A Study of Clinical Profile and Management of Nodular Goiter

Introduction: Nodular goiters are enlargements of the thyroid gland. In the absence of thyroid dysfunction, autoimmune thyroid disease, thyroiditis, and thyroid malignancy, they constitute an entity described as non-toxic nodular goiter, which occur both endemically and sporadically. Aim: The aim of the study was to study the clinical presentation and management of patients with nodular goiter. Materials and Methods: In this prospective observational study, patients admitted with nodular goiter – solitary or multinodular were included in the study. The patients diagnosed as a case of solitary or multinodular will undergo detailed history taking, clinical examination, and investigations such as complete blood count, thyroid profile, fine-needle aspiration cytology, X-ray chest and neck, and ultrasonography of the neck. Histopathology of the excised specimens was studied to evaluate the incidence of malignancy. Results: A total of 18 patients were included, 68% of cases were in 21–40 years age group, all patients had swelling, 33% had pain, 22% had difficulty in swallowing, 16 patients were euthyroid, and 2 patients had hypothyroidism. The incidence of malignancy was found to be 8%, 42% of the patients had benign follicular adenomas. The incidence of inflammatory goiter was 11% and 3% of patients showed evidence of toxicity. Preoperatively, regional lymph node metastasis evaluated and hemithyroidectomy in adenoma thyroid and colloid nodules, subtotal and total thyroidectomy in multinodular goiters and total thyroidectomy in carcinoma thyroid were done. About 89% had an uneventful post-operative period. Conclusion: Nodular goiter of the thyroid was found to be more common in young and middle-aged patients. The majority of nodular goiter was found to be a benign lesion. The incidence of malignancy was found to be 8% overall, 12.5% nodules in female were malignant.

Neoplasmas da tireoide em cães: 26 casos / Thyroid neoplasms in dogs: 26 cases

Foram revisados os protocolos de biópsias e necropsias do Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV/UFSM) entre 2004 e 2014, e todos os casos de tumores que acometeram a glândula tireoide foram selecionados. A partir disso, foram anotados sexo, idade e raça dos cães afetados. Também foi avaliado o significado clínico dos tumores, presença de aumento de volume cervical, lobos afetados, tamanho dos tumores, presença e localização de metástases e padrão histológico dos neoplasmas. Nos 11 anos que compreenderam este estudo, foram diagnosticados 26 tumores de glândula tireoide (quatro eram provenientes de exames de biópsias e 22 de necropsias), 53,9% dos cães eram fêmeas e 46,1% eram machos; 65,4% eram cães com raça definida. Desses, Boxers foram os mais afetados (15,4% dos casos). Dos 23 protocolos em que a idade foi informada, 60,9% dos cães eram idosos e 39,1% eram adultos. A avaliação dos protocolos permitiu constatar que 38,5% dos animais haviam apresentado aumento de volume cervical no momento do exame clínico. Dos cães necropsiados 13,6% morreram ou foram submetidos à eutanásia em decorrência de complicações causadas por metástases dos tumores de tireoide. Dessa forma, em 86,4% dos cães, os neoplasmas foram considerados achados incidentais de necropsia. Nos quatro casos provenientes de material de biópsia, o desfecho não foi conhecido. Em nenhum cão os tumores causaram síndrome clínica devido à hipo ou hiperfunção da tireoide. Em 24 protocolos havia informação sobre os lobos afetados e 75% dos cães tiveram acometimento unilateral da glândula. Os diagnósticos histológicos dos tumores permitiram constatar que 16 (61,5%) neoplasmas eram carcinomas de células foliculares (nesses casos, o padrão folicular-compacto foi o mais frequente [43,75%]), seis (23,1%) eram adenomas de células foliculares, dois (7,7%) eram carcinossarcomas e dois (7,7%) eram tumores de células C (adenoma e carcinoma).(AU)

Biopsy and necropsy reports of the Laboratório de Patologia Veterinária at the Universidade Federal de Santa Maria (LPV/UFSM) were reviewed, including data from 2004 to 2014; all cases of the thyroid tumors were selected. From this point on, it was recorded the gender, age and breed of affected dogs. Additionally, it was evaluated the clinical significance of these tumors, presence of cervical swelling, affected lobes, tumors size, presence and location of metastasis and histological pattern of neoplasms. Twenty six thyroid tumors were diagnosed in the study period (four came from biopsies while the other 22 were from necropsies). Of the affected dogs, 53.8% were females and 46.2% were males; most of the animals (65.4%) were purebred. Of these, Boxers were the most affected (15.4%). In 23 protocols the age was informed; 60.9% of the dogs were elderly and 39.1% were adults. The protocols evaluation allowed establishing that 38.5% of the animals had cervical swelling, at the time of clinical examination. Out of the dogs necropsied, only 13.6% died or were euthanized due to complications caused by metastases of thyroid tumors. Thus, in 86.4% of the dogs, the neoplasms were considered as incidental necropsy findings. In the four cases from biopsy samples, the outcomes were not known. There were no tumors causing clinical syndrome in these dogs, due to thyroid hypo- or hyperfunction. In 24 protocols it was found information about the affected lobes, indicating that 75% of the dogs had unilateral glandular involvement. The histological diagnosis showed that 16 (61.5%) neoplasms were follicular cell carcinomas (in these cases, the follicular-compact pattern was the most frequent [43.8%]); 6 (23.1%) were follicular cells adenoma; two (7.7%) were carcinosarcomas and two (7.7%) were C cells tumors (adenoma and carcinoma).(AU)

Macrofollicular variant of papillary thyroid carcinoma：report of 2 cases and literature review / 中华内分泌外科杂志

Objective To discuss the pathological morphological features of the macrofollicular variant of papillary thyroid carcinoma ( MFPTC ) .Methods Clinical data of 2 cases of MFPTC were reviewed .The his-topathological and immunohistochemical features were analyzed .Relevant literatures were reviewed .Results The histological characters of MFPTC mainly included its multiple macrofolliculus , plenty of colloid and atypical nuclear morphology.Immunohistochemistry stain showed cytokeratin-19, Galectin-3 and HBME-1 expressed simultaneously. Conclusions MFPTC is a thyroid papillary carcinoma with unique histological characters .It should be differen-tially diagnosed from some benign lesions such as nodular goiter and follicular adenoma .Immunohistochemical stain of cytokeratin-19, Galection-3 and HBME-1 may be very helpful in the diagnosis and differential diagnosis .

Discriminating thyroid cancers from benign lesions based on differential expression of a limited set of miRNA using paraffin embedded tissues.

Background : Micro-RNAs (miRNAs) are expressed in a tissue-specific manner and are known to demonstrate differential expression even among the various subtypes of a given tumor. This differential expression has been harnessed successfully in the development of diagnostic assays for various malignant tumors. These assays have been found to be relevant and of value as additional diagnostic tools even among thyroid tumors, particularly with regard to thyroid carcinomas of follicular morphology. Materials and Methods : A limited set of miRNA have been assessed as part of this study in an effort to use minimal number of miRNA markers (miR-187, miR-221, miR-222, and miR-224) to differentiate the benign from the malignant thyroid tumors using miRNA derived from paraffin embedded material. Results : While miR-221 and miR-222 were found to provide good accuracy as individual markers (86% and 84%), a combination of the two provided slightly better accuracy (91%). Both miR-221 and 222 were able to significantly differentiate malignant tumors from the benign samples (P< 0.001) individually and as a combination of markers. However, inclusion of miR-187 and miR-224 in the panel did not provide any additional benefit. Conclusion : While a combination of miR-221 and 222 when used in a diagnostic panel could provide fairly good accuracy additional markers may need to be investigated to augment their diagnostic utility.

Clinical application of small incisions in the treatment of benign thyroid diseases with endoscopic assistance assistance / 中华全科医师杂志

To explore the clinical application and value of small incisions in the treatment of benign thyroid diseases with endoscopic assistance.A total of 57 cases with thyroid nodules were operated under the assistance of ultrasonic scalpel and endoscope with the lifting-up of special instrument and small neck incisions.However one malignant case was converted iuto open surgery according to frozen sections.The other 56 cases were successfully operated.The mean operative duration was 42 min and postoperative stay 2 -3 days.All incisions achieved primary healing and the length range was 1.5 - 3.5 cm.Except for transient hoarseness in 1 case,there was no such complications as choking,lip paralysis or hemorrhage,etc.All were discharged uneventfully.This surgical approach shall be recommended for its merits of miniinvasiveness,less hemorrhage,fewer complications and wider applications.

Frequência de microcarcinoma papilífero em doenças benignas da tireóide / Frequency of papillary microcarcinoma in thyroid benign diseases

Objetivo: Conhecer a frequência de microcarcinoma papilífero (MCP) em doenças benignas da tireóide. Métodos: Estudo transversal e retrospectivo, realizado no laboratório Alice de Patologia, na cidade de Criciúma, SC, no período de 1996 a 2006. Foram analisados 636 laudos anatomopatológicos de tireoidectomias totais, dos quais 409 preencheram os critérios de inclusão. Destes, estudou-se as seguintes variáveis: cidade de origem, gênero, idade, doenças benignas associadas ao MCP, tamanho dos tumores, lateralidade, focalidade, localização e invasão das bordas cirúrgicas. A análise estatística foi realizada através do programa EPIINFO versão 6.0. Resultados: Dos 636 laudos estudados, 409 preencheram os critérios de inclusão. Destes, 90,7% (371) eram mulheres e 9,3% (38) homens, sendo a média de idade 48,17 anos. A maioria (95,6%) dos pacientes estudados era de Criciúma. A frequência de MCP em doenças benignas da tireóide foi de 8,8%, sendo a doença de maior coexistência com MCP o bócio multinodular, seguido pelos adenomas foliculares. O diâmetro médio dos tumores foi de 4,7mm, sendo a maioria unilateral (88,9%) e unifocal (91,7%). A variante histológica do MCP encontrada com maior frequência foi a papilífera pura (61,11%). Não houve diferença significativa na localização dos tumores. Na maioria (88,9%) dos casos as bordas cirúrgicas estavam livres de doença. Conclusão: A frequência de MCP em doenças benignas da tireóide é alta no local de realização desta pesquisa, devendo chamar a atenção dos médicos para o seu possível diagnóstico, que na maioria das vezes acaba sendo um achado incidental na análise anatomopatológica de glândulas tireóideas retiradas por doenças aparentemente benignas.

Objective: To assess the frequency of papillary microcarcinoma in benign thyroid diseases. Methods: Retrospective cross-sectional study, conducted in the laboratory of Pathology Alice in the city of Criciúma, SC, from 1996 to 2006. We analyzed 636 reports of pathological total thyroidectomy, of which 409 met the inclusion criteria. Of these, the following variables were studied: city of origin, gender, age, benign diseases associated with papillary microcarcinoma, size of tumors, laterality, focus, location and invasion of the surgical margins. Statistical analysis was performed using the program EPIINFO version 6.0. Results: Of the 636 reports studied, 409 met the inclusion criteria. Of these, 90.7% (371) were women and 9.3% (38) men, with a mean age of 48.17 years. The majority (95.6%) of patients studied was Criciúma. The frequency of papillary microcarcinoma in benign thyroid disease was 8.8%, and the disease of greater coexistence with the papillary microcarcinoma was multinodular goiter, followed by follicular adenomas. The average diameter of tumors was 4.7 mm, the majority being unilateral (88.9%) and unifocal (91.7%). A histologic variant of papillary microcarcinoma found with more frequency was papillary pure (61.11%). There was no significant difference in the location of tumorsMost(88.9%) cases the surgical margins were free of disease. Conclusion: The frequency of MCP in benign thyroid diseases is high in the place of realization of this research, and should draw the attention of doctors for their possible diagnosis, which most often ends up being an incidental finding in the anatomopathological analysis of thyroid glands removed for apparently benign diseases.

Expression and significance of ERβ and surviving in thyroid tumors / 肿瘤研究与临床

Objective To investigate the expression and clinical significance of the estrogen receptor beta isoforms and survivin in thyroid tumors. Methods The pathological data of 125 patients with thyroid tumors were, collected from june 2003 to june 2007 in our institution, including thyroid carcinoma (86 cases), thyroid follicular adenoma (39 cases) and normal thyroid tissue (10cases). SP immunohistochemistry was used to measure the expressions of ERβ and survivin in the thyroid tumors. Results ERβ not only was detected in the thyroid epithelial cell plasma and nuclear, but also in the stroma. The positive rate of ERβ in cases with thyroid carcinoma, adenoma and normal thyroid tissue were 83.72 %, 51.28 % and 20.00 % respectively. There was significant difference between carcinoma and the adenoma or normal thyroid tissue (P<0.05). The positive rate of survivin in cases with carcinoma, adenoma and normal thyroid tissue were 59.30 %, 17.95 % and 0 respectively. There was significant difference between carcinoma and the adenoma or normal thyroid tissue (P<0.05). The expressions of ERβ and survivin correlated with TNM staging and lymph node metastasis of thyroid carcinoma (P<0.05). Conclusion ERβ may play a role in accelerating proliferation in the occurrence of the thyroid carcinoma. The expressions of ERβ and survivin are related to invasion and metastasis of thyroid carcinoma.

A Clinical Analysis of 100 Cases of Gasless Endoscopic Thyroidectomy

PURPOSE: With recent developments in endoscopic surgery for thyroid tumors, several approaches have been applied to endoscopic neck surgery. Gasless endoscopic thyroidectomy has some advantages over gas insufflating surgery. We evaluated the role of gasless endoscopic thyroidectomies on various thyroid tumors including malignant thyroid tumors. METHODS: We performed thyroidectomies for a total of 195 patients who were admitted to Uijongbu St. Mary's Hospital from November 1999 to February 2002. We compared the clinical data of 100 patients who received gasless endoscopic thyroidectomies with the data of 95 patients who underwent conventional thyroidectomies. Furthermore, we subclassified the 100 patients who received a gasless endoscopic thyroidectomy into two groups, before and after the start of 2001. RESULTS: The analysis of the clinical data showed that an endoscopic thyroidectomy gave superior results with respect to the time of postoperative recovery and cosmetic results. Also, the patients in the second half group showed significantly shorter operation times reduced from 153.4 min. to 128.6 min. and length of hospital stay similarly reduced(3.55 days vs. 5.35 days). CONCLUSION: A gasless endoscopic thyroidectomy is a safe and technically feasible alternative to a conventional thyroi-dectomy in benign and early malignant tumors, and provides good cosmetic results.

Gasless Endoscopic Thyroidectomy / 대한내분비외과학회지

Gasless endoscopic surgery was applied to thyroidectomy. The procedure is a safe and technically feasible method producing good cosmetic results. Compared to the previous endoscopic thyroidectomies, this method is superior with respect to performing hemostasis and minimizing the possible complications resulting from gas insufflating surgery (e.g. hypercapnea or massive subcutaneous empysema). We successfully performed the removal of 37 thyroid tumors of 35 cases by gasless endoscopic surgery without any significant complications. No scars remained in the neck and all patients were satisfied with the cosmetic results. Gasless endoscopic thyroidectomy will become a strong alternative to conventional thyroidectomy for cases of benign thyroid tumors requiring good cosmetic results.

A Study on the Expression of Transforming Growth Factor-alpha, Epidermal GrowthFactor and Epidermal Growth Factor Receptor in Thyroid Tumors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cell proliferation and differentiation are regulated by growth factors and growth factor receptors. Inappropriate expressions of growth factors and altered responsiveness of growth factor receptors may influence the biological and clinical phenotype of tumor. The purpose of this study is to investigate the relationship between the expressions of TGF-alpha, EGF, EGFR and clinical behaviors in thyroid tumors. MATERIALS AND METHODS: The material consisted of 19 papillary carcinomas, 8 follicular carcinomas, 6 anaplastic carcinomas, 8 follicular adenomas and 5 normal thyroid tissues. The authors performed immunohistochemical staining for TGF-alpha, EGF and EGFR. RESULTS: Positive staining for TGF-alpha was found in 84.2% of papillary carcinomas, 100% of follicular carcinomas, 83.3% of anaplastic carcinomas and 25% of follicular adenomas. EGF was positive in 57.8% of papillary carcinomas, 25% of follicular carcinomas, 0% of anaplastic carcinomas and 25% of follicular adenomas. EGFR was positive in 52.6% of papillary carcinomas, 85.7% of follicular carcinomas, 83.3% of anaplastic carcinomas and 75% of follicular adenomas. There was no statistical relationship between regional lymph node metastasis, primary tumor size, patient's age and positive expression rates for TGF-alpha, EGF and EGFR. CONCLUSION: TGF-alpha expression was statistically higher in the malignant thyroid tumors than in benign thyroid tumors. However, the expression of EGFR was shown to be higher in thyroid tumors than in the normal thyroid tissues, but there was no statistical difference between benign and malignant tumors. EGF expressions demonstrated no statistical significance in thyroid tumors.