Normative data of thyroid volume-ultrasonographic evaluation in clinically asymptomatic Nigerian adults at Benue state university teaching hospital, Makurdi

Background: Thyroid gland volume is highly variable among communities. Current study was aimed to determine the local normative data on thyroid volume, assessed by ultrasonography in asymptomatic Nigerian adults.Methods: A prospective cross-sectional study conducted at a tertiary hospital between February 2020 to February 2021, which included 500 clinically asymptomatic adults in Makurdi, North-Central Nigeria. Age specific reference values for thyroid volume were obtained. Structured questionnaire was used to obtain information on other variables that could influence thyroid gland volume. The data obtained, including that from blood tests of thyroid function was collated and analysed using SPSS 23, with p=0.05.Results: The mean total thyroid gland volume for both lobes in the entire population of the study was 6.91±2.41 cm3. The mean thyroid volume for both lobes in males 7.09±2.60 cm3 was higher than that of females 6.73±2.38 cm3. The mean right and left lobe volumes were 3.56±1.14 cm3 and 3.35±1.10 cm3 respectively. The right lobe volume was significantly greater than the left lobe (p=0.000). There was a consistent steady increase in thyroid gland volume with increasing age for the general, male and female population until at least the 5th or 6th decade. The total thyroid gland volume significantly correlated with the individual’s body parameters. Highest correlation was found with height (r=0.256, p<0.05)).Conclusions: Ultrasonography was valuable in the determination of thyroid gland volume and normal values were different in various communities.

Spontaneous Thyroid Hemorrhage Caused by Langerhans Cell Histiocytosis: A Case Report and Literature Review

PurposeLangerhans cell histiocytosis (LCH) is a rare clonal disorder of Langerhans antigen-presenting cells. However, thyroid LCH involvement is relatively rare. We present the first case of spontaneous thyroid hemorrhage due to LCH progression and discuss the clinical features, diagnosis, and treatments of thyroid LCH in a literature review.MethodsClinical data were collected. Previously published articles on thyroid LCH involvement were reviewed to assess the clinical features, diagnosis, and treatments for thyroid LCH.ResultsA 54-year-old female presented with a multi-system LCH, affecting the uterus, liver, pituitary gland, and thyroid gland. Clinical stability was achieved after systemic chemotherapy. After 7 years of regular follow up, the patient complained of a sudden painful neck swelling and progressive dyspnea. Computed Tomography revealed bilateral goiter with hematoma, and the patient was diagnosed with spontaneous thyroid bleeding based on her clinical symptoms and radiological findings. The patient was incubated to relieve airway compromise and partial thyroidectomy was performed for definitive treatment. Pathological evaluation further confirmed the diagnosis of thyroid LCH. The patient recovered well after surgery.ConclusionSpontaneous thyroid bleeding due to thyroid LCH progression is extremely rare. Treatments for LCH vary depending on the severity of the disease. We suggest that, for patients with multi-system LCH with thyroid lesion, long-term active surveillance of thyroid hormone concentrations, and thyroid gland volume is required. Physicians should be alert of the potentially life-threatening spontaneous thyroid hemorrhage when aggravated diffuse goiter and hypothyroidism appear. Further investigation is required to establish the guidelines for thyroid LCH treatment.

Ultrasonographic estimation of Thyroid gland volume in healthy subjects of interior Sindh (Province of Pakistan).

Ultrasonography is the most common & easy method to estimate the thyroid gland volume. There is wide variation in the volume of the thyroid gland in normal individuals of different ages, sex, races & geography location. Objectives: To estimate the ultrasonographic thyroid gland volume & its reference range in healthy volunteers of interior Sindh, province of Pakistan. Study Design: Cross Sectional Prospective study. Setting: Conducted in Department of Radiology of PUMHS Nawabshah. Period: From 15 August 2017 to 15 February 2018. Material & Methods: Total 102 healthy subjects were included. The subjects having history of any thyroid disease or surgery, systematic disease, iodine deficiency or taking any drug were excluded. Every subject’s thyroid ultrasound was performed by experienced radiologist & thyroid gland volume of each lobe was calculated. Results: The mean total thyroid gland volume of all study subjects was 9.14+2.97 cm3. The mean volume of right lobe is significantly larger than that of left lobe (5.27+3.82 vs 3.82+1.41, p< 0.005). The mean thyroid volume of the male subjects was larger than in the females (11.67+3.06 vs 8.50+2.87 cm3), the difference between both sexes was statistically significant (p< 0.005) (Table-I). There was no statistically correlation was found between thyroid gland volume with body mass index ((p< 0.005). Conclusion: We tried to contribute to establish the reference values for our local population and further large studies are required to establish national wide reference values of thyroid gland volume.

Determination of Relationship between Thyroid Gland Volume and Anthropometric Indices

Objective: To sonographically determine the thyroid gland volume in normal adults in Jos University Teaching Hospital, as well as how it relates to anthropometric factors. Background: The thyroid gland is one of the largest endocrine glands in the body weighing about 10-25g. It regulates the rate of metabolism and controls the growth and rate of function of many other systems in the body. These it does, by producing thyroid hormones, principally thyroxine (T4) and triiodothyronine (T3). The accurate estimation of the size of the thyroid is very important for the evaluation and management of thyroid disorders. Thus, knowing the normal size in a geographic location would form a baseline for detecting abnormalities. Ultrasonography is a cheap, readily available, easy to perform and non-invasive method to image the thyroid gland, hence its use in this resource-limited setting. Methods: This is a cross-sectional study of sonographic measurement of thyroid gland volume on 400 normal (healthy) adults in Jos, Plateau State, Northern part of Nigeria. All examinations were performed using LOGIC 5, a real-time ultrasound machine using a 10MHZ linear transducer and ultrasound transmission gel to act as a coupling gel. Measurements of each lobe and isthmus were obtained in longitudinal (length), transverse (width) and depth(breath) in centimetres (cm). Blood samples were taken for thyroid function tests. The weight and heights were obtained. The data obtained were statistically analyzed using SPSS software version 17. The results were presented in forms of tables, graphs and chart. Results: The mean thyroid volume for males 6.03 cm3±2.22 was higher than that of females 5.62 cm3±2.14. The mean right lobe volume (RLV) was 3.09 cm3±1.47 and that of males and females were 3.16 cm3 ±1.34 and 3.04 cm3 ±1.55 respectively. The mean left lobe volume (LLV) was 2.69 cm3 ± 1.37 and that of males and females were 2.89 cm3±1.32 and 2.57 cm3±1.39 respectively. The right lobe volume was significantly greater than the left lobe(p=0.000). The total mean isthmus volume was 0.27 cm3±0.31. The mean isthmus volume in males 0.3±0.28 is significantly higher than that of females 0.24±0.23 (p=0.025). The BMI increases in females with increasing age. BMI and BSA are higher in males. Conclusion: The volume obtained in this study was slightly lower than those reported by previous studies in Nigerian adults. The right lobe volume was higher than that of the left and the volume was higher in males compared to females. Anthropometric parameters were noted to affect the thyroid volume.

FACTORS INFLUENCING THE SUCCESSFUL MAINTENANCE OF EUTHYROIDISM AFTER LOBECTOMY IN PATIENTS WITH PAPILLARY THYROID MICROCARCINOMA: A SINGLE-CENTER STUDY

Objective: This study aimed to evaluate factors influencing the successful maintenance of postoperative euthyroidism in patients who did not undergo immediate thyroid hormone replacement after lobectomy for papillary thyroid microcarcinoma (PTMC). Methods: From September 2015 to June 2017, 186 patients underwent lobectomy for PTMC in our hospital. Patients taking medications for hypothyroidism and hyperthyroidism before and after lobectomy were excluded. Multiple parameters, including sex, age, pre-operative free thyroxine (T4), thyroid-stimulating hormone (TSH), thyroglobulin (TG), and thyroid autoantibody levels, body mass index (BMI), postoperative histopathology of the thyroid gland, remnant thyroid gland volume, and session number of levothyroxine discontinuation were retrospectively evaluated. These factors were compared between groups based on the maintenance of postoperative euthyroidism. Results: In 88 of the 175 patients (50.3%), postoperative euthyroidism was successfully maintained without thyroid hormone replacement during the first year after lobectomy. There were significant differences in sex ( P = .003), pre-operative TSH levels ( P = .002), and histopathology of the thyroid gland ( P = .035) between the groups showing maintenance success and failure. The group showing successful maintenance had a higher percentage of male patients, lower levels of pre-operative TSH, and normal parenchymal histology of the thyroid gland. However, there were no significant between-group differences in age, pre-operative free T4, TG, and thyroid autoantibody levels, BMI, remnant thyroid gland volume, and session number of levothyroxine discontinuation. Conclusion: Patient sex, pre-operative TSH levels, and histopathology of the thyroid gland may influence the maintenance of postoperative euthyroidism after lobectomy. Abbreviations: BMI = body mass index; PTMC = papillary thyroid microcarcinoma; RR = reference range; T4 = thyroxine; TFT = thyroid function test; TG = thyroglobulin; TSH = thyroid-stimulating hormone

Determining the Thyroid Gland Volume Causing Tracheal Compression: A Semiautomated 3D CT Volumetry Study

Background and objectives: Increased thyroid gland volume (TV) may bring about tracheal compression, which is one of the causes of respiratory distress. The aim of this study was to investigate the relationship between TV and the severity of tracheal compression independent of patients’ symptoms using semiautomated three-dimensional (3D) volumetry (S3DV) reconstructed from computed tomography (CT) scans. Cut-off TVs leading to different levels of tracheal narrowing were evaluated. Materials and Methods: One hundred sixty-three contrast-enhanced head and neck CT examinations were retrospectively assessed. TVs were measured by S3DV. The degree of tracheal compression was measured at the point where the greatest percent reduction in the cross-sectional area of the trachea adjacent to the thyroid gland was observed. To determine the severity of compression, the tracheal compression ratio (TCR) was defined (TCR = A1 (the narrowest cross-sectional area of trachea)/A2 (the largest cross-sectional area of trachea)). Results: The mean tracheal narrowing was 15% (TCR = 0.85 ± 0.15) in the study population. Patients with more than 15% tracheal compression had significantly higher TV values than those with less than 15% tracheal compression (p < 0.001). In addition, a significant correlation was found between TV and tracheal compression (p < 0.001). Moreover, the receiver operating characteristic (ROC) curve analysis revealed that the cut-off levels for TV that predict a tracheal narrowing of 10%, 20%, 30%, and 40% were 19.75 mL, 21.56 mL, 24.54 mL, and 30.29 mL, respectively (p < 0.05). Conclusions: This study objectively demonstrated that larger thyroid glands cause more severe compression on the trachea. The results may be helpful during the decision-making process for thyroidectomies to be performed due to compression symptoms.