nodular goiter
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2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Huirong Wang ◽  
Yousheng Jiang ◽  
Jiayi Song ◽  
Huiwen Liang ◽  
Yuan Liu ◽  
...  

Abstract Background The incidence rates of thyroid tumors and nodular goiter show an upward trend worldwide. There are limited reports on the risk of perchlorate and iodine on thyroid tumors, but evidence from population studies is scarce, and their impact on thyroid function is still uncertain. Therefore, the objective of this study was to investigate the association of perchlorate and iodine with the risk of nodular goiter (NG), papillary thyroid microcarcinoma (PTMC), and papillary thyroid carcinoma (PTC) and to assess the correlation between perchlorate and iodine with thyroid function indicators. Methods A case–control population consisting of 184 pairs of thyroid tumors and nodular goiter matched by gender and age (±2 years) was recruited in this study. Serum and urine samples were collected from each participant. Thyroid function indicators in serum were tested by automatic chemical immunofluorescence, and perchlorate and iodine levels in urine were determined by ultra-high performance liquid chromatography tandem-mass spectrometry and inductively coupled plasma-mass spectrometry, respectively. Conditional logistic regressions and multiple linear regressions were used to analyze the associations. Results Urinary perchlorate concentration was significantly higher in total cases, NG and PTC than in the corresponding controls (P < 0.05). Perchlorate was positively associated with PTC (OR = 1.058, 95% CI: 1.009, 1.110) in a non-linear dose–response relationship, but there was no association between perchlorate and NG or PTMC. Iodine was not associated with the risk of thyroid tumors and NG and did not correlate with the thyroid function indicators. Furthermore, perchlorate showed a positive correlation with thyroid stimulating hormone (TSH) at iodine adequate levels (P < 0.05), and a negative correlation with free triiodothyronine (FT3) and a positive correlation with thyroglobulin antibody (TgAb) at iodine more than adequate or excess levels (P < 0.05). Conclusions Perchlorate can increase the risk of PTC in a non-linear dose–response relationship and disturb the thyroid hormone homeostasis and thyroid autoantibody levels.


2021 ◽  
Vol 71 (Suppl-3) ◽  
pp. 630-33
Author(s):  
Tahira Sajid ◽  
Syeda Rifaat Qamar Naqvi ◽  
Zara Sajid ◽  
Fatima Sajid ◽  
Ismail Akbar ◽  
...  

Objective: To compare the occurrence of hypocalcemia in patients undergoing subtotal and total thyroidectomy. Study Design: Comparative prospective study. Place and Duration of Study: Surgical departments of Ayub Teaching Hospital, Abbottabad and Combined Military Hospital, Rawalpindi, from Mar 2018 to Feb 2020. Methodology: A total of 171 patients were selected for this study and they were divided into 2 groups. Group 1 consisted of 95 patients undergoing Total thyroidectomy whereas group 2 had 76 patients undergoing Subtotal thyroidectomy. It was a comparative prospective study and the groups were made by convenience sampling. The data was analyzed by SPSS-23. Results: In total thyroidectomy group Hypocalcemia was detected after 48 hours in 34 patients (35%) while in subtotal thyroidectomy group hypocalcemia was detected in 20 patients (28%). Tests for hypocalcemia were also done after two months of surgery and low levels were detected in 7 patients (7.5%) who had total thyroidectomy and in 2 patients (5%) in the group undergoing subtotal thyroidectomy. There was no significant difference in hypocalcemia after 48 hour (p=0.22) and 2 months postoperatively (p=0.6) between patients of Total Thyroidectomy and Subtotal Thyroidectomy. Conclusion: Total thyroidectomy is not associated with increased risk of permanent hypocalcemia as compared to Subtotal thyroidectomy. Because of its advantages Total thyroidectomy should be the preferred surgical procedure for patients presenting with benign euthyroid multi nodular goiter.


Folia Medica ◽  
2021 ◽  
Vol 63 (6) ◽  
pp. 834-838
Author(s):  
Antoaneta Argatska ◽  
Boyan Nonchev

Thyroid surgery is generally recommended for malignant conditions and for some benign thyroid disorders. Many patients report weight gain after thyroidectomy especially during the first months following surgery. Studies on patients with Graves&rsquo; disease treated either with antithyroid drugs or radioiodine confirm that these patients frequently gain weight after restoration of thyroid function. Other studies have also shown that there is considerable weight gain after thyroidectomy for both nodular goiter and thyroid cancer. Transient hypothyroidism during the postoperative period is often thought to be associated with weight gain after thyroidectomy. The role of a number of adipocytokines and their interaction with the thyroid function has been investigated in the pathogenesis of weight changes. Levothyroxine replacement or suppressive therapy after thyroidectomy has a different impact on the metabolic parameters independent of TSH levels. The long-term effects of the impaired T3/T4 ratio are not fully understood as there are no sensitive markers to assess the biological response of target organs and tissues. Future studies are needed to identify such parameters, provide new considerations for the treatment of patients after total thyroidectomy, and help determine individual target hormone levels to ensure a sustained euthyroid state.


2021 ◽  
Vol 8 (4) ◽  
pp. 64-71
Author(s):  
Mihaela Vlad ◽  
◽  
Ana Corlan ◽  
Melania Balas ◽  
◽  
...  

Some of the patients with anaplastic thyroid carcinomas have a coexistent differentiated thyroid cancer, sustaining the hypothesis that this cancer may develop from more differentiated tumors. We describe a case with a collision tumor of the thyroid, defined as a neoplastic lesion composed of two distinct cell populations, with distinct borders. The patient presented during the COVID-19 pandemic with dysphonia, dyspnea, multinodular goiter and a painless, rapidly enlarging, left cervical swelling. She had been first time diagnosed with left nodular goiter in 2007, with an indication for surgery, which she declined. After partial excision of the left latero-cervical adenopathy, the pathological analysis showed massive lymph node metastasis from anaplastic thyroid cancer. A total thyroidectomy was done; the postoperative pathological exam identified a papillary thyroid microcarcinoma in the right lobe and an anaplastic thyroid cancer in the left lobe. Postoperatively, levothyroxine treatment was started and the patient was referred to radiotherapy. This case highlights the importance of urgent management of some cases with compressive multinodular goiter, even during the COVID-19 pandemic.


Author(s):  
O. V. Shidlovskyi ◽  
V. O. Shidlovskyi ◽  
M. I. Sheremet ◽  
O. V. Lazaruk ◽  
V. M. Pryvrotskyi ◽  
...  

Aim — todetermine indications for the choice of the surgery scope in patients with unilateral nodular goiter with compression syndrome against the background of autoimmune thyroiditis (AIT) and possibility of prognosis of the long-term results of surgical treatment.Materials and methods. The analysis has been performed for the long-term results of hemithyroidectomy in 101 femalepatients aged 23 to 72 years with unilateral nodular goiter against the background of AIT (NGAIT) with compression syndrome. The pre-operational levels of the following parameters, definingsatisfactory and unsatisfactory treatment results, have been analyzed: volume of the lobe of the gland, blood levels of thyroid stimulating hormone, free thyroxine and triiodothyronine, antibodies to thyroid peroxidase, indices of apoptosisand proliferation, variants ofechostructure.Results. Satisfactory results have been established in 75 patients based on the following results of examinations 3 years after hemithyroidectomy: no violations of thyroid gland functional state, andno progression of preoperative AIT signs or progression without hypothyroidism and changesin ultrasound picture in the parenchymaof the remaining lobe of the gland according to the data of ultrasound investigation.Unsatisfactory results were definedin 26 subjects: an increase in the volume of the remaining thyroid gland and the progression of autoimmune process with the development of hypothyroidism. A satisfactory result of hemithyroidectomy in the treatment of patients with NGAIT with compression syndrome can be expected in cases where at the time of surgery the volume of the lobe was not more than 12.7 cm3, its echostructure corresponded to hypoechoic and heterogeneous and pseudomicronodular variants, and the following blood levels were established: thyroid stimulating hormone < 2.85 IU/L, free thyroxine > 16.7 pmol/l, free triiodothyronine > 5.3 pmol/l, antibodies to thyroid peroxidase < 137 IU/ml.Conclusions. One of the possible options for surgical treatment of patients with unilateral nodular goiter against the background of AIT with compression syndrome may be hemithyroidectomy in conditions of preserved hormonal function of the gland with moderately pronounced processes of proliferation and apoptosis, structural changes in the parenchyma at the level of hypoechoic and heterogeneous and pseudomicro-nodal echostructural variants. The use of hemithyroidectomy is contraindicatedin cases of pseudo-large-nodular and more severe variants of the echostructure of the thyroid parenchyma, regardless of the indicators of hormone-producing function, antibodies to thyroid peroxi­dase, proliferation and apoptosis.


2021 ◽  
Vol 78 (4) ◽  
pp. 40-49
Author(s):  
Оksana Miroshnichenko ◽  
Myroslava Mykytyuk ◽  
Irina Chernyavskay ◽  
Viktor Dubovyk ◽  
Nataliia Seliukova ◽  
...  

Publications suggesting that thyroid nodule might be associated with insulin resistance (IR) and metabolic syndrome are quite interesting. In a very recent report, increased thyroid volume and nodule prevalence were also reported in patients with IR in an iodine-sufficient area []. The purpose of the work is to analyze the association between anthropometric indicators IR and IGF-1 in patients with nodular goiter.  Materials and methods. During the study the authors examined 73 patients with euthyroid single-node (n = 34) and multinodular goiter (n = 39) aged 17 to 74 years (mean - (51.0 ± 10.6) years), determining WC, WC / HC, BMI, WHtR, ABSI, BFD, BRI, CI, AVI, BAI, IGF-1, TSH, fT4, fT3. Thyroid volume, its structure, number, size and location of foci was assessed by an ultrasonic complex Aloka SSD-1100 (Japan), using a linear sensor 7.5 MHz.  Results and their discussion. In the total number of patients with nodular goiter IGF-1 is nonlinearly negatively associated with BMI (r = -0.30; P = 0.016), WC (r = -0.26; P = 0.036), WHtR (r = -0.30) ; P = 0.020), AVI (r = -0.27; P = 0.03), ABSI (r = -0.31; P = 0.015), nonlinear positive with BFD (r = 0.27; P = 0.033) ), BRI (r = 0.29; P = 0.02) and linearly positive with BAI (r = 0.36; P = 0.004); thyroid volume is linearly positively associated with age (r = 0.35; P = 0.009), nonlinearly positively with WC / HC (r = 0.43; P = 0.001), BFD (r = 0.26; P = 0.06 ) and CI (r = 0.31; P = 0.02). In patients with nodular goiter with BMI≥35 kg / m2 thyroid volume is linearly positively associated with BMI (r = 0.71; P = 0.049). In patients with nodular goiter with IRF-1 above the sex-age norm, thyroid volume is nonlinearly positively associated with WC / HC (r = 0.71; P = 0.01), BAI (r = 0.66; P = 0.03 ) and nonlinearly negative with BFD (r = -0.52; P = 0.01). It has been found that BAI explains 82.37% of the variance of IGF-1 in the general group and more than 90% of the variance of its level in groups of patients with nodular goiter with high IGF-1 with / without obesity. In patients with nodular goiter with high IGF-1 and obesity, the predictor of increased thyroid volume is BRI, which explains 81.14% of the variance of its volume.  Conclusions: Patients with nodular goiter with IGF-1 level in blood above the sex-age norm have significantly higher values ​​of anthropometric indicators IR (WHtR, ABSI, BFD and BAI) compared with patients with a normal level of this indicator; in patients with nodular goiter with II degree obesity and above, thyroid volume is significantly associated with BMI; BAI (R2 = 82.37%) is a predictor of increased levels of IGF-1 in blood of patients with nodular goiter, regardless of the obesity; BRI (R2 = 81.14%) is a predictor of increased thyroid volume in patients with nodular goiter with IGF -1 high level and obesity. Key words: nodular goiter, anthropometric indicators, insulin resistance


2021 ◽  
Vol 11 ◽  
Author(s):  
Tian Yang ◽  
Longsheng Huang ◽  
Chang Chen ◽  
Han Luo ◽  
Yong Jiang

BackgroundIt has been debated whether familial non-medullary thyroid carcinoma (FNMTC) is more aggressive and has a worse prognosis than sporadic non-medullary thyroid carcinoma (SNMTC). Our aim was to compare the invasiveness and prognosis of FNMTC and SNMTC by their biological behavior and molecular changes.Method and MaterialOur group mainly compared 106 patients with FNMTC whom have complete clinicopathological data during 2011–2019 in West China Hospital, Sichuan University, and 212 randomly selected cases with SNMTC were included to compare their biological behavior, recurrence and mortality, and molecular expression of BRAF V600E and TERT promoter. At the same time, FNMTC cases were divided into four subgroups, namely, two affected members group, three or more affected members, parent/offspring group, and sibling group, and they were compared with SNMTC separately to analyze the difference in their invasiveness and prognosis.ResultsWe found that the mean tumor size of FNMTC (0.96 ± 0.53cm) was smaller than that of SNMTC (1.15 ± 0.72 cm) (p = 0.020), while no significant difference in the incidence of other clinicopathological factors, including bilateral growth, capsular invasion, with thyroid nodular goiter or not, multifocality, lymph node metastasis, extrathyroidal extension, iodine 131 treatments, T stage, and American Joint Committee on Cancer (AJCC) stage, was observed between FNMTC and SNMTC (p &gt; 0.05), between each FNMTC subgroup (p &gt; 0.05), and between each FNMTC subgroup and SNMTC (p &gt; 0.05). There was no significant difference in recurrence, mortality, and BRAF V600E and TERT promoter mutation between FNMTC and SNMTC, among which 50/60 (83.33%) of FNMTC patients had BRAF V600E mutation and 1/32 (3.13%) had TERT promoter mutation, while the mutation rates of SNMTC were 93/108 (86.11%) and 3/64 (4.69%) (p &gt; 0.05).ConclusionThere was no significant difference in invasiveness and prognosis between FNMTC and SNMTC by biological behavior, patient survival, and molecular level comparison.


2021 ◽  
Vol 9 (2) ◽  
pp. 036-044
Author(s):  
Hamidou Sylla ◽  
Soriba Naby Camara ◽  
Mamadou Sakoba Barry ◽  
Habiboulaye Balde ◽  
Biro Diallo

Introduction: The aim of this study was to assess the epidemiological aspect and the difficulties associated with the surgical management of hyperthyroidism in our context. Hyperthyroidism is an over function of the thyroid gland resulting in thyrotoxicosis. Thyroidectomy is one of the Main treatments. It also uses synthetic antithyroid drugs, radioactive iodine. Methodology: We carried out a descriptive 6-year retrospective from January 1, 2011 to December 31, 2017 inclusively. Our study variables were qualitative and quantitative, Results: During our study, 26 cases were collected between January 2011 and August 2017 with a predominance of 73% female and an average age of 52, 78 years. The clinic was dominated by the signs of thyrotoxicosis which were found in all patients. The exploration identified 14 cases of toxic multi-hetero nodular goiter, ie 53.84%; 9 cases of basal disease 34, 66% and 3 cases of toxic adenoma 11, 54%. Medical preparation was required in all our patients Total thyroidectomy was performed in one patient, i.e. 4%, and Lobo isthmectomy in 24 patients, ie 96%. Postoperatively, complications were collected: 1 case of intraoperative hemorrhage 20%; 1 case of postoperative hematoma 20%; 1 case of dysphonia 20%. Conclusion: Surgery for toxic goiter known to be hemorrhagic and adherent should be performed after obtaining euthyroidism and double vigilance to minimize the morbidity represented mainly by laryngeal paralysis and hyperparathyroidism


Author(s):  
Shihong Ma ◽  
Hui Wang ◽  
Wanling Li ◽  
Zhe Yan ◽  
Xuanming Luo ◽  
...  

To explore the correlation between the activating transcription factor 4 (ATF4) and procalcitonin (PCT) expressions combined with RET mutation and the pathological staging and clinical prognosis of sporadic medullary thyroid carcinoma (SMTC). Fifty cases (tumor tissue) of SMTC diagnosed by clinicopathology were collected and the patients with nodular goiter were selected as normal control. The RET mutation site was analyzed by detection kit and expressions of PCT and ATF4 in SMTC were analyzed by Western blot and immunohistochemistry. Multiple linear regression was used to analyze the correlation of risk factors (PCT or ATF4 expression, RET mutation, tumor differentiation, SMTC stage, lymphatic metastasis) for 5-year recurrence and survival of SMTC. The ATF4 and PCT expressions were significantly decreased and increased, respectively, with the increase of the SMTC stage. The most frequent mutation of RET gene in cancer tissue was M 22458A in exon 16. The ATF4 and PCT expressions, as well as RET mutation, were significantly associated with a 5-year recurrence, while the ATF4 expression was significantly related to better 5-year survival. ATF4 and PCT expressions combined with RET mutation are related to the clinical prognosis of SMTC and can predict SMTC staging.


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