An easy approach to ultrasonographic volumetry of the thyroid.

To establish an easy way to perform volumetry of the thyroid gland using ultrasonography, we evaluated the accuracy of the products of the depth and width of the right thyroid lobe as indices of thyroid volume. The depth and width of both thyroid lobes were measured using ultrasonography before surgery in 193 patients with Graves' disease. The products were compared with the weight of the thyroid obtained from operative records. We also evaluated the depth and width of the right thyroid lobe in 312 subjects who presented without any thyroid disease. The products of depth and width of the right and left lobes of patients with Graves' disease correlated similarly well with the weight of the thyroid obtained from operative records (ρ = 0.896 for right, ρ = 0.886 for left, p < 0.0001). Because the right lobes were larger than the left lobes, the products of the depth and width of the right lobe were adopted as novel parameters for an easy volumetric approach. The relationship between the weight and the measurements of the right lobe was described using the following regression equation: weight (g) = [11.8 × depth (cm) × width (cm)] - 16.0. The products of the subjects without any thyroid diseases were distributed between 0.6 cm2 and 4.4 cm2, with a median of 2.0 cm2. The upper limit of these values in these subjects was estimated to be 3.8 cm2. This easy ultrasonographic volumetric technique makes it possible to perform a semi-quantitative assessment of thyroid volume and to differentiate diffuse goiter from normal-sized thyroids.

Prevalence of thyroid diffuse goiter and its association with body mass index and the presence of cysts and nodules in children and adolescents: the Fukushima Health Management Survey.

The main cause of diffuse thyroid goiter is autoimmune chronic thyroiditis, otherwise known as Hashimoto's thyroiditis. Thyroid hormones play pivotal roles in growth and development during childhood. However, the prevalence of diffuse goiter and the relationships between diffuse goiter, thyroid volume, cysts and nodules, and anthropometric measurements in children are not well known. Among 789,459 participants who participated in thyroid ultrasound examinations, 320,206 participants (male: 161,728; female: 158,478) aged 1-23 years were analyzed. Logistic regression analyses were conducted to calculate the odds ratios of the standard deviation score of body mass index (BMI-SDS), the SDS of bilateral width multiplied thickness area (BWTAR-SDS) as a provisional determination of thyroid volume, and the presence of nodules or cysts for positive diffuse goiter compared with negative diffuse goiter after correction for sex and age. The prevalence of diffuse goiter increased in a female-dominant manner with aging. Compared with the absence of diffuse goiter, the age- and sex-adjusted odds ratios (95% confidence intervals) for BMI-SDS (1 SD), BWTAR-SDS (1 SD), cysts, and nodules were 1.24 (1.21-1.27), 3.21 (3.13-3.29), 0.53 (0.50-0.58), and 1.38 (1.17-1.64), respectively. The odds ratios of nodules for positive diffuse goiter were 4.18 (1.08-16.08), 1.76 (1.01-3.07), 1.80 (1.32-2.45), and 1.34 (1.08-1.67) in the age groups 1-7, 8-11, 12-15, and 16-23 years, respectively. The age-dependent increase in the prevalence of diffuse goiter was independently associated with increased BMI and positive prevalence of nodules in young individuals.

Co-occurrence of Amyloid Goiter and Adipose Metaplasia in a Patient With History of Pulmonary Tuberculosis: A Case Report.

Amyloid goiter is described as an accumulation of amyloid, an amorphous proteinaceous material, in the thyroid gland. The deposition of amyloid is relatively common in the thyroid gland. However, a significant clinical enlargement due to amyloid accumulation and fat deposition in the thyroid stroma resulting in diffuse goiter leading to compressive symptoms is a rare phenomenon. In this report, we describe a rare case of amyloid goiter with adipose metaplasia in a 38-year-old woman with a history of pulmonary tuberculosis who presented to the outpatient department with complaints of heartburn, abdominal discomfort, and hoarseness of voice. Incidentally patient had diffused multinodular neck swelling. Preliminary blood investigations were normal. The contrast-enhanced computed tomography neck showed multiple non-enhancing lesions and a diffusely enlarged thyroid gland, causing a mass effect on the oropharynx posteriorly and minimally on the trachea. Fine needle aspiration cytology thyroid revealed thyroiditis. The patient underwent a total thyroidectomy, and histopathological examination of the specimen showed an extracellular eosinophilic amorphous substance that was positive for Congo red and showed apple-green birefringence under polarized light, and large areas of adipose metaplasia were noted, and a diagnosis was made. The amyloid involvement can result from localized primary deposition or secondary to chronic inflammatory disease. The prevalence of amyloid goiter in developed countries is due to primary amyloidosis, and in developing countries is due to secondary amyloidosis. Patients with a history of pulmonary tuberculosis commonly present with renal amyloidosis as its complication. Patients with an enlarged thyroid gland and a history of chronic inflammatory conditions or plasma cell dyscrasias should be evaluated with extreme suspicion. The correlation of tuberculosis with the subsequent development of amyloid goiter highlights the need for research in this area.

Metastasis to the thyroid gland from primary breast cancer presenting as diffuse goiter: A case report and review of literature.

BACKGROUND: Metastasis to the thyroid gland (TM) from primary breast cancer is uncommon and usually presents as thyroid nodules; however, diffuse goiter without thyroid nodules is the first sign of TM in rare cases. Skip metastases (SMs) to the lymph nodes in breast cancer, defined as discontiguous higher-level metastases in the absence of lower levels of contiguous metastases, have been reported in the contralateral cervical area of the primary tumor site in rare cases. CASE SUMMARY: A 49-year-old previously healthy Chinese woman was diagnosed with right lateral invasive ductal carcinoma and underwent neoadjuvant chemotherapy treatment and bilateral mastectomy with axillary lymph node dissection. No malignancy of the left breast or axillary or distant metastases were identified preoperatively. However, enlarged left cervical lymph nodes were detected 36 mo after surgery, and rapidly enlarging thyroid glands without nodules were detected 42 mo after surgery. Fine-needle aspiration cytology was performed on the left cervical lymph nodes and left lobe of the thyroid, which were both revealed to contain metastases from the primary breast cancer. Additionally, the immunostaining profiles changed in the process of metastases. The patient was discharged with the NP (vinorelbine and cisplatin) regimen for subsequent treatment, and stable disease was determined when the curative effect was evaluated. CONCLUSION: Diffuse goiter may be the first sign of TM, and enlarged lymph nodes in the contralateral cervical area may be SMs of primary breast cancer.

Type 2 Marine-Lenhart Syndrome: An Uncommon Cause of Thyrotoxicosis.

Marine-Lenhart syndrome (MLS) is an uncommon cause of primary hyperthyroidism, which can occur in the context of diffuse goiter due to Graves disease (GD) or autonomic nodular disease (Plummer disease (PD)). The coexistence of these two conditions is the hallmark of the MLS. Patients with MLS have a lower remission rate with oral antithyroid drugs, requiring definitive management therapies with radioactive iodine or surgery. We present the case of a 48-year-old female with a history of primary autoimmune hyperthyroidism (GD) since 2016, with biochemical control of hyperthyroidism with methimazole but without the possibility of stopping treatment. The scintigraphic uptake pattern showed heterogeneous uptake of the thyroid parenchyma with three hyper-uptake nodules without inhibition of the rest of the thyroid tissue, findings of an MLS condition with the indication for definitive therapy, for which he was referred to nuclear medicine for the administration of radioactive iodine.

[Prediction of activity and severity of endocrine ophthalmopathy by multidimensional linear regression modeling]. / Prognozirovanie aktivnosti i tiazhesti éndokrinnoi oftal'mopatii metodom mnogomernogo lineinogo regressionnogo modelirovaniia.

Endocrine ophthalmopathy (EOP) is a severe chronic autoimmune disease associated with autoimmune thyroid pathology that leads to loss of sight, cosmetic defects and quality of life decrease. EOP is difficult to give prognosis for due to various factors affecting its course and outcome. PURPOSE: To develop a reliable and precise prognosis method for EOP activity and severity based on personalized combination of risk factors in specific patients by multidimensional linear regression modeling. MATERIAL AND METHODS: A group of 139 patients (278 orbits) with newly diagnosed EOP associated with toxic diffuse goiter was observed during 1 year by an ophthalmologist and an endocrinologist; patient examination interval was 6 months. More than 250 indices were dynamically analyzed in the course of the study. Linear regression analysis was chosen as the research method; it allowed detection of linear dependencies between dependent and explanatory variables. RESULTS: More than 600 various linear regression equations were derived that enabled prediction of EOP onset risk and development timeline, estimation of activity and/or severity of the disease, duration of active period in specific patients for the immediate and long-term outcome. From the derived models, the most reliable and safest for practical application were picked out. The present study introduces nine optimized models that can be used for patient follow-up since day one. CONCLUSION: The onset risk, progression and outcome of the disease can be determined by a combination of factors revealed in the study.

Incidence of thyroid diseases in Zhejiang Province, China, after 15 years of salt iodization.

Thyroid diseases(TD) can be induced by either deficient or excessive iodine intake. Universal Salt Iodization(USI) program has been implemented in China since 1995, to prevent iodine deficiency disorders (IDD). To evaluate the current conditions of TD and the role of USI, a multi-stage stratified random sampling scheme was used to perform a cross-sectional survey on the incidence of TD among participants in 6600 households in Zhejiang Province, a coastal area in China. Iodine nutrition status of the population was assessed by dietary iodine intake recall and urinary iodine concentration (UIC) of the participants, and TD were diagnosed by thyroid ultrasonography for 15122 participants and for 5873 participants by serum criteria for thyroid function(fT3, fT4, TSH, TRAb, TgAb, TPOAb; see Introduction for abbreviations). The median UIC of the surveyed population was 163µg iodine/L. From the participants 23.2% had UIC<100µg/L which is moderately iodine-deficient according to WHO classification. Diffuse goiter was present in 2.3% of the population and thyroid nodule in 20.9%. The incidence of hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, subclinical hypothyroidism, Graves' disease and chronic lymphocytic thyroiditis was 0.5%, 0.6%, 0.6%, 7.8%, 0.2% and 0.3%, respectively. The proportion of several TD for participants with non-iodized salt intake was higher than that for participants with iodized salt intake.

Prevalencia y caracterización de la enfermedad tiroidea nodular y del bocio difuso en un área urbana / Prevalence and characterization of the thyroid nodule and the diffuse goiter in an urban area

Introducción: La enfermedad tiroidea nodular constituye un problema de salud en la población adulta por su alta prevalencia. Su diagnóstico se ha favorecido en las últimas décadas como consecuencia de la realización del ultrasonido del tiroides. La provincia de Sancti Spíritus, no disponía de investigaciones previas para analizar la problemática de esta enfermedad y del bocio difuso en las personas adultas, por lo que un estudio de prevalencia se realizó en la ciudad de Jatibonico. Objetivos: determinar la prevalencia de la enfermedad tiroidea nodular y del bocio difuso en la población adulta de 3 consultorios del área urbana de Jatibonico; así como precisar en las personas con enfermedad tiroidea nodular y con bocio difuso, sus antecedentes personales y familiares, el cuadro clínico de presentación, los signos ultrasonográficos y el valor de la hormona estimulante del tiroides. Métodos: el universo de estudio lo constituyó una población de 18 años o más de edad de ambos sexos, pertenecientes a 3 consultorios escogidos al azar del área urbana de Jatibonico (n= 6 126 personas). La muestra estimada para un intervalo de confianza del 95 por ciento fue de 337 personas, y se logró encuestar a 405 sujetos. A la totalidad se les realizó un ultrasonido del tiroides. A 277 personas se les determinó la hormona estimulante del tiroides. Las personas fueron clasificadas con y sin enfermedad tiroidea; y a su vez, esta última, fue subclasificada en enfermedad tiroidea nodular y bocio difuso. Resultados: la prevalencia de la enfermedad tiroidea en la población estudiada fue de 41,97 por ciento (IC- 95 por ciento: 37,17-46,77 por ciento). Al individualizarla, la enfermedad tiroidea nodular se halló en el 36,79 por ciento (IC- 95 por ciento: 32,09-41,48 por ciento) y el bocio difuso en el 5,18 por ciento (IC- 95 por ciento: 3,02-7,33 por ciento) respectivamente. Los pacientes con enfermedad tiroidea, en su mayoría, se manifestaban asintomáticos (85,3 por ciento) y se distribuyeron en todos los grupos de edades, pero con un ligero predominio en las féminas. La hormona estimulante del tiroides elevada (32,85 por ciento) y subnormal (7,58 por ciento) se constataron en los pacientes estudiados. Conclusión: en la población estudiada, la prevalencia de la enfermedad tiroidea nodular fue mayor que la del bocio difuso(AU)

Introduction: Thyroid nodule disease is a health problem in the adult population due to its high incidence. The diagnosis has improved in the last few decades as a result of the thyroid computer tomography. Previous research studies to analyze the situation of this disease and of diffuse goiter in the adult population did not exist in Sancti Spiritus province, so the prevalence study was conducted in Jatibonico city. Objective: to determine the prevalence of the thyroid nodule disease and of diffuse goiter in the adult populations from 3 physician's offices located in Jatibonico urban area as well as to determine the personal and family histories, the clinical picture of presentation, the ultrasonographic signs and the value of the thyroid-stimulating hormone in those people with thyroid nodule and diffuse goiter. Methods: the universe of study was an 18 years-old and over population of both sexes from 3 randomly selected physician's offices located in the urban area of Jatibonico (n= 6 126 people). The estimated sample for 95 % confidence interval was 337 persons and a total number of 405 individuals were surveyed. All of them were performed thyroid computer tomography. The thyroid-stimulating hormone was detected in 277 people. They were then classified into subjects having and not having the disease, and at the same time, there was sub-classification into thyroid nodule disease and diffuse goiter. Results: the prevalence of thyroid disease in the studied population was 41.97 percent (CI- 95 percent: 37.17-46.77 percent). The sub-classification yielded the presence of thyroid nodule disease in 36.79 percent of subjects (CI- 95 percent: 32.09-41.48 percent) and of diffuse goiter in 5.18 percent (CI- 95 percent: 3.02-7.33 percent), respectively. The majority of patients suffering from this disease was asymptomatic (85.3 percent) and distributed into all the age groups, with slight predominance of females. The high (32.85 percent) and the subnormal (7.58 percent) thyroid-stimulating hormones were detected in the studied patients. Conclusions: in the study population, the prevalence of the thyroid nodule disease was higher than that of the diffuse goiter(AU)

Integrative CHinese-western medicine treatment for toxic diffuse goiter complicated with diabetes mellitus:an abservation for clinical efficacy / 中国生化药物杂志

Objective To investigate the clinical efifcacy of Chinese and western medicine on toxic diffuse goiter (Graves disease) diabetes mellitus. Methods 50 cases of Graves' disease and diabetes mellitus collected in Xianhe hospitol of Dongying city,Shandong Province from June 2010 to June 2011 were randomly divided into observation group(n=25) and control group(n=25). Control group was adopted conventional western medicine treatment. Based on western medicine treatment, observation group was, conducted dialectical types according to TCM theory, and used appropriate Chinese medicine to treatment. Efficacy of two groups after 8 weeks treatment were evaluated. Results The total effective rate in observation group was 90%, higher than 80% in control group(P<0.05). Compared with before treatment, insulin resistance index (HOMA-IR), TT 3, TT 4 levels were signiifcantly decreased, and TSH was signiifcantly increased in both two groups(P<0.01). The improvement of TT 3, TT 4, TSH in treatment group were more obvious than control group, and the difference was signiifcant (P<0.01). Conclusion The combination therapy was effective on patients with Graves' disease and diabetes.

Eficacia de la apiterapia en pacientes con bocio tóxico difuso descompensado moderado / Effectiveness of the bee therapy in patients with moderate descompensated toxic diffuse goiter

Se realizó un estudio de intervención terapéutica en 44 pacientes con bocio tóxico difuso descompensado moderado, atendidos en la Consulta de Endocrinología del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde marzo del 2008 hasta igual mes del 2010, quienes fueron seleccionados aleatoriamente y luego asignados en 2 grupos de idéntica cantidad de integrantes: el de control, que consumió medicación convencional, y el de estudio, que recibió apiterapia; a fin de determinar la eficacia de la miel de abejas como tratamiento adyuvante. La información fue analizada y procesada mediante las pruebas de hipótesis de Mann Whitney y de comparación de medias, con un error de 5 %, y se obtuvo que la apiterapia resultara más efectiva que la aplicación de los fármacos habituales en la rehabilitación de los afectados, por lo que se sugirió la generalización de su uso a otros servicios de salud.

A study of therapeutic intervention was carried out in 44 patients with moderate descompensated toxic diffuse goiter, assisted in the Endocrinology Department of "Saturnino Lora Torres" Provincial Teaching Clinical-Surgical Hospital in Santiago de Cuba from March, 2008 to same month of 2010, who were randomly selected and then divided into 2 groups of identical number of cases: the control group with conventional medication, and the study group that received bee therapy; in order to determine the effectiveness of honey as auxiliary treatment. The information was analyzed and processed by means of the hypothesis tests of Mann Whitney and that of means comparison, with an error of 5%, and it was obtained that bee therapy was more effective than the application of the habitual drugs in the rehabilitation of those affected, so that the generalization of its use was suggested to other health services.

Características clínicas, perfil hormonal y marcadores de autoinmunidad de pacientes con enfermedad de Graves / Clinical characteristics, thyroid function profile and autoimmune markers in patients with Graves' disease

Objetivo: Describir las características clínicas, el perfil hormonal y los marcadores de autoinmunidad de pacientes con enfermedad de Graves (EG), atendidos en el servicio de endocrinología de un hospital general. Material y métodos: Estudio descriptivo, retrospectivo de pacientes con diagnóstico de EG atendidos en el servicio de endocrinología del HospitalNacional Cayetano Heredia durante el año 2005. Los pacientes fueron identificados utilizando el Registro Diario de Atención y Otras Actividades del consultorio externo. Para el análisis estadístico se utilizó el programa SPSS versión 12,0. Resultados: Se revisaron 111 historias clínicas. La edad promedio fue de 40,6 ± 14 años. El 71,2% eran mujeres. El 20,7% tenía antecedentefamiliar de otra enfermedad autoinmune. El tiempo de enfermedad promedio antes de la consulta fue 18,9 ± 30,4 meses. Los síntomas más frecuentes fueron: tremor, piel delgada, palpitaciones y baja de peso. El peso promedio de la glándula tiroides estimado por palpación fue 69 ± 27,5 gr, 38,7% presentaba exoftalmos y 18,9% mixedema pretibial. El perfil hormonal mostró TSH suprimida, T4 libre y T3 total elevados. El 86,7% de los casos tenía autoanticuerpos anti-peroxidasa tiroidea (anti-TPO) positivo. En 95,5% el tratamiento incluyó el uso de tionamidas. El análisis bivariado mostró que las mujeres tuvieron antecedente familiar de enfermedad tiroidea autoinmune en mayor frecuencia que los varones (27,8 vs. 9,4%) (p=0,04). Conclusión: La población estudiada con EG fueron con mayor frecuencia mujeres entre la tercera y sexta década de la vida.El peso estimado de la glándula tiroides fue tres veces lo normal, con alta frecuencia de oftalmopatía y mixedema. La mayoría tiene marcadores humorales de autoinmunidad y el tratamiento inicial se basa en el uso de tionamidas.

Objective: To describe the clinical characteristics, thyroid function profile and autoimmune markers in patients with Graves’ disease (GD) treated at the endocrine service of a general hospital. Material and methods: Descriptive and retrospective study in patients with GD treated at the Hospital Nacional Cayetano Heredia during 2005, identified in the Daily Registry of Attention and Other Activities of the Endocrine Service. For statistical analysis, SPSS software was used. Results: We reviewed 111 medical charts. The mean age was 40.6 ± 14 years. 71.2% were women. Twenty three patients (20.7%) reported familial history of autoinmune disease. The mean time of disease was 18.9 ± 30.4 months before diagnosis. The most frequent symptoms were: tremor, thin skin, palpitations and weight loss. The mean thyroid weight was 69 ± 27.5 grams. In 38.7% exophthalmos was present and 18.9% had myxedema. Hormonal profile showed suppressed TSH, elevated levels of free T4 and total T3. In 86.7% autoantibodies against thyroid peroxidase (anti-TPO) were positive. The initial treatment included thionamides in 95.5% of patients. Further statistical analysis showed that women had more frequent familiar history of autoinmune thyroid disease than men (27.8% vs. 9.4%) (p = 0.04). Conclusions: Most of our patients with GD were women between third and sixth decade of life. The estimated weight of the thyroid gland was three times the normal weight and ophthalmopathy and myxedema were frequent. Most of our patients had positive autoimmune markers and theinitial treatment included thionamides.

[Efficiency of iodine prophylaxis in pregnant women with nontoxic diffuse goiter in a mild iodine-deficiency area].

Thirty-four pregnant women with nontoxic diffuse goiter (NDG), living in a mild iodine-deficiency area, were examined. The absence of iodine prophylaxis causes a higher than normal increase in thyroid-stimulating hormone levels by the end of pregnancy and a high frequency (87.5%) of hypothyroxinemia In the second half of pregnancy. These unfavorable events are prevented by the administration of iodine in a daily dose of 150-200 g; the early initiation of iodine prophylaxis is most effective. In women with NDG, pregnancy is most commonly complicated as threatening miscarriage, particularly in those who have not received iodine prophylaxis. Smoking during pregnancy enlarges the thyroid, which is not prevented by iodine prophylaxis.

A Case of Anterior Cervical Lipoma Mimicking Diffuse Goiter / 대한내분비학회지

Lipoma is a benign fatty tumor that can arise in any location of the body where fat is present. It is found most commonly in the upper half of the body, particularly the head and neck, shoulders, and back. A mass in the antero-inferior part of the neck may be initially thought to be thyroid masses and then other cervical masses should be considered. Ultrasongraphic examination of benign lipoma demonstrates solid and echogenic mass and may differentiate nonthyroid from thyroid masses. Although the location of tumors, its consistency, and its motion with deglutition, seperation from the thyroid on sonographic examination, all pointed to nonthyroidal origin, did not rule out a possible mass that isolated from the lobes of the thyroid. Fine needle aspiration and biopsy can provide clear answer.We herein report a case of anterior cervical mass in a 48-yr-old male patient presenting a non-tender, slightly hard and nodular mass slowly growing for several years and moved with swallowing, and diagnosed his case as benign lipoma using thyroid scan and ultrasonography. When we encounter patients with anterior neck mass, we should consider benign lipoma mimicking diffuse goiter.