Evaluation of goiter endemia by ultrasound in schoolchildren in Val Sarmento (Italy).

Ultrasonography is an excellent and objective method for assessing thyroid volume, especially in children where clinical evaluation is inaccurate. The aim of this study was to evaluate the presence of goiter by thyroid ultrasound and palpation in 244 schoolchildren, 6 to 14 years old, living in some rural villages of Val Sarmento, a mountain area of Basilicata, Italy. In 1996 we revealed the presence of endemic goiter in 25% of the schoolchildren evaluated by palpation, according to World Health Organization (WHO) criteria, and in 15.9% of the schoolchildren evaluated by ultrasonography (7.5 MHz linear probe). The median urinary iodine excretion, taken from an extemporaneous sample of the first urines in the morning, was 62.2 microg/l. This study includes Val Sarmento, an area with mild-moderate grade (Grade I) of iodine deficiency, suggesting the need for iodine prophylaxis. Furthermore, it proves that the measurement of thyroid volume by ultrasonography is an essential instrumental method for a correct epidemiological study of endemic goiter, particularly in areas where there is mild iodine deficiency.

[Treatment of hot thyroid nodule with percutaneous ethanol injection. Our experience]. / Trattamento del nodulo caldo tiroideo mediante iniezione percutanea di etanolo. Nostra esperienza.

Thyroid nodule is defined as "hot" on the bous it scintigraphic appearance. It can be defined like benign nodule with autonomous functionality. On scintiscan it shows high captation because there's an increase of production and secretion of thyroid hormones with total inhibition of TSH and suppression of extranodular tissue. Generally the treatment of hot thyroid nodule was surgical or with radio-metabolic therapy. Percutaneous ethanol injection (PEI) in the treatment of hot thyroid nodules has been suggested recently. The aim of our study was to value therapeutic effects of PEI under guidance by means of ultrasound in patients with hot nodules in toxic or pretoxic phase. 36 patients with autonomous thyroid nodules of 1.8-6 cm in diameter received sterile ethanol at 95% that has been injected with a 22-gauge needle and a probe with a guide device. The administrated dose varied from 1.2 to 1.5 ml for cc of tissue in 5-12 sessions. Ethanol injection was performed in a single site in nodules with diameter < 3 cm and in double sites in nodules with diameter > 3 cm. The patients were checked after treatment and then 3 and 6 months. Our experience confirms an excellent response to PEI in these patients. In fact after therapy symptoms of hyperthyroidism and hormonal levels become normal; no patient has even reached the range of subclinical or clinical hypothyroidism. Scintigram showed that previously suppressed thyroid tissue resumed functioning; at ultrasound all nodules had shrunk: thyroglobulin levels increased during treatment because ethanol induces coagulative intranodular necrosis with release in systemic circulation of this glycoprotein.(ABSTRACT TRUNCATED AT 250 WORDS)