[SURGICAL TREATMENT OF NECK-RETROSTERNAL GOITER].

Results of 91 patient with neck-retrosternal goiter localization operative treatment were analysed. The first degree of thyroid retrosternal part distribution by I. Cohen, H. Cho classification (1994) was observed in 41 patient, the second degree--in 28, the third degree i - n 17 and the fourth degree--in 5 patients. In most cases of neck--retrosternal goiter localization, operation can be performed from neck access, removel of the submerged part of thyroid gland needs to be begun with mobilization of neck part of lobe, the observance of the offered actions algorithm allows to prevent the origin of complications and get good postoperative results.

Histopathological findings in goiter: A review of 624 thyroidectomies.

OBJECTIVES: To identify the histopathological patterns of goiter in thyroidectomy specimens and their frequency in relation to age and gender of the patients. METHODOLOGY: We present a retrospective data of 624 thyroidectomy specimens diagnosed over a period of six year (2007-2012) at the Department of Pathology, Holy Family Hospital, Rawalpindi, Pakistan. RESULTS: A total of 624 consecutive thyroidectomy specimens were selected. Patient's age ranges from 11-89 years, 541 females and 83 males. There were 512 (82%) non-neoplastic lesions, which includes; 475 (76.1%) multi-nodular goiter (MNG), 16 (2.6%) Hashimoto thyroiditis, 11 (1.8%) colloid goiter, 4 (0.6%) toxic goiter, 2 (0.3%) chronic lymphocytic thyroiditis, 2 (0.3%) tuberculous thyroiditis and 2 (0.3%) miscellaneous. From 112 (18%) neoplastic lesions, 43 (6.9%) were adenomas (41 females and 2 males) and 69 (11.0%) were carcinomas (58 females and 11 males). Peak age for thyroid malignancy was 3rd to 4th decades. The histological subtypes of thyroid carcinomas includes, 35 (5.6%) follicular variant of papillary carcinoma (FVPC), 15 (2.5%) well-differentiated tumor of uncertain malignant potential (WDT-UMP), 6 (1%) medullary carcinomas, 6 (1%) papillary carcinomas, 3 (0.5%) anaplastic carcinomas, 2 (0.3%) follicular carcinomas and 2 (0.3%) other carcinomas. Twenty-nine (4.6%) neoplastic lesions were associated with MNG, includes; 2 (3.5%) follicular adenomas, 3 (0.5%) WDT-UMP and 4 (0.6%) FVPC. CONCLUSIONS: MNG is common and FVPC is the common thyroid cancer seen in females. The overall frequency of thyroid cancer is 11%. Follicular adenoma and FVPC appears to be associated with long standing MNG of iodine deficiency.

Amiodarone-induced thyrotoxicosis: type 1 or type 2?

A 69-year-old man presented with a 6-week history of shortness of breath on exertion, unintentional weight loss, altered bowel habits and lethargy. He was diagnosed with atrial fibrillation 2 years previously and started on amiodarone and warfarin. He subsequently reverted to sinus rhythm and his medication was stopped 1 year prior to presentation. He denied history of thyroid dysfunction. On examination, he had a small firm goitre of grade I. His skin was warm and sweaty. Thyroid function tests showed him to be thyrotoxic. He was started on carbimazole 20 mg; however, he further became significantly thyrotoxic. Given the severity of his presentation and lack of any clinical or biochemical improvement, oral prednisolone 30 mg once daily was coadministered. His symptoms subsequently resolved and he became euthyroid. The prednisolone was tapered down and stopped while the carbimazole was incrementally reduced to 10 mg daily.

Spatial spectral imaging as an adjunct to the Bethesda classification of thyroid fine-needle aspiration specimens.

BACKGROUND: Thyroid fine-needle aspiration (FNA) biopsy, the preoperative diagnostic standard of care for patients with thyroid nodules, has limitations. Spectral imaging captures visible light information that is beyond the capability of the human eye, potentially increasing the accuracy of FNA biopsy. In the current study, the authors demonstrated the feasibility of using spectral imaging in combination with automated spatial analysis based on trainable pattern recognition as an adjunct test for thyroid FNA classification by developing an algorithm that distinguishes between images of papillary thyroid carcinoma (PTC) and benign goiter (BG). METHODS: A multispectral camera was used to capture spectral images representing 100 cases of PTC and BG. Used in conjunction with commercial software, 10 cases were used as a training set to develop a "classifier," a classification algorithm that segments digitized multispectral images into regions of PTC, BG, and "nonfeature." This algorithm was used to generate a screening test and a diagnostic test that were validated on an independent set of images representing 30 cases of PTC and 30 cases of BG. RESULTS: The area under the receiver operating characteristic for the PTC/BG classifier was 0.90. The screening test had a sensitivity of 0.93 and a specificity of 0.73. The diagnostic test had a sensitivity of 0.70 and a specificity of 0.90. CONCLUSIONS: The authors developed image classification tests that distinguish between FNAs of PTC and BG, demonstrating the potential value of spatial spectral imaging as an adjunct test for the classification of thyroid FNA samples. The data support prospective testing to determine the value of the PTC/BG classifier in routine clinical use.

[Riedel's goitre - rare and difficult to diagnose reason for surgical treatment of goiters]. / Wole Riedela - rzadka i trudna diagnostycznie przyczyna chirurgicznego leczenia wola.

INTRODUCTION: The paper reports a female patient treated surgically for Riedel's goitre. A total of 4775 patients were treated surgically between 1 January 2000 and 31 December 2007 for various types of goitres. Thyroiditis was diagnosed in 193 (4.0%) cases. Among them Riedel's goitre was found in one (0.5%). CASE REPORT: A 51-year-old woman P.G. (case record No. 1377/2007) was admitted to our hospital with considerable dyspnea, both inspiratory and expiratory, accompanied by marked stridor and retrosternal goitre, the latter suspected of neoplasmic process. Thyroid gland was hard, its left lobe extending behind the sternum. No disorders in thyroid hormonal function or high antibody titre against thyroid peroxidase were observed. Ultrasonography revealed large thyroid gland with mediastinal invasion, nodulated and hypoechogenic. Fineneedle biopsy suggested thyroid colloidal tumor. X-ray of the chest and neck revealed wide upper portion of the mediastinum and narrow trachea. Laryngological examination confirmed paralysis of left vocal fold. The patient was operated under general endotracheal anesthesia. Both thyroid lobes were partially resected together with the isthmus, and malacic trachea was decompressed. No complications were observed during postoperative period. Paraffin histopathological examination confirmed the presence of Riedel's goitre. The patient was discharged in general good condition. She was under regular follow-up control and died 1.5 year after operation from further progress of the disease. CONCLUSIONS: Clinical course of Riedel's goitre may cause remarkable diagnostic problems, and requires a differentiation with thyroid malignant tumor. Surgical treatment of Riedel's goitres helps to quickly obtain correct diagnosis and improve both clinical condition and life comfort of the patients.

Enfermedades frecuentes del tiroides en la infancia / No disponible

La aparición de alteraciones de la función tiroidea en los niños es muy frecuente. Parece que hay datos suficientes para asegurar que el seguimiento de las hormonas tiroideas, al menos durante la infancia, es muy útil para evitar posibles problemas a largo plazo. Por tanto, cualquier beneficio potencial sería mayor que los posibles efectos dañinos. En los controles de salud de los niños, siempre debe investigarse la presencia de signos de sospecha de disfunción endocrinológica. En esta especialidad tan vinculada a los procesos de crecimiento y desarrollo, donde los signos de casi todas sus patologías son muy discretos en su comienzo, debe agudizarse al máximo la observación, ya que es importante el diagnóstico precoz para que los tratamientos resulten eficaces y puedan evitar las secuelas de la enfermedad. Solo si se investiga, la mayoría de las enfermedades endocrinológicas pueden ser descubiertas tempranamente. Únicamente el pediatra puede contribuir al diagnóstico precoz. La interpretación de normalidad/anormalidad del proceso de crecimiento y desarrollo del niño, es una herramienta de gran utilidad durante la infancia. En la etapa de estudio, así como en la de tratamiento, una vez confirmada la enfermedad, el pediatra debe integrar el equipo ampliado de atención del niño. El pediatra por su parte, en estrecha comunicación con el grupo especializado, conducirá a la familia y al paciente en su nueva condición de enfermo crónico(AU)

The appearance of alterations of the thyroid function in children is very frequent. It seems that there are sufficient data to assure that the control of thyroid function during childhood is at least very useful in order to avoid possible problems in the long-term development. Therefore, any potential benefit would be greater than the possible harmful effects. In the controls of the well child, the signs of suspicion of endocrinologic disfunción must be investigated always. In the processes of growth and development, where the signs of almost all their impairments are very discreet in their beginning, the observation must become thorough since early diagnosis is important for the treatments to be effective and to be able to avoid the sequels of the disease. Pediatricians have an important contribution to the early diagnosis. The interpretation of normality/abnormality of the process of growth and development of the infant, is a very useful tool during childhood. In the stage of study as well as in the treatment, pediatricians must integrate the extended team of childcare. Pediatricians will lead the family and the patient in its new condition of chronic patient(AU)

Iodine status and cognitive function of women and their five year-old children in rural Sidama, southern Ethiopia.

OBJECTIVE: Iodine deficiency is one of the most common micronutrient deficiencies worldwide and is a major cause of preventable mental retardation. The purpose of this study was to assess the iodine status and cognitive function of women of childbearing age and their five-year-old children. METHOD: A cross-sectional study was conducted in a rural village in southern Ethiopia. A convenience sample of one hundred women and their five year-old children participated in the study. Goiter grade, urinary iodine excretion, Raven's CPM and cognitive tests from the Kaufman ABC-II, were administered to the women and their children. RESULTS: The use of iodized salt was only 2%. The mean iodine content of water in and around the study area was 4.46 microg/l. Occurrence of goiter was 85% in the women and 33% in children. Urinary iodine excretion for all participants was <49 microg/L, the top of the range for moderate iodine deficiency. The median urinary iodine excretion (UIE) was 1 microg/L for both mothers and children. For children, measures of short term memory (Sequential index) were correlated with the visual processing (Simultaneous index) (r = 0.49, p < 0.0001). Goiter and urinary iodine excretion were correlated to Sequential index (r = 0.39, p = 0.0011 and r = 0.2, p = 0.05) respectively, but not to the Simultaneous index for children. Sequential (r = 0.21, p = 0.03) and Simultaneous (r = 0.29, p = 0.004) indices of mothers and children were correlated. CONCLUSION: The high prevalence of goiter and the low urinary iodine excretion demonstrate serious long- and short-term iodine deficiency in the study area. Relations between measures of iodine status and short term memory in children raise concern about potential functional effects of iodine deficiency.

ACTUALIZACIÓN EN MEDICINA DE FAMILIA: Manejo de la patología tiroidea en Atención Primaria I. Cribado de patología tiroidea. Hipotiroidismo / UP-DATE IN FAMILY MEDICINE: Management of thyroid disease in Primary Care I. Screening of thyroid disease. Hypothyroidism

La patología tiroidea es un trastorno muy común en la consulta de Atención Primaria. Las enfermedades del tiroides tienen una elevada prevalencia en todas las edades y especialmente en el sexo femenino. Las manifestaciones clínicas son inespecíficas y de instauración lenta, por lo que es frecuente que el diagnóstico sea casual. La sospecha clínica en la consulta de Atención Primaria es fundamental para el diagnóstico. Estos tres artículos tratan de dar una visión global sobre los problemas del tiroides y su manejo en Atención Primaria. En el primero se hablará del cribado de la patología tiroidea y del hipotiroidismo; en el segundo, del hipertiroidismo y las tiroiditis y en el tercero y último, sobre el bocio y los nódulos tiroideos (AU)

Thyroid disease is a very common disorder in Primary Carevisit. Thyroid diseases have a high prevalence in all agesand especially in the female gender. The clinical manifestationsare nonspecific and of slow establishment. Thus, itsdiagnosis is often by chance. Clinical suspicion in PrimaryCare clinic is fundamental for diagnosis.These three articles will provide an overall view on thethyroid problems and their management in Primary Care. Inthe first article, screening of thyroid disease and hypothyroidismwill be discussed. The second one will deal with hyperthyroidismand thyroiditis and the third and final onewill be on goiter and thyroid nodules (AU9

The majority of Danish nontoxic goitre patients are ineligible for Levothyroxine suppressive therapy.

OBJECTIVE: Levothyroxine suppressive therapy (LT4-therapy), aimed at shrinking thyroid nodules is controversial. Despite evidence of limited effect and long-term side-effects, questionnaire surveys indicate widespread use. Our aim was to determine, in consecutive nontoxic goitre patients, the proportion ineligible for LT4-therapy. Exclusion criteria were set up in agreement with recent guidelines. SETTING: Secondary/tertiary referral centre at University Clinic. SUBJECTS AND METHODS: During 1997-2001, 822 patients were referred to our endocrine unit on suspicion of nontoxic goitre. Patients were evaluated clinically including fine needle aspiration biopsy, thyroid scintigraphy and ultrasound. Seven-hundred and forty-five patients (627 women and 118 men; median age 47 years, range 11-90) were potential candidates for LT4-therapy. Based on guidelines we defined conditions where LT4-therapy is contraindicated. Exclusion criteria included (1) Serum TSH < 1.0 mIU/l, (2) Post-menopausal status, or males older than 60 years, (3) Thyroid volume above 100 ml, (4) Intrathoracic goitre, (5) Clinical suspicion of malignancy, (6) Dominant thyroid cyst, (7) Nondiagnostic FNA, (8) Previous ineffective LT4-therapy, (9) Elevated serum calcitonin, (10) Osteoporosis or cardiovascular disease. RESULTS: Of patients 84% were ineligible for LT4-therapy. In diffuse goitre (n = 35) 63%, in uninodular goitre (n = 320) 77% and in multinodular goitre (n = 390) 91% were ineligible. Main ineligibility reasons were a low serum TSH, post-menopausal status, a large goitre or clinical suspicion of malignancy. CONCLUSION: The vast majority of consecutive Danish nontoxic goitre patients (84%) were ineligible for LT4-therapy. Due to low efficacy and potential long-term adverse effects on the skeleton and cardiovascular system we strongly advocate against LT4-therapy for nontoxic goitre.

A new classification system for retrosternal goitre based on a systematic review of its complications and management.

INTRODUCTION: There is no standard definition for thyroid glands extending below the thoracic inlet, and there are no clear guidelines for pre-operatively identifying those patients that may require an intrathoracic approach. We therefore reviewed the current literature in order to establish the current practices regarding the management of retrosternal goitres (RSGs), and propose a classification system to aid pre-operative planning for this important group of patients. MATERIALS AND METHODS: A PubMed Medline search was conducted using the search terms 'retrosternal', 'substernal', 'intrathoracic', 'mediastinal', 'goitre' and 'goiter', resulting in 626 hits. Exclusion criteria reduced the number of papers to the 34 used for this review. RESULTS: A total of 34 papers totaling 2426 patients were included. Eighty-four percent of patients operated on for RSG were achieved via a cervical approach, with the remainder also requiring manubriotomy (3.1%), full sternotomy (6.6%) or thoracotomy (4%). Tracheomalacia occurred in 1% of patients and Superior Vena Cava syndrome (SVC) in 3.2%. There was a clear and highly significant association between the extent and definition of RSG and reported complications, as well as the approach used, with the incidence of tracheomalacia, SVC and need for intrathoracic approach increasing more than 10-fold in cases of RSG reaching the aortic arch. DISCUSSION: There is a clear need to establish a common standard in the definition and description of the extent of RSG. Using our findings, we propose a new, simple, 3-grade classification system of RSGs, based on their relation with the aortic arch and the right atrium.

Surgical therapy of goiter plunged in the mediastinum. Considerations regarding our experience with 165 patients.

Thyroid goiter is called plunged when, starting from the cervical region, it grows in the anterior-superior mediastinum to a depth of more than 2 cm. The highest frequency (48.44%) is evident in the age range from 60 to 70. From February 2002 to August 2005, performed 133 (80.6%) near total thyroidectomies, 26 total thyroidectomies (15.7%), 4 lobectomies (2.4%) and 2 (1.2%) totalisations of recurrences for plunged goiter in the 7th Division of General Surgery of the Second University of Naples. The goiters were classified using Lamke and Ferrante's topographical classification, which distinguishes between prevascular and retrovascular cervico-mediastinal goiters depending on the position assumed by the part plunged in the mediastinum in relation to the vascular layer of the epiaortic trunks. Retrovascular goiters are further subdivided into: pre-tracheal, laterovisceral and retrovisceral goiters depending on the relation to the trachea, oesophagus and epiaortic trunks. Among the patients who underwent near total thyroidectomy, there were 3 cases of permanent hypocalcaemia, 7 (7.2%) of temporary hypocalcaemia and only 1 (0.6%) monolateral temporary recurrent nerve lesion. Among those who underwent total thyroidectomy there was 1 case (0.6%) of temporary hypocalcaemia, and 1 (0.6%) of permanent hypocalcaemia. Postoperatively we also observed 3 cases (1.8%) of haemorrhage and 3 (1.8%) transfers to intensive care for respiratory insufficiency; 1 of these patients died 25 days after the operation. Ligature of the inferior and superior thyroid artery near the thyroid capsule protects the vascularisation of the parathyroid glands as well as the recurrent nerve and its division branches.

New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report.

BACKGROUND: Goiter prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDDs) in a population. In areas of mild-to-moderate IDDs, measurement of thyroid volume (Tvol) by ultrasound is preferable to palpation for grading goiter, but interpretation requires reference criteria from iodine-sufficient children. OBJECTIVE: The study aim was to establish international reference values for Tvol by ultrasound in 6-12-y-old children that could be used to define goiter in the context of IDD monitoring. DESIGN: Tvol was measured by ultrasound in 6-12-y-old children living in areas of long-term iodine sufficiency in North and South America, central Europe, the eastern Mediterranean, Africa, and the western Pacific. Measurements were made by 2 experienced examiners using validated techniques. Data were log transformed, used to calculate percentiles on the basis of the Gaussian distribution, and then transformed back to the linear scale. Age- and body surface area (BSA)-specific 97th percentiles for Tvol were calculated for boys and girls. RESULTS: The sample included 3529 children evenly divided between boys and girls at each year ( +/- SD age: 9.3 +/- 1.9 y). The range of median urinary iodine concentrations for the 6 study sites was 118-288 micro g/L. There were significant differences in age- and BSA-adjusted mean Tvols between sites, which suggests that population-specific references in countries with long-standing iodine sufficiency may be more accurate than is a single international reference. However, overall differences in age- and BSA-adjusted Tvols between sites were modest relative to the population and measurement variability, which supports the use of a single, site-independent set of references. CONCLUSION: These new international reference values for Tvol by ultrasound can be used for goiter screening in the context of IDD monitoring.

Factores pronósticos de recidiva, presentes en el momento del diagnóstico del hipertiroidismo en la enfermedad de graves-basedow tratada con antitiroideos / Prognostic factors of hyperthyroidism of diagnosis of graves-basedow's disease treated with antithyroid drugs

Introducción. En el hipertiroidismo por enfermedad de Graves-Basedow (EGB), un elevado porcentaje depacientes no entran en fase de remisión o recidivan tras tratamiento con fármacos antitiroideos yrequieren tratamiento definitivo. En este estudio intentamos identificar los factores, presentes en elmomento del diagnóstico del hipertiroidismo, que pudieran predecir la ausencia de curación de laenfermedad tras tratamiento médico. Pacientes y método. Se estudió de forma retrospectiva a los pacientes diagnosticados de hipertiroidismo por EGB de la consulta de endocrinología de una población del sur de Madrid (Getafe). Se utilizó para su búsqueda un fichero de diagnósticos. Se seleccionaron a los pacientes que habían recibido tratamiento antitiroideo durante más de 12 meses y con un seguimiento superior a un año tras suspenderlo, que tenían estudio autoinmunitario en el momento del diagnóstico (anticuerpos antimicrosomales [AAM] y anticuerpos antirreceptor de TSH [TRAb]) y que presentaban positividad de TRAb ( 9U/l). Se estudió la posible influencia del sexo, edad, T4 libre, AMM, TRAb, oftalmopatía y tamaño del bocio, en el momento del diagnóstico del primer brote de hipertiroidismo, sobre la evolución de la enfermedad. Resultados. No encontramos diferencias estadísticamente significativas en la edad, sexo, T4 libre o grado de oftalmopatía inicial entre los pacientes que no presentaron recidiva y los que la presentaron. Se observó una asociación significativa de menor probabilidad de curación con AAM > 3.000 U/ml, TRAb > 80 U/l y grado de bocio II-III. En el estudio multivariante, únicamente el grado de bocio se asoció de forma independiente a la aparición de recidiva. Conclusiones. La presencia de bocio grado II-III y títulos elevados deAAM o de TRAb, en el momento del diagnóstico de la EGB, predicen una escasa remisión del hipertiroidismo, por lo que, en estos casos, se podría plantear desde el inicio un tratamiento definitivo (AU)

Thin layer compared to direct smear in thyroid fine needle aspiration.

The efficacy of preparing thyroid fine needle aspirations (FNAs) by the thin layer as opposed to the direct smear method has not been evaluated sufficiently in a regional laboratory setting. At the Foothills Hospital (Calgary, Canada), the method of processing thyroid FNAs was changed from direct smear to thin layer in January 1996. The results of 327 patients who had direct smear from 1994 to 1995 were compared to 401 who had thin layer between 1996 and 1997. While there were no significant differences across a broad range of quality indicators, thin layer showed a trend towards a higher proportion of true benign diagnoses (31% vs 24%), a lower proportion of inadequate specimens (41% vs 50%) and, most importantly, a lower false negative rate (3% vs 9%). In conclusion, the changeover to thin layer did not compromise the interpretation of thyroid FNAs.

[Role of diagnostic and therapeutic tools in the definition of differentiated thyroid carcinoma (1800-1950)]. / Nosologie du cancer thyroïdien différencié: rôle des outils diagnostiques et thérapeutiques (1800-1950).

This paper is an attempt to evaluate the role of diagnostic and therapeutic tools to define differentiated thyroid carcinoma. At the beginning of the last century, physicians described its clinical feature: hard and invasive goiter arising after 25 and leading to death. In 1860, the surgical revolution encouraged the surgeons of goiter to treat thyroid cancer: simple goiter was viewed as precancer. From 1880, cell and tumor theories led pathologists to define microscopically thyroid cancer. In 1920, they demonstrated that the two most constant indications of thyroid epithelial malignancy were invasion of the blood vessels and distant metastasis. In 1930, radiotherapists introduced the concept of prognostic classification which combines histological criteria and patient survival for thyroid cancer. From 1940, the medical use of radioiodine led to distinguish two groups of thyroid tumors: those which are able to concentrate radioiodine and those which are not. Physicians, specialised in thyroid endocrinology, established the rules of thyroid cancer treatment. Our purpose is to analyse the epistemological and historical context of this pathology definition.

Gender, clinical findings, and serum thyrotropin measurements in the prediction of thyroid neoplasia in 1005 patients presenting with thyroid enlargement and investigated by fine-needle aspiration cytology.

One thousand five euthyroid patients (870 females and 135 males, mean age 47 years), who presented with thyroid enlargement were evaluated by fine-needle aspiration cytology (FNAC) of the thyroid as the first-line investigation. The final cytological or histological diagnosis was determined after surgery (n = 312) or clinical follow-up for a minimum period of 2 years (range 2-14 years, mean 6.7 years). Goiter type was assessed clinically and was classified as diffuse in 147, multinodular in 247, or solitary nodule in 611. The overall sensitivity and specificity of the procedure in the detection of thyroid neoplasia was 88% and 89%, respectively. Males who presented with thyroid enlargement had significantly higher rates of malignancy (p = 0.007) and neoplasia (benign + malignant) (p = 0.002) than females, as did subjects with solitary nodule compared with diffuse or multinodular goiters (malignancy p = 0.001, neoplasia p < 0.001). Subjects with normal thyrotropin (TSH) (>0.4 mU/L) at presentation had a nonsignificantly increased risk of thyroid neoplasia (p = 0.07) and malignancy, in contrast to those with low TSH (<0.4 mU/L). We confirmed FNAC of the thyroid to be an accurate test in the detection of thyroid neoplasia. Gender and goiter type at presentation both contribute significantly to the prediction of the diagnosis of thyroid neoplasia.

Morphometry in the cytologic evaluation of thyroid follicular lesions.

BACKGROUND: The current study was undertaken to evaluate the quantitative estimation of cytologic features on aspirated smears for the preoperative differential diagnosis of follicular lesions of the thyroid. METHODS: The subjects were 60 patients with follicular lesions of the thyroid (including 20 follicular carcinomas, 15 follicular adenomas, and 25 adenomatous goiters) whose histopathologic explorations were conducted fully postoperatively. Using a microscope connected to a computerized video system, the mean nuclear area, the mean nuclear perimeter, the circular rate, the largest to the smallest dimension ratio (LS ratio) of the nuclei, and the coefficient of variation of the nuclear area (NACV) were measured and analyzed. RESULTS: Among the quantitative morphometric parameters of nuclei, the circular rate was significantly higher in the group with adenomatous goiters than those with follicular carcinomas (P < 0.00001) and adenomas (P < 0.005). The group with follicular carcinomas had a higher LS ratio than the group with adenomatous goiters (P < 0.0005). The NACV value increased as the malignant potential of the lesion increased and showed significant differences between the groups. When a NACV of 21.5% was chosen as the cutoff point, the incidence of malignancy was significantly higher in patients with high NACV values than in those with low NACV values (P < 0.00001). Using this borderline value, it was possible to distinguish malignant from benign diseases with a sensitivity of 85.0%, a specificity of 82.5%, and an accuracy of 83.3%. CONCLUSIONS: Preoperative quantitative estimations of cytologic nuclear features are useful for the preoperative differential diagnosis of follicular lesions of the thyroid.