RÉSUMÉ
Retrosternal expansion of a goiter is one of the most common types of mass in the upper mediastinum. Although there is no clear definition of retrosternal, substernal, or mediastinal goiter in the literature, it usually refers to an extension of thyroid tissue from the cervical part that continues to the anterior mediastinum of the aortic arch. One of the interesting features of these cervical mediastinal lesions is that they may not be continuous. Such goiter types classically present with compression symptoms such as dyspnea, dysphonia, dysphagia, or sleep apnea, and less frequently, these masses can compress neurovascular structures, leading to superior vena cava (SVC) syndrome and Horner’s syndrome. In our case report, A 47-year-old female from North Karnataka presented to the hospital with history of dyspnea, dysphonia, and dysphagia persisting for the last 3 years. After careful examination and investigation, a diagnosis of thymoma was made initially. However, upon biopsy of the excised tumor, unexpected finding was revealed, it was identified as a multinodular goiter (MNG) rather than a thymoma.
RÉSUMÉ
OBJECTIVE To compare the metabolomic characteristics of stage T1 papillary thyroid carcinoma(PTC)and nodular goiter(NG),and the relationship between metabolites and lymph node metastasis of PTC.METHODS Serum samples were collected from 60 patients with stage T1 PTC and 30 patients with NG who underwent thyroidectomy at the Department of Otolaryngology Head and Neck Surgery,Civil Aviation General Hospital between September 2021 and April 2022.The PTC group was divided into the N+ group with lymph node metastasis and the N-group without lymph node metastasis according to the presence or absence of lymph node metastasis.The serum metabolites of the N+ and N-groups and the PTC and NG groups were compared and analyzed using an ultra-performance liquid chromatography-mass spectrometry(UPLC-Q-Exactive-MS)coupled platform,and principal component analysis(PCA),partial least squares discriminant analysis(PLS-DA),and orthogonal partial least squares discriminant analysis(OPLS-DA)was performed using SIMCA-P 14.1 software.OPLS-DA modeling,combined with FDR-corrected Mann-Whitney-Wilcoxon test results and metabolite difference multiples in the two groups undergoing comparison,etc.to screen for potential small molecule metabolic markers,and to establish a joint diagnostic model by binary logistic regression analysis.RESULTS There were no significant differential metabolites between the N+ group with lymph node metastasis and the N-group without lymph node metastasis.Seven differential metabolites were found between PCA patients and NG patients,and the five relevant metabolic pathways were the pentose phosphate pathway,pentose and glucuronide interconversion,glycolysis/gluconeogenesis,fructose,and mannose metabolism,and fatty acid biosynthesis.The differential metabolite with an area under the ROC curve>0.9 was D-glyceraldehyde 3-phosphate,and another N-undecanoylglycine,uronic acid,and the area under the ROC curve for three metabolites,N-undecanoylglycine,uric acid,and triiodothyronine glucuronide,was>0.8.CONCLUSION PTC patients differed from NG patients mainly in glucose metabolism and lipid metabolism,and D-glyceraldehyde 3-phosphate could be distinguished from NG patients with the aid of N-undecanoylglycine,uric acid,and triiodothyronine glucuronide,combined with imaging findings.Also,no significant differences in serum metabolites were found in the N+ group compared with the N-group,and the presence or absence of lymph node metastases did not affect serum metabolites in patients with stage T1 PTC.
RÉSUMÉ
Objective:To investigate the changes of thyroid hormones and the flow velocity of superior thyroid artery in patients with Graves' disease and Hashimoto's thyrotoxicosis before and after treatment with methimazole.Methods:A case-control study was conducted to select 45 cases of Graves' disease and 45 cases of Hashimoto's thyroiditis from October 2021 to December 2022 in the Department of Endocrinology, North China University of Science and Technology Affiliated Hospital. The changes of thyroid hormone and blood flow velocity of superior thyroid artery in patients with Graves' disease and Hashimoto's thyroiditis before and after treatment with methimazole were analyzed. Measurement data satisfying normal distribution were expressed by xˉ±s, and the mean between two groups was compared by t test. Measurement data not satisfying normal distribution were expressed by M( Q1, Q3), and the median between two groups was compared by Wilcoxon rank sum test. χ 2 test was used to compare the constituent ratio of enumeration data among groups. Results:There was no significant difference in thyroid stimulating hormone (TSH) between the two groups before treatment, and there was no significant difference in TSH between the two groups after 1 month and 3 months of treatment (all P>0.05). The levels of free triiodothyronine (FT3) were (24.09±9.29) pmol/L and (17.41±9.36) pmol/L in Graves' disease group and Hashimoto's thyroiditis group respectively before treatment. FT4 were (60.23±20.82) and (43.47±21.71) pmol/L, respectively, and the peak stolie vloiy (PSV) were (69.53±5.70) and (52.65±4.64) cm/s, respectively in Graves' disease group and Hashimoto's thyroiditis group respectively before treatment. There were significant differences between the two groups ( t values wrere 3.39 and 3.74, Z=13.83, all P<0.001). The difference of FT3 between one month after treatment and before treatment was (-6.36±5.32) and (-12.64±9.08) pmol/L ( t=4.02, P<0.001) and the difference in FT3 between 3 months of treatment and before treatment was (-10.14±9.50) and (-17.80±11.17) pmol/L, respectively ( t=3.51, P<0.001) between the Graves disease group and the Hashimoto's thyroiditis group. The difference in FT4 between the Graves disease group and the Hashimoto's thyroiditis group after 1 month of treatment and before treatment was (-28.47±10.09) and (-20.57±14.48) pmol/L ( t=7.01, P<0.001), and the difference of FT4 was (-47.06±20.57) and (-30.17±20.54) pmol/L ( t=3.91, P<0.001) between the Graves disease group and the Hashimoto toxin group. The difference between one month after treatment and before treatment was (-13.10(-34.10,-2.60)) and (-10.50(-27.5,-0.20)) cm/s ( Z=2.63, P=0.009), respectively. The difference between 3 months and before treatment was (-31.40(-53.20,-12.70)) and (-19.90(-46.00,-4.70)cm/s ( Z=4.40, P<0.001)) between the Graves disease group and the Hashimoto's thyroiditis group, and the difference was statistically significant. Conclusion:Thyroid hormone levels were decreased after treatment with methimazole in patients with diffuse toxic goiter and Hashimoto toxemia, but the difference was not statistically significant. The PSV level of superior thyroid artery in patients with diffuse toxic goiter was significantly lower than that in patients with Hashimoto's thyrotoxicosis.
RÉSUMÉ
ObjectiveTo observe the effects of Sargassum and Glycyrrhizae Radix et Rhizoma incompatible pair with the Haizao Yuhutang （HYT） on oxidative stress in the liver of goiter rats under the condition of 2 times the dose limit of the Pharmacopoeia of the People's Republic of China 2020. MethodA total of 128 male Wistar rats were randomly divided into a blank group， a model group， a euthyrox group （20 μg·kg-1）， a HYT group （12.06 g·kg-1）， a HYT without Sargassum （HYT-H） group （9.90 g·kg-1）， a HYT without Glycyrrhizae Radix et Rhizoma （HYT-G） group （10.26 g·kg-1）， a HYT without Sargassum and Glycyrrhizae Radix et Rhizoma （HYT-HG） group （8.10 g·kg-1）， and a Sargassum and Glycyrrhizae Radix et Rhizoma （HG） group （3.96 g·kg-1）. The blank group was given deionized water by gavage， and the others were given propylthiouracil （PTU） to replicate the goiter pathological model. Euthyrox was taken as a positive control drug， and the rest of the Chinese medicine groups were given the corresponding decoction by gavage， the material was collected 12 hours after the last dose. The serum levels of aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， alkaline phosphatase （ALP）， and the contents of superoxide dismutase （SOD）， glutathione peroxidase （GSH-Px）， malondialdehyde （MDA）， reactive oxygen species （ROS） in liver tissue were detected in each group. The pathological changes in the liver were observed via hematoxylin-eosin （HE） staining. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was utilized to detect the mRNA expressions of Kelch-like Ech-associated protein 1 （Keap1）， nuclear factor E2-related factor 2 （Nrf2）， heme oxygenase-1 （HO-1）， p53 and Caspase-3 in liver tissues. Western blot was adopted to detect the protein expressions of Nrf2 and HO-1 in liver tissues in oxidative stress-related signaling pathways. ResultCompared with control group， the model group showed significantly increased serum ALT level and contents of MDA and ROS in liver tissues （P<0.05， P<0.01）， significantly reduced activities of SOD and GSH-Px in the liver （P<0.01）， significantly increased mRNA expression of Keap1 （P<0.01）， and significantly decreased mRNA and protein expressions of Nrf2 and HO-1 （P<0.05， P<0.01）. Compared with the model group， the HYT group manifested significantly reduced serum levels of AST， ALT， and ALP （P<0.05， P<0.01）， significantly reduced contents of MDA and ROS in liver tissue （P<0.01）， significantly increased the activities of SOD and GSH-Px （P<0.01）， significantly decreased mRNA expressions of Keap1， p53， and Caspase-3 （P<0.01）， and significantly increased mRNA and protein expressions of Nrf2 and HO-1 （P<0.05， P<0.01）. ConclusionUnder the condition of 2 times the dose limit of the Pharmacopoeia of the People's Republic of China 2020， Sargassum and Glycyrrhizae Radix et Rhizoma incompatible pair with the HYT on oxidative stress in the liver of goiter rats had different effects. The HYT that contains Sargassum and Glycyrrhizae Radix et Rhizoma has a protective effect on the liver of goiter rats， and the effect is better than that of the HG group， the euthyrox group， and the incomplete groups. Its mechanism may be related to activating the Nrf2/HO-1 signaling pathway to alleviate liver oxidative stress and inhibiting the p53/Caspase-3 signaling pathway to reduce hepatocyte apoptosis.
RÉSUMÉ
Objective To understand the impact of system reform of salt industry on iodine nutrition of people in Gansu Province, and to provide a scientific basis for policy adjustment of relevant departments. Methods The investigation period (2014-2021) was divided into two sub-periods: before system reform of salt industry (2014-2016) and after system reform of salt industry (2017-2021). Thirty counties were selected according to the method of “population proportional probability sampling (PPS)” in 2014. According to the iodine deficiency disease monitoring program of Gansu Province, from 2016 to 2021, children aged 8-10 years and pregnant women were taken as research objects to collect urine samples for urine iodine detection. Children in 2014 and 2018 were selected to measure thyroid volume. Results A total of 90 989 children urine iodine samples were investigated, and the median urinary iodine (MUI) of children was 194.70µg/L; 7 663 and 83,326 children's urinary iodine samples were investigated in the two periods, the MUI was 180.73 µg/L and 196.00 µg/L, respectively, and the difference was statistically significant (P<0.05). A total of 44 741 pregnant women's urinary iodine samples were investigated, and the MUI of pregnant women was 176.50 µg/L; 4 480 and 40 261 pregnant women's urinary iodine samples were investigated in the two periods, the MUI was 160.61 µg/L and 178.10 µg/L, respectively, and the difference was statistically significant (P<0.05). The thyroid volume of 1 555 children and 8 509 children was investigated in the two periods, the median thyroid volume was 2.70 mL and 2.55 mL , respectively, and the difference was statistically significant (P<0.05). The rates of goiter in children were 3.15% and 1.26%, respectively, and the difference was statistically significant (P<0.05). Conclusion The iodine nutrition of people in Gansu Province has not fluctuated significantly after the reform of salt industry system and has maintained an appropriate level. It is necessary to pay attention to the potential risk of insufficient iodine nutrition level and thyroid health of key populations such as children and pregnant women and strengthen health education of scientific iodine supplementation.
RÉSUMÉ
Objective:To investigate the iodine nutritional status of children and the consumption condition of non-iodized salt in Henan Province after implementation of the new standard of "Definition and demarcation of water-borne iodine-excess areas and iodine-excess endemial areas" (GB/T 19380-2016, hereinafter referred to as new standard) for four years (2021), and to provide a basis for scientific adjustment of intervention strategies.Methods:In 2021, according to the requirements of the new standard and based on the results of the water iodine survey in Henan Province from 2017 to 2020, a survey was conducted on the iodine nutrition status of children in water-borne high iodine areas in 47 counties (cities, districts, hereinafter referred to as counties) with high iodine administrative village (neighborhood committee, hereinafter referred to as administrative village). In each county, 5 administrative villages with median water iodine > 100 μg/L were selected as the investigation villages, and water samples were collected to determine the water iodine value. Forty non-boarding students aged 8 - 10 (age balanced, half male and half female, age increased to 6 - 12 when less than 40) were selected from each village as investigation subjects. Salt samples from their homes and urine samples were collected to detect salt iodine and urine iodine content, and thyroid volume of children was measured. And the monitoring results of areas where the supply of iodized salt had been suspended for less than 4 years (in newly high iodine areas) and more than 10 years (in previously high iodine areas) were further compared and analyzed.Results:A total of 257 administrative villages in the province were monitored, and the range of water iodine was 1.6 - 609.5 μg/L, with a median of 132.5 μg/L. A total of 8 611 children were tested for salt iodine, urine iodine and thyroid volume. The non-iodized salt rate was 58.3% (5 017/8 611), and the median urine iodine was 342.2 μg/L, thyroid enlargement rate was 2.9% (250/8 611). The median water iodine (153.0 vs 118.4 μg/L), the median urine iodine in children (371.6 vs 287.7 μg/L) and the goiter rate [3.8% (211/5 537) vs 1.3% (39/3 074)] in the newly high iodine areas were higher than those in the previously high iodine areas, and the differences were statistically significant ( Z = 583.12, - 14.09, P < 0.001; χ 2 = 44.40, P < 0.001); the non-iodized salt rate was lower than that of the previously high iodine areas [37.2% (2 057/5 537) vs 96.3% (2 960/3 074)], and the difference was statistically significant (χ 2 = 2 841.37, P < 0.001). Conclusions:The iodine nutrition level of children in water-borne high iodine areas of Henan Province in 2021 is at an excess level, but the non-iodized salt rate in residential households is low. We should make every effort to ensure the precise supply of non-iodized salt in high iodine areas after implementation of the new standard, and strengthen iodine nutrition monitoring and health education for key populations to prevent the occurrence of high iodine hazards.
RÉSUMÉ
Objective:To investigate the iodine nutrition status of key population in Fuzhou City, and to provide scientific basis for adjusting intervention strategies.Methods:From March to October 2021, a survey was conducted on iodine nutrition status of key population in 12 counties (cities, districts) of Fuzhou City. Each county (city, district) was divided into 5 sampling areas according to the east, west, south, north and middle directions. One township (street) was selected from each area, and 40 non-boarding children aged 8 - 10 (age balanced, half male and half female) from one primary school and 20 pregnant women (early, middle and late pregnancy balanced) were selected as survey subjects. Household salt samples and random urine samples were collected, and the salt iodine and urine iodine levels were tested by direct titration and arsenic and cerium catalytic spectrophotometry, respectively. Children's thyroid volume was measured by B-ultrasonography. At the same time, in cooperation with Fuzhou Maternal and Child Health Hospital, the thyroid stimulating hormone (TSH) testing results of heel blood of full-term natural delivery newborns in Fuzhou City in 2021 were collected.Results:A total of 2 400 children were monitored for salt iodine, urine iodine and goiter. The median salt iodine was 24.40 mg/kg, with an iodine salt coverage rate of 93.04% (2 233/2 400), a qualified rate of iodized salt of 97.40% (2 175/2 233), and a consumption rate of qualified iodized salt of 90.62% (2 175/2 400). The median urine iodine was 181.47 μg/L. The rate of goiter was 1.04% (25/2 400). A total of 1 200 pregnant women were monitored for salt iodine and urine iodine. The median salt iodine was 24.10 mg/kg, the coverage rate of iodized salt was 91.08% (1 093/1 200), the qualified rate of iodized salt was 97.90% (1 070/1 093), and the consumption rate of qualified iodized salt was 89.17% (1 070/1 200). The median urine iodine was 128.10 μg/L. The median TSH level in the heel blood of 14 242 newborns was 3.38 mU/L, and the proportion of TSH level > 5 mU/L was 30.96% (4 410/14 242).Conclusions:In 2021, children in Fuzhou City are at an appropriate level of iodine, but pregnant women are insufficient of iodine. We should continue to maintain comprehensive prevention and control measures mainly based on salt iodization, provide health education for pregnant women, and strengthen monitoring of TSH level in newborns.
RÉSUMÉ
Goiter is a kind of non-inflammatory and non-neoplastic hyperplasia and enlargement. Many studies have shown that substances such as thiocyanates and isothiocyanates can prevent the development of a variety of tumors. However, some studies have also found that such substances can lead to goiter. In this article, relevant information on common goitrogen in food are collected to explore their mechanism of action, laying a foundation for guiding residents to maintain a healthy and balanced diet.
RÉSUMÉ
ABSTRACT Objective: Mutations in DICER1 are found in differentiated thyroid carcinoma (DTC) and in multinodular goiter (MNG) at a younger age with other tumors, which characterizes DICER1 syndrome. DICER1 is one driver to DTC; however, it is also found in benign nodules. We speculated that patients with mutations in DICER1 may present long-lasting MNG. Our aim was to investigate the frequency of DICER1 variants in patients with MNG. Subjects and methods: Patients who submitted to total thyroidectomy due to large MNG with symptoms were evaluated. DICER1 hotspots were sequenced from thyroid nodule samples. To confirm somatic mutation, DNA from peripheral blood was also analyzed. Results: Among 715 patients, 154 were evaluated with 56.2 ± 12.3 years old (28-79) and the thyroid volume was 115.7 ± 108 mL (16.2-730). We found 11% with six DICER1 variations in a homo or heterozygous state. Only rs12018992 was a somatic DICER1 variant. All remaining variants were synonymous and likely benign, according to the ClinVar database. The rs12018992 was previously described in an adolescent with DTC, measuring 13 mm. There were no significant differences according to gender, familial history of goiter, age, thyroid volume, TSH and TI-RADS classification between DICER1 carriers. Free T4 were lower in patients with DICER1 polymorphisms (13.77 ± 1.8 vs. 15.44 ± 2.4 pmol/L, p = 0.008), regardless of TSH levels. Conclusions: We conclude that germline DICER1 variants can be found in 11% of large goiters but no second-hit somatic mutation was found. DICER1 is one driver to thyroid lesion and a second-hit event seems unnecessary in the MNG development.
RÉSUMÉ
Introducción: Un bocio se considera intratorácico cuando más de un 50 por ciento de la glándula tiroides está en el mediastino, o sea, por debajo del nivel del estrecho torácico superior. Se trata de una enfermedad poco frecuente que padece aproximadamente el 3 por ciento de los pobladores del mundo. La incidencia del bocio nodular ha disminuido debido a la ingestión en algunos países de sal yodada y alimentos ricos en yodo. Esta enfermedad alcanza alrededor del 10 por ciento de las masas mediastínicas. Objetivo: Presentar el caso de un paciente masculino, operado de bocio endotorácico en la provincia de Cienfuegos. Presentación de caso: Se presenta un paciente masculino, de 48 años de edad, que acude a consulta y refiere aumento de volumen del cuello en la región anterior, que se acompaña de decaimiento y en ocasiones disfagia tanto a los alimentos líquidos como a los sólidos. Además, refiere ligera disnea que tolera adecuadamente cuando realiza las actividades de la vida diaria. Por tratarse de una enfermedad poco frecuente, se considera de interés científico publicar el caso para conocimiento de los profesionales dedicados al estudio y tratamiento de las afecciones tiroideas. Conclusiones: El bocio endotorácico es una entidad poco frecuente y en todos los casos requiere de intervención quirúrgica(AU)
Introduction: A goiter is considered intrathoracic when more than 50 percent of the thyroid gland is in the mediastinum; in other words, below the level of the superior thoracic outlet. It is a rare disease that affects approximately 3 percent of the world's population. The incidence of nodular goiter has decreased due to the ingestion of iodized salt and iodine-rich foods in some countries. This disease accounts for about 10 percent of mediastinal masses. Objective: To present the case of a male patient operated on for endothoracic goiter in the province of Cienfuegos. Case presentation: The case is presented of a 48-year-old male patient who comes for consultation referring a volume increase in the anterior neck region, accompanied by decay and sometimes dysphagia to both liquid and solid food. In addition, he reports slight dyspnea that he tolerates adequately when performing daily living activities. Since this is a rare disease, it is considered of scientific interest to publish the case for the knowledge of professionals dedicated to studying and treating thyroid disorders. Conclusions: Endothoracic goiter is a rare entity and, in all cases, requires surgical intervention(AU)
Sujet(s)
Humains , Mâle , Adulte d'âge moyen , Goitre nodulaire/épidémiologieRÉSUMÉ
Introducción: Un bocio se considera intratorácico cuando más del 50 % de la glándula tiroides se halla por debajo del estrecho torácico superior. Es una enfermedad infrecuente, que representa alrededor del 10 % del total de las masas mediastínicas. Objetivo: Describir las características clínicas de un bocio endotorácico como forma de presentación de una tiroiditis linfocítica. Presentación del caso: Se informa el caso de una paciente de 65 años que acudió a cuerpo de guardia por dificultad para respirar, asociada a disfonía, disfagia y estertores sibilantes en vértice pulmonar derecho. Se estudió la función tiroidea a partir de análisis de laboratorio, radiografía, tomografía de tórax, ecografía tiroidea y biopsia de aspiración con aguja fina. Se diagnosticó un bocio endotorácico hipotiroideo en el transcurso de una tiroiditis linfocítica. Conclusiones: La presentación del bocio endotorácico como tiroiditis linfocítica se considera inusual en la práctica clínica. Los síntomas y los signos apuntaban un síndrome mediastinal. Se llegó al diagnóstico nosológico gracias al interrogatorio, el examen físico y los estudios imagenológicos e histológicos.
Introduction: Goiter is considered intrathoracic when more than 50% of the thyroid gland is below the level of the upper thoracic narrowing. It is an uncommon disease, accounting for about 10% of all mediastinal masses. Case presentation: We report the case of a 65-year-old female patient who presented to the on-call department with shortness of breath associated with dysphonia, dysphagia and wheezing rales in the right pulmonary apex. Thyroid function was studied on the basis of laboratory tests, radiography, chest CT scan, thyroid ultrasound and fine needle aspiration biopsy. A hypothyroid endothoracic goiter was diagnosed in the course of lymphocytic thyroiditis. Conclusions: The presentation of endothoracic goiter as lymphocytic thyroiditis is unusual in clinical practice. Symptoms and signs pointed to a mediastinal syndrome. The nosologic diagnosis was reached by questioning, physical examination, and imaging and histologic studies.
RÉSUMÉ
Resumen: La malposición de los catéteres venosos centrales se asocia a importantes riesgos, a menudo infraestimados. Aunque se han descrito algunos factores que pueden favorecer la malposición, generalmente su causa no llega a diagnosticarse y parece ser de origen multifactorial. Presentamos dos casos de malposición de catéteres venosos centrales motivadas por causas anatómicas inusuales, diagnosticadas en el perioperatorio. En el primer caso, se diagnostica una agenesia de vena cava superior en el transcurso de una sustitución mitral por esternotomía, que lógicamente se asocia con una malposición de la vía central insertada. La utilización de catéteres y dispositivos a través de venas yugulares y subclavias en pacientes con esta infrecuente patología implica importantes limitaciones y complicaciones potenciales graves. En el segundo caso, la existencia de un bocio no diagnosticado provoca la malposición bilateral y simultánea de dos catéteres venosos canalizados, en el contexto de una situación de emergencia, en ambas venas yugulares internas.
Abstract: Malposition of central venous catheters is associated with important and underestimated risks. Although some factors have been related with malposition, its cause is generally not diagnosed, and it seems to have multifactorial origin. We present two cases of central venous catheter malposition due to unusual anatomical causes, diagnosed in the perioperative period. In the first case, superior vena cava agenesis was diagnosed during mitral replacement by sternotomy, which was logically associated with malposition of the inserted central line. The use of catheters and devices through jugular and subclavian veins in patients with this infrequent pathology is associated with important limitations and serious potential complications. In the second case, an undiagnosed goiter causes bilateral and simultaneous malpositioning of two inserted central venous catheters, in the context of an emergency situation, in both internal jugular veins.
RÉSUMÉ
Thyroidectomy is the treatment of choice for large retrosternal goiters. These tumors often are large enough to require thoracotomy. Robotic surgery can help in avoiding thoracotomy and its associated post operative complications. Rarely, such tumors and their surgery can be complicated by tracheal tears. Such tears, especially those near the carina are difficult to repair and often require open thoracotomy. We described such a case where we avoided open thoracotomy and instead performed a minimally invasive robotic repair of tracheal tear. The maintenance of ventilation during this robotic repair was critical. A combination of several airway devices was used to allow the complex surgical repair to be executed without affecting ventilation.
RÉSUMÉ
Background: Thyroid gland produces thyroid hormone, thyroxine. Goiter is an indefinite term applied to the enlargement of thyroid gland. The normal thyroid gland in non-goitrous state weighs 25–35 g. Thyroid gland disorders are common endocrine disorders in the world. Aims and Objectives: This is a retrospective study done to know the age and gender distribution of goiter and various pathological conditions in goiter. This study showed that the incidence is common in 3rd–5th decade of life and nodular and colloid goiter are the common causes of goiter followed by follicular adenoma and papillary carcinoma. Materials and Methods: The data were collected from cytology registers of Pathology Department of FIMS Hospital, Image Diagnostics and Seetha Diagnostics, Kadapa, during the 2-year period from January 2021 to December 2022. The data collected as above were systematically analyzed and reviewed for age and sex distribution, clinical presentation, and cytological diagnosis. Results: Majority of the patients were female accounting for 324 cases (94.18%) and 20 patients (5.81%) were male. The maximum incidence is in young females between 31 and 40 years age group (24.70%) followed by 41–50 years age group (23.83%) and then in 21–30 years age group (22.38%). All together, the overall maximum incidence is seen in females between 21 and 50 years age group (70.91%). The most common pathological disease is nodular goiter followed by colloid nodule, both being iodine deficiency goiters. Conclusion: The study showed the thyroid disorders are more common in females. The non-neoplastic lesions constitute the predominant cause for goiter followed by benign neoplasms and then malignant neoplasms.
RÉSUMÉ
Introducción: En las últimas décadas la incidencia del cáncer tiroideo en el curso de la enfermedad nodular se ha incrementado debido a las novedosas técnicas de diagnóstico; sin embargo, la tasa de mortalidad se ha mantenido muy baja. Objetivo: Evaluar las características clínicas, epidemiológicas y quirúrgicas de pacientes con afecciones nodulares tiroideas. Métodos: Se realizó un estudio descriptivo observacional de cohorte prospectivo, longitudinal con los pacientes operados de afecciones tiroideas durante el período comprendido entre enero del 2008 y diciembre del 2018. El universo y la muestra quedaron constituidos por 467 pacientes que cumplieron con los criterios de inclusión. Resultados: Predominaron el sexo femenino (89,5 por ciento) y el grupo etario de 45-60 años (29,5 por ciento). Asociaron comorbilidades 338 pacientes y algún factor de riesgo de malignidad (6,2 por ciento). Un total de 174 pacientes manifestaron síntomas y 264 mostraron algún signo. Predominaron los reportes ecográficos (TI-RADS) y citológicos (Bethesda) tipo II (54,3 por ciento) y (55,5 por ciento), respectivamente. La hemitiroidectomía fue el procedimiento más realizado (59,9 por ciento) y la disfonía la complicación más encontrada (1,9 por ciento). Conclusiones: El diagnóstico oportuno del cáncer tiroideo en el curso de una enfermedad nodular contribuye a individualizar todas las decisiones terapéuticas atendiendo a las características de cada paciente y sus circunstancias(AU)
Introduction: In recent decades, the incidence rates of thyroid cancer in the course of nodular disease has increased due to novel diagnostic techniques; however, the mortality rate has remained very low. Objective: To evaluate the clinical, epidemiological and surgical characteristics of patients with nodular thyroid disease. Methods: A descriptive, observational, of prospective cohort, longitudinal and observational study was conducted with patients operated on for thyroid disorders during the period from January 2008 to December 2018. The study universe and sample consisted of 467 patients who met the inclusion criteria. Results: The female sex (89.5 percent) and the age group 45-60 years (29.5 percent) predominated. Comorbidities were present in 338 patients, as well as some risk factor for malignancy in 6.2 percent. A total of 174 patients manifested symptoms and 264 showed some sign. There was a predominance of echography (TI-RADS) and cytology (Bethesda) type II reports, accounting for 54.3 percent and 55.5 percent, respectively. Hemithyroidectomy was the most performed procedure (59.9 percent), while dysphonia was the most encountered complication (1.9 percent). Conclusions: Timely diagnosis of thyroid cancer in the course of nodular disease contributes to individualizing all therapeutic decisions considering the characteristics of each patient and their circumstances(AU)
Sujet(s)
Humains , Maladies de la thyroïde/épidémiologie , Tumeurs de la thyroïde/épidémiologie , Thyroïdectomie/méthodes , Épidémiologie Descriptive , Études prospectives , Études longitudinales , Études observationnelles comme sujetRÉSUMÉ
Thyroid disease and hyperparathyroidism (HPT) are among the most common endocrine disorders. Thyroid hormones play an important role in bone and calcium metabolism. The rate of HPT is greater in patients with thyroid disease than in the general medical population. Simultaneous occurrence of hyperthyroidism and hyperparathyroidism in the same patient is a rare combination. The clinical manifestations of hyperthyroidism may overshadow the more subtle and varied symptoms and signs of primary hyperparathyroidism. It poses difficult diagnostic and therapeutic problems. Both diseases, however, may have a profound influence on calcium metabolism. The resulting disturbances in thyrotoxicosis may simulate hyperparathyroidism. Contrariwise, the diagnosis of an associated parathyroid adenoma may be missed, or unnecessarily delayed because hypercalcemia is known to occur in hyperthyroidism. The coexistence of thyroiditis and thyroid nodules with parathyroid disorders is also known. Graves� disease (GD) and primary hyperparathyroidism (PHPT) are two common endocrine disorders. However the co- occurrence of hyperthyroidism and primary hyperparathyroidism (PHPT) is rare. However, the link between the two disorders remains unclarified. Hypercalcemia in Graves' hyperthyroidism should warrant a thorough investigation for concomitant primary hyperparathyroidism. Concomitant thyroid nodular disease and hyperparathyroidism (PHPT) disease has been also documented. PHPT is also reported in patients with thyroid malignancy. We hereby report a rare case of a patient who presented with coexistence of Hyperparathyroidism and Multinodular Goiter with Hashimotos Thyroiditis and Hyperthyroidism.
RÉSUMÉ
Nodular goiter has become increasingly prevalent in recent years. Clinically, there has been a burgeoning interest in nodular goiter due to the risk of progression to thyroid cancer. This review aims to provide a comprehensive summary of the mechanisms underlying the therapeutic effect of Chinese medicine (CM) in nodular goiter. Articles were systematically retrieved from databases, including PubMed, Web of Science and China National Knowledge Infrastructure. New evidence showed that CM exhibited multi-pathway and multi-target characteristics in the treatment of nodular goiter, involving hypothalamus-pituitary-thyroid axis, oxidative stress, blood rheology, cell proliferation, apoptosis, and autophagy, especially inhibition of cell proliferation and promotion of cell apoptosis, involving multiple signal pathways and a variety of cytokines. This review provides a scientific basis for the therapeutic use of CM against nodular goiter. Nonetheless, future studies are warranted to identify more regulatory genes and pathways to provide new approaches for the treatment of nodular goiter.
Sujet(s)
Humains , Goitre nodulaire/métabolisme , Médecine traditionnelle chinoise , Tumeurs de la thyroïde , Apoptose , ChineRÉSUMÉ
Objective To investigate the molecular mechanism of YingZhongXiao Ointment(YZXO)in the treatment of goiter based on network pharmacology and experimental validation.Methods TCMSP,TCMID,BATMAN-TCM,TCM-MESH,were used to screen the effective active ingredients and targets of YZXO.GeneCards,OMIM,Pharm GKB and Drug Bank databases were used to obtain goiter disease targets.After mapping the drug targets to the disease targets,the intersecting targets were screened,and then the intersecting targets were used to construct a PPI network and screen the core targets,which were subjected to GO and KEGG enrichment analysis.Results In this study,227 active ingredients,314 targets and 847 goiter targets were screened,and 78 potential targets for goiter treatment were obtained after mapping.449 biological processes were obtained from GO enrichment analysis,and 118 pathways were identified from KEGG enrichment analysis,including PI3K-Akt,mitogen-activated protein kinase(MAPK),tumor necrosis factor(TNF)and other signalling pathways.The results of animal experiments showed that compared with the model group,the gene expression of PI3K/Akt/m TOR signalling pathway in thyroid tissue of rats in each dose group and LT4 group was decreased(P<0.01 or P<0.05),p-PI3K/PI3K、p-Akt/Akt was decreased(P<0.01),the protein content of VEGF and PCNA was decreased(P<0.01 or P<0.05),and the protein content of Fas and FasL was increased(P<0.05 or P<0.01).Conclusion This study suggests that the mechanism of YZXO treated goiter by Resolving the Fire may be related to downregulation of PI3K/Akt/m TOR signalling pathway,inhibition of abnormal thyroid cell proliferation and promotion of thyroid cell apoptosis.
RÉSUMÉ
Objective:To explore the prenatal diagnosis, clinical intervention and pregnancy outcome of fetal goiter complicated by hypothyroidism.Methods:Three fetuses diagnosed with goiter and hypothyroidism in the First Affiliated Hospital of Anhui Medical University from January 2021 to December 2022 were retrospectively included. Thyroid function tests were performed using umbilical cord blood samples after the fetuses were diagnosed with goiter by prenatal ultrasound. Oral L-thyroxine was given to pregnant women diagnosed with fetal goiter complicated by hypothyroidism, and the changes in fetal thyroid ultrasound imaging and serological indexes were monitored. Clinical manifestations, pregnancy outcomes and postnatal follow-up were summarized using descriptive statistical analysis.Results:Case 1, 2 and 3 were diagnosed as having fetal goiter with rich blood flow signals in the thyroid by ultrasound at 24, 21 and 23 +5 weeks of gestation, respectively. Thyroid function tests showed abnormal increase of thyrotropin in umbilical cord blood and the fetuses were diagnosed with congenital hypothyroidism. Oral administration of L-thyroxine to pregnant women had no significant impact on the sizes of the enlarged thyroid glands, but the blood flow richness was significantly reduced. Moreover, the level of thyrotropin in umbilical cord blood decreased significantly after intervention. Case 2 was terminated due to social factors in another hospital at 34 + weeks of gestation. Cases 1 and 3 were full-term deliveries and followed up for 12 or 18 months. The thyroid function of both neonates were normal at birth and during follow-up. Conclusions:Ultrasound combined with thyroid function tests using umbilical cord blood are helpful in the prenatal diagnosis of fetal goiter complicated by hypothyroidism. Oral administration of L-thyroxine to pregnant women may have practical clinical significance in improving fetal thyroid function.
RÉSUMÉ
Objective:To summarize the prenatal ultrasound features and prognosis of fetal goiter.Methods:The prenatal ultrasound findings and clinical data of five cases of fetal goiter in the Affiliated Hospital of Qingdao University from August 2018 to October 2022 were retrospectively analyzed regarding the sonographic features, concomitant signs, and prognosis using descriptive statistical method.Results:The five cases were first diagnosed as fetal goiter at 25-35 weeks of gestation, with all of them showing hypoechoic or medium echoic masses in the fetal anterior neck area. One case exhibited a central blood flow signal, early appearance of the distal femoral ossification center, tachycardia, increased cardiothoracic ratio during pregnancy, and developed postnatal hyperthyroidism. Three cases showed peripheral blood flow signals and had postnatal hypothyroidism, one of which had delayed appearance of distal femoral ossification center and increased cardiothoracic ratio. One case showed a peripheral blood flow signal with normal thyroid function after birth. Among the five cases, tracheal compression and polyhydramnios were found in one case; neck hyperextension was found in three cases. After treatment, the size of goiters did not change or shrunk in three cases and increased with the gestations in one case. One case did not receive any prenatal treatment and was born through cesarean section due to late detection and increased cardiothoracic ratio. Two cases underwent cesarean section at 35 gestational weeks, one had full-term cesarean section, and two delivered vaginally at term. Hyperthyroidism in one neonate was caused by excessively elevated maternal thyrotropin receptor antibody. Three cases of hypothyroidism occurred due to maternal antithyroid medication whose thyroid function recovered after supplementation of thyroxine. The thyroid function was normal in the rest of the baby. During the follow-up from 9 months to 4 years and 11 months old, no abnormalities in the intellectual and motor development of the five children were found.Conclusions:Fetal goiter often exhibits hypochoic or medium echoic mass in the anterior neck during prenatal ultrasonography. The fetal thyroid function could be evaluated according to different blood flow patterns and the presence of the ossification center. The prognosis of fetal goiter is good after active prenatal treatment.