Incidental thyroid carcinoma in an endemic goiter area in Italy: histopathological features and predictors of a common finding.

PURPOSE: The occurrence and histopathological features of incidental thyroid carcinoma (ITC) vary considerably among populations from different geographical regions. The aim of this study is to assess the prevalence and histopathological characteristics of ITC in patients who underwent thyroid surgery for apparently benign thyroid diseases in an endemic goiter area in Italy. METHODS: A total of 649 consecutive patients (531 females and 118 males; mean age, 52.9 ± 11.0 years), who underwent thyroid surgery at the Endocrine Surgery Unit of the tertiary care "Renato Dulbecco" University Hospital (Catanzaro, Italy) in the period between years 2017 and 2022, were included in this retrospective study. A comprehensive histopathological examination was performed on surgically excised thyroid tissue. Logistic regression analysis was employed to identify potential predictors of ITC. RESULTS: The histopathological examination revealed the presence of ITC in 81 patients, accounting for 12.5% of the total study population. The female to male ratio was found to be 6.4 to 1. Among the patients with ITC, 72 had papillary carcinoma (PTC), with 53 of these tumors being microcarcinomas (microPTC). Additionally, 5 patients had follicular thyroid carcinoma, 2 patients had low-risk follicular cell-derived thyroid neoplasms, 1 patient had an oncocytic carcinoma, and 1 patient had a medullary thyroid carcinoma. Logistic regression analysis demonstrated a significant association between female sex and incidental microPTC. CONCLUSIONS: These findings provide further evidence of the common occurrence of ITC, typically in the form of microPTC, among individuals who undergo thyroid surgery for apparently benign thyroid diseases.

The Prevention of Iodine Deficiency: A History.

Iodine is an essential component of the hormones produced by the thyroid gland and is, therefore, essential for mammalian life. A landmark trial in the early 20th century definitively demonstrated that iodine supplementation could prevent what was then known as "endemic goiter." Subsequent studies over the next decades demonstrated that iodine deficiency causes a spectrum of disease, including not just goiter, but also cretinism, intellectual impairment, and adverse obstetric outcomes. Salt iodization, first used in Switzerland and the United States in the1920s, has become the mainstay of iodine deficiency prevention efforts. The dramatic reduction in the global prevalence of iodine deficiency disorders (IDD) over the past 30 years represents an outstanding and under-recognized public health achievement. This narrative review provides an overview of critical scientific discoveries and advances in public health nutrition related to the prevention of IDD in the United States and worldwide. This review was written to commemorate the centennial of the founding of the American Thyroid Association.

[Epidemiology of benign thyroid disorders in the adult population of the Republic of Belarus: analysis of nationwide statistics 2009 to 2019].

BACKGROUND: Nowadays, the Republic of Belarus belongs to the countries with sufficient iodine supply, which made it possible to reduce the incidence of non-toxic goiter and congenital hypothyroidism. However, even a slight change in iodine consumption influences the pattern of thyroid diseases. In addition to iodine deficiency, other environmental conditions, as well as genetic factors, play a significant role in the etiology of thyroid diseases. AIM: To analyze the dynamics of the main epidemiological indicators of benign thyroid diseases from 2009 to 2019 in the adult population of the Republic of Belarus, using the data of official state statistics. MATERIALS AND METHODS: The indicators of the incidence and prevalence of benign thyroid diseases were studied on the basis of state statistics for 2009-2019. To analyze the dynamics of the studied indicators, regression analysis was used with the construction of linear and polynomial models. RESULTS: A decrease in the incidence and prevalence of diffuse euthyroid goiter and an increase in the incidence and prevalence of nodular euthyroid goiter, thyroiditis, acquired hypothyroidism, Graves' disease, as well as the incidence of nodular toxic goiter were revealed. CONCLUSION: Obtained data indicate, that there is an increase in the prevalence of most of the studied thyroid diseases, despite the adequate iodine supply. The above justifies the need for further study of the causes of the identified trends, as well as the necessity of developing new methods of diagnosis and treatment of thyroid diseases.

Thiocyanate in excess develops goiter followed by auto immune thyroid diseases even after effective salt iodization in a rural community of north east India.

PURPOSE: Salt iodization in Manipur of north-east India failed to prevent endemic goiter, therefore an in depth study carried out to evaluate thyroid functions of goitrous subjects in a randomly selected region. METHODS: Goiter survey conducted in children and women of reproductive ages by palpation followed by measurement of urinary iodine, thiocyanate and house-hold salt iodine to evaluate iodine nutritional status and consumption pattern of bamboo-shoots (BS). In all grade-2 goitrous subjects, free thyroxine, triiodothyronine, TSH, TPO and Tg antibodies, thyroid volume and echogenecity by ultrasonography and cytomorphology of thyroid by FNAC studied. RESULTS: Study population was 2486 children and 1506 women, goiter prevalence was 12.59% and 16.27% respectively; median urinary iodine and mean thiocyanate were 166 µg/l and 0.729 ± 0.408 mg/dl while salt iodine was ≥30 ppm. Serum thyroid hormones and TSH profiles of all grade-2 goitrous subjects showed 16.21% were subclinically hypothyroid, 2.16% overt hypothyroid, 4.86% subclinically hyperthyroid and 6.48% overt hyperthyroid, serum TPO- and Tg-antibodies found positive in 41.62%. Ultrasonographic results showed 24% had enlarged thyroid and 86.4% hypoechoic. Cytomorphological studies showed prevalence of colloid goiter (41.08%), lymphocytic thyroiditis (37.83%), Hashimoto's thyroiditis (8.10%), autoimmune thyroiditis (4.32%), sub-acute thyroiditis (2.16%) and 1.62% each papillary, medullary carcinoma, simple diffused hyperplasia and adenomoid nodular goiter. CONCLUSIONS: Grade-2 goitrous individuals in this mild goiter endemic region were affected by hypo- and hyperthyroidism with hypoechoic thyroid and thyroiditis. Thiocyanate that originates from BS even in presence of adequate iodine developed goiter and led goitrous population towards such diseases.

Familial Aggregation of Endemic Congenital Hypothyroidism Syndrome in Congo (DR): Historical Data.

Familial aggregation of endemic congenital hypothyroidism (CH) in an iodine-deficient population from northern Congo (Democratic Republic (DR)) was analysed on data collected four decades ago (1979-1980). During a systematic survey of 62 families, 46 endemic CH subjects (44 myxedematous and 2 neurological) were identified based on clinical evidence within a village cohort of 468 subjects. A distribution analysis showed that two families presented significant excess of cases versus a random background distribution. Both families were characterised by two healthy parents having all of their five offspring affected by some form of endemic CH. Goitre prevalence in endemic CH was lower than that in the general population, while goitre prevalence in the unaffected part of the cohort (parents and siblings) was similar to that of the general population. Some unidentified genetic/epigenetic factor(s) could contribute to the evolution of some iodine-deficient hypothyroid neonates through irreversible and progressive loss of thyroid functional capacity during early childhood (<5 years old). Besides severe iodine deficiency, environmental exposure to thiocyanate overload and selenium deficiency, factors not randomly distributed within families and population, intervened in the full expression of endemic CH. Further exploration in the field will remain open, as iodine deficiency in Congo (DR) was eliminated in the 1990s.

Evaluation of the Bethesda System and the ACR TIRADS in an Endemic Goiter Region.

BACKGROUND: Various factors can affect incidence of thyroid disorders and disease profiles may show abrupt changes in endemic goitrous areas. In this study, it was aimed to analyze the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in terms of risk of malignancy and general recommendations in an endemic goiter region (EGR). METHODS: In this retrospective study, a total of 500 patients who had thyroidectomy following thyroid fine needle aspiration biopsy were enrolled. For the assessment of thyroid cytology, BSRTC was used and for the evaluation of ultrasound features of thyroid nodules, ACR TIRADS lexicon was adopted. For the assessment of thyroid cytology, Bethesda classification was used and for the evaluation of ultrasound features of thyroid nodules, ACR TIRADS lexicon was adopted. RESULTS: In the EGR setting, benign category of BSRTC had a cancer risk of 6.2% which was two times more than the 2017 BSRTC revision reported. Nodules 10-14.9 mm in diameter had nearly 4 times higher malignancy risk than nodules >15 mm. In this group of patients, the risk of malignancy for TIRADS level 1, 2, 3, 4 and 5 was 1.16%, 2.94%, 7%, 45.64% and 94.44%, respectively. The malignancy rates for Bethesda system category I, II, III, IV, V and VI were as follows: 14.43%, 6.2%, 19.05%, 36.73%, 75.68% and 100%. CONCLUSIONS: There are slight differences between the common set of standards and this study results regarding risk of malignancy. This brings up the question whether there is need for revision for the use of categories and the appropriate management in endemic goiter regions.

Goiter in Brazilian modernism paintings / Bócio em pinturas da arte moderna brasileira

Objective: To evaluate Di Cavalcanti's artworks in which goiters are represented before and after the introduction of iodized salt to the Brazilian population. Methods: One hundred and thirty paintings by Di Cavalcanti from the 20's to 70's demonstrating necks were evaluated. All the paintings were observed in reproductions. The neck circumference in the paintings was measured. Since there were no standard thresholds of neck circumference, cutoffs were based on the median. Baseline characteristics of artworks were compared based on high and normal neck circumference categories using Student's t-test, Mann-Whitney-Wilcoxon test, or chi square test. Results: We analyzed 29 artworks which portray the neck of 60 women (84.5%), 8 men (11.3%) and 3 children (4.2%). The analyses of the neck circumference showed 23.3% of women (14/60), 12.5% of men (1/8), and 33.3% of children (1/3) with an abnormal profile of the neck circumference. The neck circumference ratio in 29 paintings showed that the relative sizes of the necks painted between the 1920's and 1950's (r=0.45; p=0.03), and painted between the 1960's and 70's (r= 0.54; p=0.003) have linearly decreased. The decades in which the artworks were painted explained 40.0% of the variation in size of the neck circumference (p=0.002). Conclusion: Art imitates life. Di Cavalcanti was not a physician, and probably did not have the intention to illustrate a pathological condition, although the images observed in this study should be considered as goiter or enlarged neck.

Objetivo: Avaliar as obras de Di Cavalcanti em que bócios estão representados, antes e após a introdução da iodação do sal para a população brasileira. Método: Foram avaliadas 130 pinturas de Di Cavalcanti entre os anos 1920 e 1970 demonstrando pescoços. Todas as pinturas foram observadas em reproduções. A circunferência do pescoço nas pinturas foi mensurada. Como não existia limite-padrão da circunferência do pescoço, os limites foram baseados na mediana. As características básicas das obras de arte foram comparadas por categorias da circunferência do pescoço em elevadas e normais, usando o teste t de Student, o teste de Mann-Whitney-Wilcoxon ou o teste qui-quadrado. Resultados: Analisamos 29 obras de arte que representavam o pescoço de 60 mulheres (84,5%), 8 homens (11,3%) e 3 crianças (4,2%). Ao analisar a circunferência do pescoço, 23,3% das mulheres (14/60), 12,5% dos homens (1/8) e 33,3% das crianças (1/3) demonstraram perfil anormal dela. A relação da circunferência do pescoço em 29 pinturas demonstrou que as circunferências do pescoço relativas aos pescoços pintados entre os anos 1920 e 1950 (r=0,45; p=0,03) e pintados entre os anos 1960 e 1970 (r=0,54; p=0,003) reduziram linearmente. As décadas em que as obra foram pintadas explicaram 40,0% da variação no tamanho da circunferência do pescoço (p=0,002). Conclusão: A arte imita a vida. Di Cavalcanti não era médico e, provavelmente, não tinha intenção de ilustrar uma condição patológica, embora as observações das imagens, neste estudo, tenham sido consideradas como bócio ou com aumento de volume do pescoço

Endemic Goiter and Iodine Prophylaxis in Calabria, a Region of Southern Italy: Past and Present.

Iodine, a micronutrient that plays a pivotal role in thyroid hormone synthesis, is essential for proper health at all life stages. Indeed, an insufficient iodine intake may determine a thyroid dysfunction also with goiter, or it may be associated to clinical features such as stunted growth and mental retardation, referred as iodine deficiency disorders (IDDs). Iodine deficiency still remains an important public health problem in many countries, including Italy. The effective strategy for the prevention and control of IDDs is universal salt iodization, which was implemented in Italy in 2005 as a nationwide program adopted after the approval of an Italian law. Despite an improvement in the iodine intake, many regions in Italy are still characterized by mild iodine deficiency. In this review, we provide an overview of the historical evolution of the iodine status in the Calabria region, located in the South of Italy, during the past three decades. In particular, we have retraced an itinerary from the first epidemiological surveys at the end of the 1980s to the establishment of the Regional Observatory of Endemic Goiter and Iodine Prophylaxis, which represents an efficient model for the surveillance of IDDs and monitoring the efficacy of iodine prophylaxis.

Assessment of Iodine Nutritional Status of School-Age Children in Kolkata District of West Bengal State in Post-Iodation Scenario.

To evaluate the state of iodine nutrition in post-iodation scenario, 3500 children were examined clinically for endemic goitre. Iodine and thiocyanate were measured in 240 urine samples; iodine content in 210 salt samples was measured. Total goitre prevalence was 6.1%. Median urinary iodine level was 21.80 µg/dl, and mean (±SD) urinary thiocyanate was 0.89 ± 0.49 mg/dl. Iodine content of only 11.9% salt samples was below recommended level of 15 ppm, 25.2% was between 15 and 30 ppm and 62.9% was >30 ppm. Iodine deficiency disorders are thus clinically mild public health problem of the studied population; however, they have no biochemical iodine deficiency. Studied population found exposed to thiocyanate load that might be the possible cause for persistence of endemic goitre. People of Kolkata should be advised to eat commonly consumed goitrogenic foods after boiling and decanting the water. Periodical monitoring and evaluation of iodine status should be mandatory.

Iodine Deficiency and Toxicity Among School Children in Damoh District, Madhya Pradesh, India.

OBJECTIVE: To estimate the prevalence of Iodine Deficiency Disorders, and household consumption of adequately iodized salt in Damoh district, Madhya Pradesh in 2016. METHODS: Cross-sectional study with cluster sampling method was used among school-going children. 30 clusters, each with 90 children were selected to access Total Goiter rate (TGR). 540 salt samples were collected to estimate salt iodine content from their household and 270 on the spot urine samples were collected to estimate Urine Iodine Excretion level. RESULTS: TGR was 2.08%. The prevalence of iodine deficiency, adequate iodine nutrition, and either more than adequate or toxic level of Iodine was 26%, 28% and 46 %, respectively. 72.4% people were consuming adequately iodized salt. CONCLUSION: Damoh district is no more an endemic area for iodine deficiency. We recommend continuous monitoring to assess IDDs as well Iodine-induced toxicity in future.

The effect of 17 years of increased salt iodization on the prevalence and nature of goiter in Croatian schoolchildren.

Background High goiter prevalence caused by iodine deficiency (medium content 5.6 mg potassium iodide [KI]/kg of salt, median urine iodine concentration [UIC] 68 µg/L) in Croatia was observed in 1991 and 1995 when salt was iodized with 10 mg KI/kg. A new regulation introduced in 1996, specified 25 mg KI/kg of salt resulting in an increase of median UIC to 248 µg/L. Afterwards, goiter prevalence was only assessed in two small studies. Methods In this study, we investigated the prevalence and etiology of goiter in 3594 schoolchildren 17 years after an increase in salt iodization in Croatia. Thyroid size was determined by palpation in 1777 girls and 1817 boys aged 10-18 years. In goitrous children, a thyroid ultrasound and thyroid-stimulating hormone, free thyroxine (fT4), free triiodothyronine (fT3), thyroid peroxidase (TPO) and thyroglobulin (TG) antibody measurements were performed. Results Goiter was found in 32 children (0.89% vs. 2.8% in 1991, p<0.00001 and 27% in 1995, p<0.00001), simple goiter (SG) in 18/32 (56%) goitrous children vs. 126/152 (82.8%) in 1991 p<0.00001, autoimmune thyroiditis (AT) in 13/32 (40.6%) vs. 19/152 (12.5%) in 1991 p<0.0009, nodules in four: two cysts, toxic adenoma and carcinoma (in 1991 two adenomas and one cyst), Graves' disease was not found (four in 1991). Subclinical hypothyroidism was found in three children. Thyroid disease was diagnosed in four of 32 children before the investigation. Increased iodine supply decreased goiter prevalence and SG/AT ratio in goitrous patients. Conclusions As thyroid abnormalities were found in 0.89% of children and some required treatment, thyroid examination is important in apparently healthy children regardless of sufficient iodization.

Estado de nutrición de yodo y prevalencia de concentraciones anormales de TSH en la población escolar de 6-7 años de la comunidad autónoma del País Vasco / Iodine nutrition status and prevalence of abnormal TSH levels in schoolchildren aged 6-7 years in the autonomous community of the Basque Country

Introducción: Un estudio epidemiológico realizado entre 1988 y 1992 puso de manifiesto la existencia de deficiencia de yodo y bocio endémico en la población escolar de la comunidad autónoma del País Vasco. Objetivos: 1) Conocer el estado de nutrición de yodo de los escolares de 6-7 años de edad y 2) estimar la prevalencia de concentraciones anormales de TSH en sangre capilar. Población y métodos: Fueron estudiados 497 escolares seleccionados mediante muestreo aleatorizado. Para evaluar el estado de nutrición de yodo se utilizó la mediana de las concentraciones urinarias de yodo (mCUY). Para estimar la prevalencia de concentraciones anormales de TSH se utilizó el intervalo de referencia derivado de la población estudiada. Resultados: La mCUY (P25-P75) fue de 140 μg/L (82-217). Fue mayor en los que utilizaban sal yodada en sus domicilios que en los que no lo hacían (146 [85-222] frente a 126 μg/L [73-198]; p < 0,05). También fue mayor en los que consumían 2 o más raciones diarias de leche y yogur que en los que consumían menos de 2 raciones (146 [87-225] vs. 110 μg/L [66-160]; p < 0,0001). La prevalencia de concentraciones anormales de TSH fue del 2%. No hubo correlación entre las concentraciones de TSH en sangre capilar y las CUY (R = 0,082; p = 0,076). Discusión y conclusiones: Los escolares de 6-7 años de la comunidad autónoma del País Vasco tienen un estado de nutrición de yodo adecuado. La utilización de sal yodada en el domicilio y el consumo diario de leche y yogur se asociaron con las mayores CUY

Introduction: An epidemiological study conducted between 1988 and 1992 showed iodine deficiency and endemic goiter in the schoolchildren of the autonomous community of the Basque Country. Objectives: 1) To ascertain the iodine nutrition status of schoolchildren aged 6-7 years, and 2) to estimate the prevalence of abnormal TSH levels in capillary blood. Population and methods: The study was conducted on 497 schoolchildren selected by random sampling. Median urinary iodine concentration (mUIC) was used to assess iodine nutritional status, and the reference interval derived from the study population was used to estimate the prevalence of abnormal TSH levels. Results: The mUIC (P25-P75) was 140 (82-217) μg/L. A higher value was found in those who used iodized salt at home than in those who did not (146 [85-222] versus 126 μg/L [73-198], P<0.05). It was also higher in those who consumed 2 or more daily servings of milk and yogurt than in those taking less than 2 servings (146 [87-225] versus 110 μg/L [66-160], P<0.0001). Abnormal TSH levels were found in 2% of children. There was no correlation between TSH levels in capillary blood and urinary iodine concentrations (R=0.082; P=0.076). Discussion and conclusions: Schoolchildren aged 6-7 years of the autonomous community of the Basque Country have an adequate iodine nutrition status. Use of iodized salt at home and daily consumption of milk and yogurt were associated to the highest UICs

Endemic goiter and iodine deficiency status among Guinea-Bissau school-age children.

BACKGROUND/OBJECTIVES: Iodine deficiency disorders are estimated to affect 25% of all school-age children around the world. Current policies concerning iodine deficiency disorders in many countries are not based on robust or recent national data. Our objective was to evaluate the current status of iodine nutrition in Guinea-Bissau (West Africa). SUBJECT/METHODS: A cross-sectional survey including 299 school-age children, aged 6-14 years old, from four distinct regions of Guinea-Bissau across a coast-hinterland gradient (Bolama, Bissau, Cambaju-Bafatá, and Gabú) was performed. Several iodine deficiency disorders indicators were used: total goiter rate, median urinary iodine concentration (UIC) and regional iodine content in household salt and drinking water samples. Data on the total goiter rate were obtained by thyroid ultrasound. RESULTS: Goiter was found in 73.5% (CI 95%, 68.5-78.2%) of the school-age children. We observed a median urinary iodine concentration of 110 mcg/l, with 7.3% of the studied population presenting urinary iodine concentration < 50 mcg/l. Only 12.5% of the household salt samples revealed iodine content ≥ 15 mg/kg. Median well water iodine concentration was 11.7 mcg/l. CONCLUSIONS: Guinea-Bissau presents high rates of goiter in school-age children despite satisfactory median urinary iodine concentration population levels. Salt and drinking water iodine median content cannot explain these findings. Further studies following the progress in iodine deficiency status and the presence of potential goitrogens in diet of this vulnerable population are in needed.

[Iodine prophylaxis, voices from the past after 65 years]. / Yodoprofilaxis, 65 años después suenan las voces del pasado.

In 1953, Dr. Felipe Rodríguez Moreno joined the Granada Research Group on Endemic Goiter, which was led by Dr. Ortiz de Landázuri. A high goiter prevalence (62% in women) was found out within the area, and that prevalence was observed to be related to the dietary habits of the time, being the most disadvantaged those who were showing a greater prevalence. A relationship between the high goiter prevalence and the family of the subjects with goiter was also found out, as they usually had a first-degree relative with affection. Iodine content of drinking water was poor throughout the area, so the prevalence was not significantly different between individuals who drank from different water sources. There were only two females with cretinism and two males affected by "idiocy", so the goiters were probably euthyroid. After introducing iodine prophylaxis with iodized salt in Güejar-Sierra, prevalence decreased from 53% to 13% between 1953 and 1958.

En el año 1953, el Dr. Felipe Rodríguez Moreno se incorpora para continuar el trabajo sobre endemia bociosa de la escuela de Granada, liderada por el Dr. Ortiz de Landázuri. En ese paisaje descubre una alta prevalencia de bocio (62% en mujeres), que se relacionaba con el tipo de dieta consumida, de tal forma que los más desfavorecidos tenían una prevalencia de bocio aún mayor. Así mismo, se encuentra una relación familiar en cuanto al bocio, de manera que los sujetos con bocio normalmente tienen un familiar en primer grado también afectado. El agua de bebida es pobre en yodo de forma generalizada, por lo que no hay diferencias significativas en la prevalencia de bocio según la fuente de la que se surtan los paisanos.  Solo se encontraron dos mujeres con cretinismo y dos varones afectados de "idiocia". Por ello, cabe pensar que se trata de bocios normofuncionantes.  Tras iniciar yodoprofilaxis con sal yodada en Güejar Sierra, se produce un descenso de la prevalencia de bocio de un 53% a un 13% entre los años 1953-1958.

Yodoprofilaxis, 65 años después suenan las voces del pasado / Iodine prophylaxis, voices from the past after 65 years

En el año 1953, el Dr. Felipe Rodríguez Moreno se incorpora para continuar el trabajo sobre endemia bociosa de la escuela de Granada, liderada por el Dr. Ortiz de Landázuri. En ese paisaje descubre una alta prevalencia de bocio (62% en mujeres), que se relacionaba con el tipo de dieta consumida, de tal forma que los más desfavorecidos tenían una prevalencia de bocio aún mayor. Así mismo, se encuentra una relación familiar en cuanto al bocio, de manera que los sujetos con bocio normalmente tienen un familiar en primer grado también afectado. El agua de bebida es pobre en yodo de forma generalizada, por lo que no hay diferencias significativas en la prevalencia de bocio según la fuente de la que se surtan los paisanos. Solo se encontraron dos mujeres con cretinismo y dos varones afectados de «idiocia». Por ello, cabe pensar que se trata de bocios normofuncionantes. Tras iniciar yodoprofilaxis con sal yodada en Güejar Sierra, se produce un descenso de la prevalencia de bocio de un 53% a un 13% entre los años 1953-1958 (AU)

In 1953, Dr. Felipe Rodríguez Moreno joined the Granada Research Group on Endemic Goiter, which was led by Dr. Ortiz de Landázuri. A high goiter prevalence (62% in women) was found out within the area, and that prevalence was observed to be related to the dietary habits of the time, being the most disadvantaged those who were showing a greater prevalence. A relationship between the high goiter prevalence and the family of the subjects with goiter was also found out, as they usually had a first-degree relative with affection. Iodine content of drinking water was poor throughout the area, so the prevalence was not significantly different between individuals who drank from different water sources. There were only two females with cretinism and two males affected by «idiocy», so the goiters were probably euthyroid. After introducing iodine prophylaxis with iodized salt in Güejar-Sierra, prevalence decreased from 53% to 13% between 1953 and 1958 (AU)

Concomitant thyroid cancer in patients with primary hyperparathyroidism in an endemic goitre region.

OBJECTIVE: Primary hyperparathyroidism (pHPT) is often accompanied by underlying thyroid pathology and 1 to 36% of these thyroid pathologies are malignant. How the identification of these lesions affects patient management is unclear. We present a single-center experience with the prevalence of concomitant thyroid cancer in patients who underwent parathyroidectomy for pHPT. MATERIALS AND METHODS: This was a retrospective cohort study. Two hundred-two patients with primary hyperparathyroidism included study. Demographic data, clinical findings, and final histopathological diagnosis were recorded retrospectively. RESULTS: Preoperative cervical ultrasound examination revealed co-existent thyroid abnormalities in 117 (57.9%) patients. Mean age of these patients was 57.8 ± 12.2 years and 88% were female. Sixty-three (53.9%) of the patients with thyroid abnormalities, underwent preoperative fine needle aspiration biopsy (FNAB). Cytology result was malignant in one (1.6%) patient, benign in 47(85.7%) patients, indeterminate in six (9.5%) patients and Hurthle cell neoplasm in two (3.2%) patients. Ninety-four (80.3%) of the patients underwent simultaneous thyroid surgery. Final pathology of the thyroid specimen was malignant in 26 (12.9%) patients. Sixteen of the malignant patients had preoperative FNAB. Preoperative FNAB result of these patients was malignant in one patient, indeterminate in two patients and benign in 13 patients. CONCLUSION: By implementing a comprehensive approach to patients with pHPT who present with thyroid disease, concomitant pathology may be elucidated preoperatively. But, this approach will not facilitate the detection of otherwise unsuspected thyroid cancer in an endemic goitre region. KEY WORDS: Cancer, Parathyroid adenoma, Parathyroidectomy, Thyroid, Thyroidectomy.