[Ultrasonographic diagnosis of parathyroid glands]. / Ultrasonografická diagnostika prístitných teliesok.

Enlarged parathyroid glands are, if their localization is typical behind the thyroid gland, during basic USG examination with 5 MHz to 10 MHz using a linear probe, hypoechogenic or anechogenic, larger than 0.5 cm, oval in shape, elongated in a cranoiocaudal direction, separated from the thyroid gland. During swallowing they move upwards. Such a picture may be simulated also by enlarged lymph nodes, sympathetic ganglia a cranked vessel or oesophagus. By using coloured Doppler sonography in the algorithm of examinations the percentage of falsely positive findings may decline. Between 90 degrees and 270 degrees the vascular arch is sought which is formed by the branch of the a. thyroidea inferior. This vascular arch is found only when the parathyroid is involved, even when it is located in the parenchyma of the thyroid gland.

Recognition of a subgroup of adolescents with rapidly growing thyroids under iodine-replete conditions: seven year follow-up.

OBJECTIVE: To evaluate whether small iodine supplements decrease the incidence of adolescent thyroid hypertrophy in an iodine-sufficient population or whether such thyroid enlargement should be considered an inevitable physiological phenomenon. DESIGN: Beginning in September 1991 (after an initial examination in September 1990), 54 11-year-old children in Bardejov, Slovakia were given small iodine supplements (Thyrojod depot tablets containing 1530 microg iodide) every 2 weeks for 2 years followed by once weekly for 2 years. A second group of 63 children served as controls. In June 1995, there were still 52 treated and 60 control children in the study and these were examined; 44 treated and 48 control children remained in the study until June 1997. METHODS: In 1990, 1993, 1995, 1996 and 1997 the thyroid volume (ThV) was measured by ultrasound. Serum levels of TSH, thyroglobulin, total and free thyroxine and tri-iodothyronine and anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG) and anti-TSH receptor (TSR) antibodies were estimated in 1990 and 1994, while only TSH, and anti-TPO and anti-TSR antibodies were measured in 1997. RESULTS: There was no difference between the groups at any interval in the serum levels of the hormones measured. Marginally increased TSH was found in two treated and two control children. Anti-TSR antibodies were negative in all children, while anti-TPO and anti-TG antibodies were found in one treated and four control children. At the age of 10 years (1990), 84% of all ThVs were less than 4 ml, indicating a previous life-long sufficient iodine intake. After the treatment was completed (June 1995), a significant difference in ThV (P < 0.04) was found between the whole treated (5.78 +/- 0.19 ml) and the whole control group (6.56 +/- 0.30 ml). However, there was already a marked difference in the 75th percentile (6.4 ml in treated vs 8.5 ml in controls) due to more rapid thyroid growth in certain children of the control group (ThV > 7.0 ml in 6/52 treated children vs 24/60 controls; P < 0.01). Since such differences were much higher in 1997, the children in each group whose ThV was in the range of the upper 25% in 1997 were retrospectively evaluated as arbitrary separate subgroups in all the time intervals and compared with the remaining 75% of children who showed moderate thyroid growth rate. Two years after the termination of treatment (June 1997), excessive thyroid growth continued in the upper quarter of 12 controls with the highest ThV (13.60 +/- 0.40 ml or 7.60 +/- 0.29 ml/m2; 12/12 with ThV > 11.0 ml), and a similar subgroup now also appeared in 11 previously treated children (10.79 +/- 0.51 ml or 6.19 +/- 0.30 ml/m2; 5/11 with ThV > 11.0 ml). At the same time, ThV in the remaining 75% of both control (8.12 +/- 0.38 ml or 4.82 +/- 0.17 ml/m2; 3/36 with ThV > 11.0 ml) and treated (7.20 +/- 0.30 ml or 4.39 +/- 0.17 ml/m2; 0/33 with ThV > 11.0 ml) children was significantly less (P < 0.01 to P < 0.001) than that in the appropriate rapidly growing subgroups. During the whole observation period (1990-1997), no difference was found between treated and control subgroups with moderate thyroid growth. CONCLUSIONS: Since iodine intake in Slovakia has been adequate for decades and sporadic iodine deficiency is highly unlikely, the observed excessive thyroid growth in certain adolescents may result from causes other than simple iodine deficiency (e.g. hereditary), which are nevertheless ameliorated by small iodine supplements. The question remains whether such a subgroup with rapidly growing thyroids should be included in the range of normal thyroid volumes in adolescents.

[Pregnancy and the thyroid gland]. / Tehotenstvo a stítna zl'aza.

The authors assessed, using ultrasonography, the volume of the thyroid gland in 93 women 4 days and then 3 and 6 months after parturition. The results were compared with a control group of women who were not delivered of a baby during the last 12 months. Women 4 days after delivery had on average a thyroid gland by 3.1 ml larger (P < 0.01) than controls. Three months after delivery there was still a significant difference in the volume between women who had a baby and the control group (P < 0.05). Goitre (volume larger than 22 ml) was observed after childbirth in 11 (11.8%), where as in the control group only in 3 women (5.3%). The authors analyze the causes which may bring about enlargement of the thyroid gland during pregnancy.

[Postpartum thyroiditis and the contribution of ultrasonographic examination of the thyroid gland in its diagnosis during the first half-year after delivery]. / Popôrodná tyreoiditída a prínos ultrasonografického vysetrenia stítnej zl'azy v prvom polroku po pôrode k jej diagnostike.

Changes which take place in the thyroid parenchyma of the mother from postpartum thyroiditis and which lead to a change of echogenicity can be detected by ultrasonographic examination of the thyroid gland before clinical manifestation of impaired thyroid function caused by inflammation. The authors evaluated the echogenicity of the thyroid gland in 60 women three months after delivery. From the whole group of women 47 (78.4%) had a homogenous and adequate echogenicity, 13 (21.6%) had a reduced echogenicity. A positive cytological finding, i.e. lymphocytic infiltration was found in 9 women and concurrently positive antithyroglobulin antibodies in 5 of them. During the first six months after childbirth impaired thyroid function was recorded in 4, i.e. 6.6%: 1x hyperthyroidism and 3x hypothyroidism.

[Ultrasonography in subacute thyroiditis]. / Subakútna tyreoiditída v ultrasonografickom obraze.

The authors draw attention to the altered ultrasonographic (USG) picture of the thyroid gland with subacute inflammation (SAT). A typical finding in the first to third stage of the disease are irregular different sized hypoechogenic to almost echo-void foci with normal parenchyma in between. The finding is normal only in the fourth stage of the disease. In 22 patients before 1987 the USG finding of the thyroid gland was evaluated. In 17 the examination revealed the assumed SAT which was confirmed in 15 patients. Seven patients were at that time hypothyroid. The USG finding was evaluated again in 1990. Ten patients, 2.8 years after the acute stage of SAT had a normal USG finding and were euthyroid. Five patients, not more than one year after the acute stage of SAT had still a pathological USG finding. Four of them were hypothyroid. Based on USG examination it is possible to identify before the cytotogical examination at first ill defined hypothyroidism or hypothyroidism as SAT in stage 1 to 3.

[Ultrasonography as the primary method for examination of the kidneys and the retroperitoneum in adolescents and adults]. / Ultrasonografia ako primárna vysetrovacia metóda obliciek a retroperitonea u mladistvých a dospelých.

The authors give an account of the application of USG as the primary examination method of the kidneys and retroperitoneum based on the examination of 2330 patients aged 15-93 years. A positive USG finding was recorded in 44%. A urological case-history was recorded in 81.5% of the patients. Patients in the 6th decade were affected most frequently. Cystic changes were found in 15.1%, chronic inflammatory changes in 11.24%. Tumours of the kidneys were present in 4.3% patients. The examination was unsuccessful in 5.1%, whereby it supported in 66% the negative urological finding. Ultrasonography is recommended as the method of first choice in patients with urological symptomatology after the basic clinical and laboratory examination.

Thyroid volume by ultrasound in boys and girls 6-16 years of age under marginal iodine deficiency as related to the age of puberty.

The results of thyroid volume estimation with the aid of ultrasound in a total of 921 boys and girls 6-16 years of age are reported. The thyroid volume was found to be increasing slowly between the age of 6 and 12 years, but somewhat more remarkable increase occurred at 13 and 14 years of age. However, in both sexes it was nearly doubled at the age of 15-16 years as compared with the values at 13-14 years irrespective of body weight. The thyroid growth rate (as calculated from the least squares analysis of the correlation between thyroid volume and body weight) in girls was significantly higher (P less than 0.001) than in boys. In spite of long-term mandatory iodine prophylaxis the average urinary excretion of iodine as estimated in 69 randomly selected subjects was 78.06 micrograms/g creatinine (geometrical mean). It may be suggested that such intake of iodine, though marginally deficient, may be satisfactory up to the age of about 12-14 years, while it appeared to be inadequate for the adolescents at the age of puberty.

Goiter prevalence and thyroid volume by ultrasonographic volumetry in two groups of schoolchildren and adolescents from east Slovakia.

Thyroid volume by ultrasonographic volumetry was estimated in a total of 427 boys and 425 girls aged 7 to 16 years from East Slovakia. It was found that the volume is increasing by age and body weight, being in average about 2.5 ml in 7-8 years old, 3.5 to 4.5 ml in 9-12 years old, 5.2-6.0 ml in 13-14 years old and, as reported previously, 11-12 ml in 15-16 years old. Comparing these results to the findings reported from other countries, it may be concluded that in 13-14 years old schoolchildren the thyroid volume was about twice as high as reported for the same age group from Sweden (with presumably sufficient iodine intake) and by about 20 percent less than found in 13 years old schoolchildren in Federal Republic of Germany (with insufficient iodine intake). The average thyroid volume found in pubertal adolescents aged 15-16 years closely resembled that found in Federal Republic of Germany and was even higher than that found in adults from Sweden and Netherlands where the iodine intake is considered to be sufficient. Palpatory findings according to WHO scale showed 21 percent of goiter stage 1a in boys aged 7-14 years and 24 percent in girls of the same age group, while such values were 23 and 27 percent for boys and girls aged 15 and 16 years, respectively. In addition, in those aged 15-16 years about 3 percent of goiter stage 1b were found, while in those aged 7-14 only 3 cases of goiter stage 1b out of 425 examined were observed. It may be concluded that the present status of thyroid size in examined group closely resembles the first grade endemy of goiter as defined recently by Hetzel and, moreover, it may be suggested that the intake of iodine about 100 micrograms daily (which was recently reported by other authors from Czechoslovakia as based on urinary excretion of iodine) apparently does not fully prevent the development of goiter stage 1 in a considerable amount of children and adolescents.

Thyroid volume of East Slovakian adolescents determined by ultrasound 40 years after the introduction of iodized salt.

Thyroid volume was examined by ultrasonography in 207 boys and 220 girls aged 15-16 years from East Slovakia and it was found that 49.3% of the boys and 52.3% of the girls had thyroids between 10 and 15 ml. These thyroid volumes resemble those found in school children from areas of mild iodine deficiency (e.g. FRG) and are twice as large as those reported from Sweden, where iodine intake is sufficient. The findings were compared to these reported by others in 1949-53 before the introduction of iodine prophylaxis. It may be concluded that 40 years of goiter prophylaxis with iodized salt, though resulting in urinary excretion of approximately 100 micrograms/24 hr (as found by others in 1984), abolished large and medium size goiters in adolescents and decreased a prevalence of goiter grade I to about 25 percent, but appeared still to be insufficient to prevent goiter grade I completely.