal duct. Ectopic mediastinal thyroid tissue is normally asymptomatic, but particularly after orthotopic thyroidectomy, it might turn out to be symptomatic. Symptoms are normally due to compression of adjacent structures. Case presentation We present a case of a 66-year-old male submitted to a total thyroidectomy 3 years ago, due to multinodular goiter (pathological results revealed nodular hyperplasia and no evidence of malignancy), under thyroid replacement therapy. Over the last year, he developed hoarseness, choking sensation in the chest, and shortness of breath. Thyroid markers were unremarkable. He was submitted to neck and thoracic computed tomography, magnetic resonance imaging, and radionuclide thyroid scan. Imaging results identified an anterior mediastinum solid lesion. A radionuclide thyroid scan confirmed the diagnosis of ectopic thyroid tissue. The patient refused surgery. Conclusions Ectopic thyroid tissue can occur either as the only detectable thyroid gland tissue or in addition to a normotopic thyroid gland. After a total thyroidectomy, thyroid-stimulating hormone can promote a compensatory volume growth of previously asymptomatic ectopic tissue. This can be particularly diagnosis challenging since ectopic tissue can arise as an ambiguous space-occupying lesion.

RADIOACTIVE IODINE THERAPY FOR PROGRESSIVE MALIGNANT EXOPHTHALMOS

1966 ◽  
Vol 51 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Franz K. Bauer ◽  
Boris Catz
Keyword(s):  
Thyroid Gland ◽  
Marked Improvement ◽  
Radioactive Iodine ◽  
Thyroid Tissue ◽  
Complex Problem ◽  
Radioactive Iodine Therapy ◽  
Thyroid Glands ◽  
Therapeutic Doses ◽  
Precise Role

ABSTRACT Eighteen euthyroid patients with progressive malignant exophthalmos, of whom 16 had been treated by other forms of therapy, were treated with large therapeutic doses of radioactive iodine in an effort to ablate their thyroid glands. In four of the patients no functioning thyroid tissue could be demonstrated; in the others thyroid tissue can still be demonstrated with 5 mc doses of 131I preceded by thyrotrophin. In all patients, marked improvement of the infiltrative changes of ophthalmopathy resulted. Proptosis improved but in none of them did it regress completely to normal. The doses of radioactive iodine required to destroy thyroid remnants were much larger than the doses employed in the treatment of hyperthyroidism. It is suggested that the thyroid gland plays an important part in the complex problem of progressive exophthalmos and the presence of LATS, although its precise role remains to be determined.

scholarly journals Comparison of Complications between Total and Subtotal Thyroidectomy in Simple Multinodular Goitre

2018 ◽  
Vol 9 (2) ◽  
pp. 55-59
Author(s):  
Nadim Ahmed ◽  
Sami Ahmad ◽  
Farhad Uddin Ahmed ◽  
Muhammad Anwar Hossain ◽  
Krishna Pada Saha ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Subtotal Thyroidectomy ◽  
Fisher Exact Test ◽  
Multinodular Goitre ◽  
Chi Square ◽  
College Hospital ◽  
Nodular Goitre ◽  
Exact Test ◽  
Postoperative Haemorrhage ◽  
Significant Difference

Background: Multinodular goitre is one of the most common endocrine surgical problems. Because controversy still continues to surround the use of total thyroidectomy for management of simple nodular goitre, the present study was conducted to compare the complications between total and subtotal thyroidectomy for management of simple multinodular goitre.Materials & methods: The experimental study was conducted in the department of Surgery and ENT, Rajshahi Medical College Hospital over a period of 2 years from July 2011 to June 2013. Of the total 83 simple multinodular goitre patients – 38 were assigned to total and 45 to subtotal thyroidectomy groups. Student’s t-test was done to analyze the means of quantitative variables & Chi-square (X2) and Fisher Exact test was applied to analyze categorical variables.Results: Most (88.9%) of patients in subtotal thyroidectomy (STT) group and 86.8% in total thyroidectomy (TT) group did not receive any blood transfusion during operation. Only 1(2.2%) patient in STT group experienced significant intraoperative haemorrhage. All patients were successfully operated. However, few patients of either group experienced some complications. Tetany was developed in 7.89% patients of TT and 4.44% patients of STT group. The other complication was recurrent laryngeal nerve (RLN) palsy (5.3% in TT and 2.2% in STT groups). No case of postoperative haemorrhage (haematoma) or wound infection was occured in either group. In TT group 5 (13.16%) patients and in STT group 4 (8.89%) patients developed different complications with no significant difference between the groups (p=0.533). The mean postoperative hospital stay was higher in TT group than In STT group (6.21 ± 0.99 vs. 5.96 ± 0.79 days), though the difference is not statistically significant (p= 0.206).Conclusions: The study shows that total thyroidectomy can be performed without increasing risk of complications and is a better alternative to subtotal thyroidectomy for the treatment of simple multinodular goitre.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 55-59

scholarly journals Thyroglobulin Gene Mutations Producing Defective Intracellular Transport of Thyroglobulin Are Associated with Increased Thyroidal Type 2 Iodothyronine Deiodinase Activity

2007 ◽  
Vol 92 (4) ◽  
pp. 1451-1457 ◽  
Author(s):  
Yasuhiko Kanou ◽  
Akira Hishinuma ◽  
Katsuhiko Tsunekawa ◽  
Koji Seki ◽  
Yutaka Mizuno ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Intracellular Transport ◽  
Mrna Level ◽  
Thyroid Tissue ◽  
Compound Heterozygous ◽  
Free T4 ◽  
Iodothyronine Deiodinase ◽  
Normal Thyroid ◽  
Thyroid Glands

Abstract Context: Most patients with defective synthesis and/or secretion of thyroglobulin (Tg) present relatively high serum free T3 (FT3) concentrations with disproportionately low free T4 (FT4) resulting in a high FT3/FT4 ratio. The mechanism of this change in FT3/FT4 ratio remains unknown. Objective: We hypothesize that increased type 2 iodothyronine deiodinase (D2) activity in the thyroid gland may explain the higher FT3/FT4 ratio that is frequently observed in patients with abnormal Tg synthesis. Design: We recently identified a compound heterozygous patient (patient A) with a Tg G2356R mutation and one previously described (C1245R) that is known to cause a defect in intracellular transport of Tg. In the current study, after determining the abnormality caused by G2356R, we measured D2 activity as well as its mRNA level in the thyroid gland. We also measured the thyroidal D2 activity in three patients with Tg transport defect and in normal thyroid tissue. Results: Morphological and biochemical analysis of the thyroid gland from patient A, complemented by a pulse-chase experiment, revealed that G2356R produces a defect in intracellular Tg transport. D2 activity but not type 1 deiodinase in thyroid glands of patients with abnormal Tg transport was significantly higher than in normal thyroid glands, whereas D2 mRNA level in patient A was comparable with that in normal thyroid glands. Furthermore, there was a positive correlation between D2 activity and FT3/FT4 ratios. Conclusion: Increased thyroidal D2 activity in the thyroid gland is responsible for the higher FT3/FT4 ratios in patients with defective intracellular Tg transport.

The relationships between surgical histometry, outcome and pre-treatment in Graves' disease

1981 ◽  
Vol 98 (1) ◽  
pp. 43-49 ◽  
Author(s):  
T.J. Wilkin ◽  
A. Gunn ◽  
M. Al Moussa ◽  
T. E. Isles ◽  
J. Crooks ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Surgical Technique ◽  
Total Thyroidectomy ◽  
Diagnostic Criteria ◽  
Operative Treatment ◽  
Thyroid Tissue ◽  
Lymphocytic Infiltration ◽  
Graves Disease ◽  
Pre Treatment ◽  
The Relationship

Abstract. Quantitative histometric methods were used to established the relationship between the extent of thyroid lymphocytic infiltration at operation, and outcome exactly 18 months later in 50 surgically-treated Graves' disease patients prepared by carbimazole and triiodothyronine. Periods of pre-operative treatment, surgical technique, histometric analysis and diagnostic criteria were all standardised. Controls (107) were obtained from the forensic laboratory. Thirty-seven patients became euthyroid, but there was no relationship between outcome and epithelial or lymphoid content of the thyroid gland. Neither was there any correlation between the size of lymphoid infiltrate and epithelial mass of the resected thyroids, suggesting that simple lymphocyte infiltrations do not replace thyroid tissue as once thought. The variation in thyroid epithelial content was nearly 3-fold, so that a surgeon, even if able accurately to judge the anatomical mass of the remnant, would still have little or no idea of its functional mass. The scatter of epithelial content was even greater in glands from patients prepared for surgery by propranolol alone (38 glands, variation × 5.5) or propranolol and iodide (32 glands, variation × 5.9). Outcome after sub-total thyroidectomy for Graves' disease seems unrelated to the lymphocyte content of the gland and it is questionable to what extent the surgeon can either predict or control the outcome of thyroidectomy in individual Graves' disease patients.

scholarly journals Papillary Thyroid Carcinoma Within Thyroglossal Duct Cyst

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A895-A896
Author(s):  
Raghda Al Anbari ◽  
Majlinda Xhikola ◽  
Sushma Kadiyala
Keyword(s):  
Thyroid Gland ◽  
Total Thyroidectomy ◽  
Thyroid Cartilage ◽  
Thyroid Tissue ◽  
Neck Mass ◽  
Thyroglossal Duct Cyst ◽  
Papillary Thyroid ◽  
Anterior Neck ◽  
Duct Cyst ◽  
Thyroglossal Duct

Abstract A 55-year-old female with medical history of hypothyroidism and fibrocystic disease of the breast presented with complains of a painful anterior neck mass, difficulty swallowing and hoarseness of the voice. Symptoms had progressed over a period of 5 months. CT neck with contrast indicated the presence of an ectopic thyroid tissue anterior to the thyroid cartilage measuring approximately 1.7 x 1.2 x 3.1 cm, with indistinct inferior margins and internal calcifications. The hyoid bone or thyroid cartilage had no irregularities. The thyroid gland itself was unremarkable except for small complex thyroid nodules in both lobes. No masses within the pharynx or larynx were noted. Family history was significant for lymphoma in her father. On physical exam, a hard, mobile right anterior neck mass was appreciated. Labs showed normal TSH of 1.05 uIU/mL and normal free T4 of 1.2 ng/dL. Further evaluation with a dedicated neck US showed a right submandibular mass, superior to the thyroid, lobulated and heterogeneous measuring 2.0 x 1.0 x 2.3 cm with multiple areas of calcifications and internal Doppler flow. The thyroid gland had normal size and texture with bilateral sub centimeter non-concerning nodules. After ENT evaluation and an unremarkable flexible fiberoptic nasolaryngoscope, patient underwent surgical excisional biopsy of the neck mass. Pathology was consistent with thyroglossal duct cyst with the presence of thyroid follicles. An incidental finding of a 0.9 cm papillary microcarcinoma was noted, which was encapsulated with focal extracapsular follicular structures showing papillary nuclear features with no perineural or lymphovascular invasion. The tumor cells were immunoreactive for TTF-1 and PAX8. Development of papillary thyroid cancer within the thyroglossal duct cyst is a rare event, reportedly occurring in 1% of thyroglossal duct cysts. There are no well-established management guidelines. Current management strategies consist of monitoring with serial neck ultrasound versus total thyroidectomy with consideration of postsurgical I-131 treatment, based on pathology results. Our patient opted for undergoing total thyroidectomy.

scholarly journals Application of LigaSure Technology in Thyroid Surgery

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
I. M. Deykalo ◽  
O. V. Shidlovsky ◽  
Ya. Ya. Bodnar ◽  
T. V. Bodnar
Keyword(s):  
Surgical Treatment ◽  
Thyroid Gland ◽  
Radio Frequency ◽  
Thyroid Surgery ◽  
Thyroid Tissue ◽  
Coagulative Necrosis ◽  
Nodular Goitre ◽  
Surgical Access ◽  
The Impact ◽  
Frequency Current

The incidence of nodular forms of goitre, compression syndrome in particular, as well as thyroid oncopathology is steadily growing. The number of patients with diffuse toxic goitre and functional autonomy of nodular forms of goitre exhibits no tendency toward reduction. Thyroid surgery remains one of the major and most effective methods of treatment.  Parathyroid glands and laryngeal nerves are located close to large branches of the thyroid arteries; therefore, thyroid surgery should be performed in a dry operative field.The objective of the research was to assess the efficacy of the LigaSure technology in the formation of reliable homeostasis as well as to provide morphological basis for blood clot quality and morphofunctional state of the thyroid parenchyma after hemithyroidectomy.Materials and methods. The results of surgical treatment of 100 patients with nodular and toxic forms of goitre being treated in the surgical department of the Ternopil Municipal Emergency Hospital during 2011-2012 were compared with the results of surgical treatment of 200 patients with similar pathology who underwent surgical treatment during 2014-2016. According to the in-patient medical records, in patients operated on during 2011-2012 to achieve homeostasis the traditional ligature method was used; the length of surgical access was 6-8 cm. However, to achieve homeostasis in patients operated on during 2014-2016 the LigaSure device was used during surgery; the length of surgical access was 2.5-3 cm. The removed part of the thyroid gland was sent for morphological examination. The thyroid tissue was fixed in a 10% neutral formalin solution to be studied macro-and microscopically. A 1.0x0.5-cm fragment of the thyroid tissue was dissected out from three areas: the first fragment was dissected out from the area of the impact of radio-frequency current; the second fragment was dissected out in the perifocal area 0.5 cm from the electrocoagulation area, and the third one was dissected out 0.8-1.0 cm from the electrocoagulation area.  Dewaxed sections were stained with haematoxylin, eosin as well as with Hart and Mallory’s fuchselin. Histological preparations were studied using the SEOSCAN and Lumam P-8 microscopes at different magnifications. Results. Histological study revealed local coagulative necrosis in the area of the impact of LigaSure radio-frequency current. The contours of the follicles without coloured structures, which were saturated with haemolytic erythrocytes, indicated necrosis. The thyrocyte cytoplasm and intercellular tissue were eosinophilic; the nuclei were not identified. In the lumen of intraorganic blood vessels, there was formed homogeneous agglutinative thrombus tightly adhering to the vascular wall indicating the formation of reliable and high-quality homeostasis in the area of direct effect of radio-frequency current. In the perifocal area there were the signs of the adaptive processes on the background of pronounced microcirculatory disturbances. Changes in thyrocytes manifested themselves as necrotic and dystrophic swelling and enlightenment of the cytoplasm. Clinically, these changes may manifest themselves as an increase in the secretory function of the thyroid gland in the particular area. Changes being typical to chronic manifestations of nodular goitre were found in the areas more distant from coagulative necrosis. The thyroid parenchyma was represented by clusters of large and small follicles separated by connective tissue interlayers.Conclusions. The application of the LigaSure technology in surgical treatment of the thyroid gland improves the quality of surgical interventions due to a decrease in intraoperative blood loss, duration of surgery as well as postoperative in-patient treatment. In addition, the LigaSure technology provides better surgical access, thereby improving cosmetic effect. Morphologic changes in the thyroid gland due to the effect of radio-frequency current were distance-dependent: in the area of direct effect of radio-frequency current coagulative necrosis developed; in the perifocal area intensified secretory response of the thyroid tissue to the extreme factor occurred; in distant areas the typical structure of the nodular goitre with the signs of disturbed microcirculation was found. 

THE HYPOCALCAEMIC AND HYPOPHOSPHATAEMIC EFFECT OF EXTRACTS FROM CHICKEN ULTIMOBRANCHIAL GLANDS

1969 ◽  
Vol 60 (4) ◽  
pp. 689-695 ◽  
Author(s):  
O. Helmer Sorensen ◽  
S. Pors Nielsen
Keyword(s):  
Thyroid Gland ◽  
Serum Calcium ◽  
Dose Response ◽  
Thyroid Tissue ◽  
Response Curves ◽  
Gland Extract ◽  
Ultimobranchial Glands ◽  
Thyroid Glands ◽  
Dose Response Curves ◽  
Ultimobranchial Gland

ABSTRACT Acid extracts of chicken ultimobranchial and thyroid glands were assayed in the rat for their effects on serum calcium and phosphate. The concentration of a hypocalcaemic factor in the ultimobranchial tissue was more than 100 times greater than that found in pig thyroid tissue. No hypocalcaemic activity was found in the chicken thyroid gland. An extract of the ultimobranchial glands was found to have a significant hypophosphataemic effect in the rat. This fact combined with the parallelism of the log dose-response curves found for the ultimobranchial gland extract and a calcitonin standard, suggests that hypocalcaemic factor is similar to mammalian calcitonin.

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