Benign Goiter Research Articles

Incidental Papillary Microcarcinoma and Papillary Thyroid Carcinoma in Multinodular Goiter.

This study aimed to examine the incidence of incidental papillary microcarcinoma (PMC) and papillary thyroid carcinoma (PTC) in patients with benign multinodular goiter (MNG) and to compare their relationship with some prognostic factors from a new perspective. Bilateral total thyroidectomy (BTT) was used to evaluate the data of 716 patients who underwent a surgery for MNG. The prognostic data for these tumors and the relationship between patients with bilateral and multifocal tumors were evaluated using statistical tests. Papillary carcinomas were detected in 201 patients, PMC in 134 of them, and PTCs in 67. Bilaterality was more common in patients with PTCs than in those with PMC. The incidence of bilaterality in male patients with PTC was statistically more common. The presence of intra-tumoral lymphocytes was higher in multifocal PTC cases than in unifocal PTC cases. The results revealed that the number of PMC s was high in incidental tumors, and patients with PTC with male sex, bilaterality, multifocality, and tumor capsule invasion were associated with poor prognosis.

Whole-exome sequencing and bioinformatic analyses revealed differences in gene mutation profiles in papillary thyroid cancer patients with and without benign thyroid goitre background.

Papillary thyroid cancer (PTC) is the most common thyroid malignancy. Concurrent presence of cytomorphological benign thyroid goitre (BTG) and PTC lesion is often detected. Aberrant protein profiles were previously reported in patients with and without BTG cytomorphological background. This study aimed to evaluate gene mutation profiles to further understand the molecular mechanism underlying BTG, PTC without BTG background and PTC with BTG background. Patients were grouped according to the histopathological examination results: (i) BTG patients (n = 9), (ii) PTC patients without BTG background (PTCa, n = 8), and (iii) PTC patients with BTG background (PTCb, n = 5). Whole-exome sequencing (WES) was performed on genomic DNA extracted from thyroid tissue specimens. Nonsynonymous and splice-site variants with MAF of ≤ 1% in the 1000 Genomes Project were subjected to principal component analysis (PCA). PTC-specific SNVs were filtered against OncoKB and COSMIC while novel SNVs were screened through dbSNP and COSMIC databases. Functional impacts of the SNVs were predicted using PolyPhen-2 and SIFT. Protein-protein interaction (PPI) enrichment of the tumour-related genes was analysed using Metascape and MCODE algorithm. PCA plots showed distinctive SNV profiles among the three groups. OncoKB and COSMIC database screening identified 36 tumour-related genes including BRCA2 and FANCD2 in all groups. BRAF and 19 additional genes were found only in PTCa and PTCb. "Pathways in cancer", "DNA repair" and "Fanconi anaemia pathway" were among the top networks shared by all groups. However, signalling pathways related to tyrosine kinases were the most significantly enriched in PTCa while "Jak-STAT signalling pathway" and "Notch signalling pathway" were the only significantly enriched in PTCb. Ten SNVs were PTC-specific of which two were novel; DCTN1 c.2786C>G (p.Ala929Gly) and TRRAP c.8735G>C (p.Ser2912Thr). Four out of the ten SNVs were unique to PTCa. Distinctive gene mutation patterns detected in this study corroborated the previous protein profile findings. We hypothesised that the PTCa and PTCb subtypes differed in the underlying molecular mechanisms involving tyrosine kinase, Jak-STAT and Notch signalling pathways. The potential applications of the SNVs in differentiating the benign from the PTC subtypes requires further validation in a larger sample size.

Outcomes of laser-induced thermotherapy for thyroid nodules at the West Vascular Center, Ukraine.

Thyroid nodules are common, occurring in 50-60% of healthy patients. Currently, there are no effective conservative treatment options for nodular goiter, and surgery can have limitations and potential complications. The purpose of this study was to evaluate the efficacy, tolerability, and long-term results of using sclerotherapy and laser-induced interstitial thermotherapy (LITT) to treat benign thyroid nodules. A retrospective analysis was conducted on 456 patients with benign nodular goiter who received LITT. The volume of the nodular goiter was measured at 1, 3, 6, and 12 months post-treatment, and a repeated fine needle aspiration (FNA) with the cytological examination was performed to verify the structure of the nodular goiter in the long term. The results showed that LITT was an effective method for treating nodular mass (nodules), as evidenced by a decrease in the volume of NG by 51-85% after 6-12 months. FNA results 2-3 years after LITT showed no thyrocytes, only connective tissue, indicating the efficacy of LITT for benign thyroid nodules. LITT is highly effective in most cases, often resulting in the disappearance or significant decrease in nodular formations.

Indiscriminate Nodule Sampling in Goitre: A Series of 5 Cases of Thyroid Microcarcinoma

Papillary Thyroid Carcinoma (PTC), which is a form of thyroid cancer, originates from follicular epithelial cells and can be identified histopathologically by distinct nuclear characteristics and architecture. It is the most common thyroid neoplasm and is typically found in young females, with a good prognosis. Within the subset of PTC, exists incidentally detected lesions called papillary microcarcinomas (IPMC), having a size ≤1 cm which are usually clinically not suspected, radiologically undetected, and often missed in gross pathological examinations. The present case series highlights five cases (2 males and 3 females) of papillary microcarcinomas that were detected over the course of one year. The patients’ ages ranged from 31 to 60 years, with a mean age of 48.8±10.1 years. The male-to-female ratio was 1:1.5. These patients presented with complaints of neck swelling and were initially diagnosed with benign nodular goitre in 47 cases based on clinical and radiological evaluations. The detection rate of papillary microcarcinomas was 10.6%, with one case showing bilaterality (20%). The authors of the present case series adopted a novel approach of indiscriminate nodule sampling of thyroidectomy specimens to observe changes in detection rates. This approach facilitated a higher yield of papillary microcarcinomas. The authors also considered the dilemma of surgical measures and prognostic outcomes in such cases.

Benign goiters requiring thyroidectomy as the signal for PTEN hamartoma tumor syndrome diagnosis.

PTEN hamartoma tumor syndrome (PHTS) is a rare genetic cancer and tumor predisposition syndrome. Due to the wide spectrum of clinical manifestations and variable age at onset, the pathways leading to a PHTS diagnosis are difficult and highly variable. Many patients were found to have PHTS after a cancer diagnosis, missing the opportunity of prevention or enhanced cancer screening. This retrospective study evaluated a PHTS cohort followed in a high-risk surveillance clinic in a comprehensive cancer institution. A significant portion of the patients (60.9%, 14/23) had at least one cancer diagnosis (average age 34.6 years at diagnosis). A significant portion (78.3%, 18/23) were affected with clinically significant goiters (age 27.9 years), and many (60.9%, 14/23) had partial or total thyroidectomy (age 27.1 years). The average age at goiter diagnosis or thyroidectomy is younger than a cancer diagnosis. In 12 individuals who were affected with clinically significant goiter and cancer, all cancers were diagnosed after the thyroid disease (6.3 years). As clinically significant thyroid nodules in childhood or early young adulthood are common in PHTS, but uncommon for general population, these early onset thyroid nodules may alert the clinician to initiate PHTS-targeted evaluation and genetic testing.

Association of Fine-Needle Aspiration of Thyroid Nodules With Final Histopathology in Diagnosing Thyroid Malignancy: A Single Institute Retrospective Study.

Background Fine needle aspiration cytology (FNAC)is the gold standard for detecting thyroid nodules. It is a cost-efficient approach that affords prompt and accurate evaluation. It is crucial in deciding to treat patients with suspected malignancy of thyroid nodules that might have thyroid surgery. According to findings in cytology, patients may be observed when the cytology is benign, and surgery can be performed if the cytology is malignant, which leads to a reduction in the incidence of unneeded surgery. Aim The current study aims to assess the concordance between FNAC of thyroid nodules with final histopathology and identify the different types of detected thyroid lesions. Methodology A retrospective record-based study reviewed the medical files of all patients presenting to the Armed Forces Hospital, Southern region, with suspected thyroid nodules from April 2018 to January 2020. Data were extracted using pre-structured data extraction sheet to avoid inconsistency. Data extracted included patients' demographic data, swelling laterality, size, ultrasound, and histopathological findings. Results The baseline characteristics of studied samplesin the present study:Forty-seven samples had a mean age of 44.27 (SD=±13.5) years, and 85.1% were female gender. The study showed that 12.5% of benign samples were lymphocytic in histopathology, 25% suspicious for follicular neoplasm samples were benign multi-nodular goiter in histopathology, and all 100% of samples suspicious for malignancy were malignant in final histopathology. Conclusions The current study showed that the malignancy rate of the examined nodules was not uncommon in FNAC and histopathology. Where papillary carcinoma was the most detected malignancy, the diagnosis of malignancy using FNAC is a cost-efficient approach that affords prompt and accurate evaluation. Once diagnosed, these cases should be subjected to surgery.

Association of Ultrasonography With Final Histopathology in Diagnosing Thyroid Malignancy: A Single-Institute Retrospective Study.

Background Thyroid nodules are well-defined regions of aberrant echogenicity within the thyroid parenchyma that are radiologically distinct from the normal thyroid gland. The most common incidental finding in imaging scans that include the neck is a thyroid nodule. Rarely are thyroid nodules cancerous, as the majority are benign. Aim The current study aims to assess the concordance between ultrasound (US) of thyroid nodules and final histopathology results to identify the different types of detected thyroid lesions. Methodology A retrospective study reviewed the medical files of all patients presenting to the Armed Forces Hospital, Southern Region, with suspected thyroid nodules from April 2018 to January 2020. Data were extracted using pre-structured proforma to avoid inconsistency. Data extracted included patient demographic, swelling laterality, size, and US and histopathological findings. Results In the present study, 47 samples had a mean age of 44.27 (SD = ±13.5) years, 85.1% were of the female gender, the majority (85.1%) had multiple nodules, 38.3% were with Thyroid Imaging Reporting and Data System (TI-RADS) TR4 US score, and the median size of the nodule on US was 3 cm with a range of 0.6 to 14 cm. The study showed that 10% of TR1 samples were lymphocytic in histopathology, 66.7% of TR3 samples were benign multinodular goiter in histopathology, and 55.6% of samples of TR4 were malignant in histopathology. Conclusions The current study showed that the malignancy rate of the examined nodules was not uncommon both by US and histopathology, where papillary carcinoma was the most detected malignancy. The study showed a satisfactory agreement rate between TI-RADS classification by US sonography and histopathological reporting, where TR4 and TR5 by the US were mainly categorized as pre-malignant/malignant lesions by histopathology.

ODP470 Compressive Goiter with COVID-19: An Unusual Etiology of Respiratory Distress Requiring Endotracheal Intubation with Surgical Resection

Abstract Introduction Gradual enlargement of multinodular goiter (MNG) may compress surrounding structures which may progressively cause complications of tracheal stenosis and airway compromise. Surgical resection remains the gold standard treatment in MNG patients presenting with respiratory distress. In the current global COVID -19 pandemic, compressive goiter should be a differential diagnosis in patients with stable benign thyroid goiter presenting with dyspnea. We present a case of MNG with life threatening airway obstruction during an active COVID-19 infection. Case presentation A 74-year-old female with a history of hyperthyroidism with multi-nodular goiter and recurrent atrial fibrillation status-post ablation, was transferred to the intensive care unit for treatment after being intubated for respiratory distress at a nearby hospital. She was diagnosed with hyperthyroidism about 40 years ago and managed with methimazole. Over the last two years, thyroid ultrasound and prior imaging showed MNG with patent but moderate tracheal narrowing; fine-needle aspiration (FNA) confirmed benign colloid nodules with cystic degeneration. She was pending cardiac clearance for surgery when symptoms acutely worsened two days before admission. On initial assessment, she was hemodynamically stable, afebrile, with oxygen saturation of 86% on room air. She was alert and able to follow commands. On physical examination, she had stridor and thyromegaly was evident with mild tenderness on palpation. Cardiopulmonary examination was remarkable for coarse breath sounds. Labs showed TSH 4.82 (Normal 0.3 - 4.5 ulU/mL), FT4 0.64 (Normal 0.5- 1.26 ng/dL). Respiratory panel test came back positive for SARS-CoV-2. Racemic epinephrine and albuterol nebulizers were administered to help with her symptoms. CT scan of the neck revealed a severe narrowing and mild rightward shift of the trachea by a large multinodular goiter, prompting the decision to intubate for airway protection. CT scan of the chest with contrast demonstrated the large MNG with tracheal stenosis. Her methimazole dose was adjusted. After cardiac clearance, she underwent thyroidectomy through a transcervical approach. Levothyroxine and calcium supplementation were started post-surgery. She was extubated two days after her thyroidectomy. Pathology results showed no evidence of malignancy. Discussion Acute airway obstruction by large MNG requiring emergent airway protection is rare. Typically airway compromise from large otherwise stable benign goiters results from sudden hemorrhage into a cyst, upper respiratory tract infection leading to tracheal edema, or worseningcomorbid conditions. During the COVID-19 pandemic, acute respiratory failure and shortness of breath is typical of worsening disease course. This case highlights the importance of maintaining wider differentials of respiratory failure even and we need to consider worsening of tracheal narrowing with a large goiter due to tracheal edema from SARS- CoV-2 Infection. Thyroidectomy before SARS-CoV-2 infection may have reduced her need for emergent intubation for acute respiratory failure by improving pre existing airway compression. Presentation: No date and time listed

良性の甲状腺腫瘍による気道狭窄で緊急気道確保を要した2症例(Acute airway obstruction due to a benign goiter in the cervical region: a report of two cases)

要旨 症例1は46歳の女性。来院当日突然の呼吸困難を自覚し救急要請した。救急隊接触時意識レベルがJCS 100であり，救急隊による補助換気を施行されながら当院へ搬送となった。CT検査にてびまん性に腫大する甲状腺が気管を圧排しており救急外来にてフェンタニルのみ使用し気管挿管，翌日甲状腺全摘術を施行し第6病日に軽快退院となった。症例2は88歳の女性。来院当日突然の呼吸困難を自覚し救急要請した。来院時嗄声とstridorが見られ，上気道狭窄を疑いフェンタニルのみ使用し気管挿管を行った。CT検査にて甲状腺左葉の嚢胞性病変内の出血が穿破し，前頸部血腫により気管が右に圧排されていた。甲状腺部分切除術を施行し第6病日に軽快退院となった。両症例ともに術後の病理診断は腺腫様甲状腺腫であった。良性腫瘍でも致死的な経過をたどる可能性があることを念頭に置き，診療にあたることが重要である。また，本症例のように頸部に巨大な甲状腺腫瘍が存在する場合には解剖学的に外科的気道確保の実施が困難であることが予想される。挿管困難となった場合に備えて，意識下気管挿管を試みるとともにECMOスタンバイ下での気道確保を考慮することが重要である。

Thyroglobulin is a poor predictor of differentiated thyroid cancer in patients who undergo surgery for thyroid nodular diseases.

Thyroglobulin, produced exclusively by thyroid follicular cells, serves as a specific tumor marker for the follow-up of differentiated thyroid cancer (DTC) patients after thyroidectomy. However, its role as a predictor of malignancy in patients with thyroid nodules is controversial. We assessed the potential role of preoperative serum thyroglobulin concentration to predict DTC in patients without a preoperative diagnosis of malignancy who underwent partial or total thyroidectomy. This retrospective study included patients with a preoperative diagnosis of benign multinodular goiter (MNG) or a thyroid nodule with indeterminate cytology (INC) (Bethesda system categories III/IV) who underwent partial or total thyroidectomy between January 2014 and May 2019. We compared the patients' demographic, clinical, imaging, and biochemical data according to their final diagnosis: DTC or benign thyroid nodular disease. Further statistical analysis included odds ratio calculation and receiver operating characteristic (ROC) curve analysis. Of 131 patients who met inclusion and exclusion criteria, the indication for surgery was benign MNG in 69 patients and a thyroid nodule with INC in 62 patients. A final diagnosis of DTC was reported in 18 of the 69 benign MNG patients (26%) and in 30 of the 62 thyroid nodule with INC patients (48%). The preoperative measurements of nodule diameter and serum thyroid-stimulating hormone and thyroglobulin concentrations did not significantly differ between patients with a final diagnosis of DTC and those with benign histology. Preoperative serum thyroglobulin alone is insufficient to differentiate between malignant and benign thyroid nodular disease.

TH8.8 Retrospective study on the safety of thyroid surgery with confirmed benign histology in a UK district general hospital

Abstract Aim With increasingly aging population, more thyroidectomies are being performed in the elderly. These surgeries may be suspected to be unsafe as majority of the geriatric population suffer from comorbidities. Our local study explored the safety of thyroid surgery with confirmed benign histology in the elderly, with the post-operative complication rates being the primary outcome measures. Methods The study group included patients over 75 years who had thyroid surgeries with confirmed benign histology in a UK district general hospital from January 2010 to January 2022. We then analysed the rates of complications including temporary hypocalcemia, permanent hypocalcemia, vocal cord palsy and haematoma. Results 41 elderly patients underwent thyroid surgery with confirmed benign histology in our facility within the period. 78% of them had thyroid lobectomy and the commonest indication for surgery was benign multinodular goitre. There were no haematomas, no permanent vocal cord palsies and no cases of permanent hypocalcemia. Only 3(7.3%) patients had transient hypocalcemia, and 2(4.9%) had vocal cord palsy which all resolved before 6 months. Conclusions Our study has demonstrated that it is generally safe to perform thyroidectomy in the elderly population with low hypocalcemia and vocal cord palsy rates as compared to the British Association of Endocrine and Thyroid Surgeons’ report of 10.2% and 7.8% for hypocalcemia and early cord palsy rates respectively in all age-groups. Nevertheless, we would advocate appropriate patient selection in terms of ASA classification. For example, 50% of those who had post-operative vocal cord palsy in our study had an ASA of 3.

Proteomic profiling of thyroid tissue in patients with obesity and benign diffuse goiter.

Goiter is a term to describe the enlargement of the thyroid gland. The pathophysiology and molecular changes behind development of diffuse benign goiter remains unclear. The present study targeted to identify and describe the alterations in the thyroid tissue proteome from patients (obese euthyroid) with benign diffuse goiter (BDG) using proteomics approach. Thyroid tissue samples, from 7 age and sex matched, patients with BDG and 7 controls were obtained at the time of surgery. An untargeted proteomic analysis of the thyroid tissue was performed out utilizing two-dimensional difference (2D-DIGE) in gel electrophoresis followed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) for identification of the proteins. Progenesis software was used to identify changes in expression of tissue proteins and found statistically significant differences in abundance in a total of 90 proteins, 46 up and 44 down (1.5-fold change, ANOVA, p ≤ 0.05) in BDG compared to the control group. Bioinformatic analysis using Ingenuity Pathway Analysis (IPA) identified dysregulation of signalling pathways linked to ERK1/2, Glutathione peroxidase and NADPH oxidase associated to organismal injury and abnormalities, endocrine system disorders and cancer. The thyroid tissue proteome in patients with BDG revealed a significant decrease in thyroglobulin along with dysregulation of glycolysis and an increase in prooxidant peroxidase enzymes. Dysregulation of metabolic pathways related to glycolysis, redox proteins, and the proteins associated with maintaining the cytoskeletal structure of the thyrocytes was also identified.

The correlation between iodine nutrition and autoimmunity among hyperthyroid goiter patients in tertiary care hospital of Tamil Nadu

Background: Iodine is a trace element that is essential for the formation of thyroid hormones. It is essential for the human life’s growth and development. The thyroid gland size and functions affected by deficient or excessive intake of iodine. Iodine excess intake was found to associating with iodine-induced hyperthyroidism (IIH) and autoimmune thyroiditis. Aims and Objectives: The present study was to find the hyperthyroid goiter patient nutritional status by urinary iodine excretion (UIE) measurement and correlate them with thyroid hormone and thyroid autoantibodies. Materials and Methods: In this study, 100 adult hyperthyroid goiter ssubjects and 100 apparently normal adult subjects were conveniently recruited in this study.Urinary iodine estimation and serum TSH, fT4, fT3, AMA, and ATG were estimated,which were estimated for case and control groups. Results: The hyperthyroid goiter patient mean UIE concentration was 278.98 μg/L and 68% of excess UIE which was found. There was significant difference in the UIE between the hyperthyroid goiter patient and control (P<0.001). The following types of goiter, based on palpation, were identified among the 100 hyperthyroid patients: Grade I – 4 %, Grade II – 63%, and Grade III – 33%. There were elevated serum AMA levelswith positive correlation of excess iodine for hyperthyroid goiter patient. Conclusion: In this study, there were excess UIEs among patients; hence, these associated complications, namely, benign goiter (14%), thyroiditis (43%), cancer of thyroid (4%), and thyrotoxicosis (39%) were observed.

The Thyroid Gland's Glycosylation: Aspect of Glycoprotein Function in Thyrocyte Physiology and Thyroid Disorders

Objective: The focus of this study is on the role of glycoproteins in normal thyrocyte activity and pathologies of the thyroid. Study Design: Observational study Place and Duration: The study was carried at Pak International Medical College and Hospital from November 2021 to January 2022 Methods: There were 38 patients of both genders were presented in this study. Detailed demographics of enrolled cases included age, sex and body mass index were recorded after taking informed written consent. 19 patients had benign diffuse goiter in were included in group I and 19 (controls) patients were include in group II. Using a nonspecific proteomic strategy, such as this double difference (2D-DIGE) electrophoresis and lattice laser desorption/ionization time-of-flight masses spectrometry, we were able to determine which proteins were present in thyroid tissue (MALDI-TOF-MS). Results: Among the 92 proteins significantly different between BDG and the control group, 47 were found to be elevated and 45 were found to be lowered (1.5-fold change, ANOVA, p 0.05). Bioinformatics analysis of Ingenuity Pathway Analysis has connected the dysregulation of ERK1/2, Glutathione peroxidase, and NADPH oxidase signaling pathways to tissue damage, endocrine system dysfunction, and cancer (IPA). Conclusion: Low levels of thyroglobulin, dysregulated glycolysis, and an uptick in pro-oxidant peroxidase enzymes were found in the thyroid tissue proteome of patients with BDG. There was also a finding of dysregulation in the thyrocyte cytoskeletal proteins, redox proteins, and glycolytic pathways. Keywords: Thyroid Gland's, Benign Diffuse Goiter, Proteins, Glycosylation

The Impact of Post-Thyroidectomy Neck Stretching Exercises on Neck Discomfort, Pressure Symptoms, Voice and Quality of Life: A Randomized Controlled Trial.

BackgroundFollowing surgery for benign nodular goiter, patients may experience neck and shoulder pain, neck pressure and tightness, choking sensation, altered voice function, and dysphagia leading to decreased short-term quality of life (QoL). This single-blinded randomized controlled trial investigated the effect of post-thyroidectomy rehabilitative neck stretching and movement exercises on these variables including QoL.MethodsPatients undergoing thyroid lobectomy or total thyroidectomy were randomized to perform neck stretching and movement exercises three times daily in four weeks following surgery (intervention group) or conventional follow-up without exercises (control group). Outcome measures were scores in the following questionnaires: Disease-specific Thyroid-Related Patient-Reported Outcome (ThyPRO-39) involving symptoms of “sense of fullness in the neck,” “pressure in the throat,” and “discomfort swallowing” combined in the multi-item Goiter Symptom Scale, the Voice Handicap-Index-10 (VHI-10), neck and shoulder pain measurement by a numeric rating scale (NRS), and General measure of health (EQ-5D-5L). All scores were assessed prior to surgery and one, two, four weeks, and three months after surgery. Data were analyzed using a linear mixed model.ResultsEighty-nine patients were included and randomized to the control (n = 45) or the intervention group (n = 44). At three months after surgery, both the control and the intervention group experienced large to moderate improvements in the Goiter symptom and Hyperthyroid symptom scale of the ThyPRO questionnaire (p < 0.004). No significant between-group differences were found in any of the other applied scales.ConclusionsThis study confirms that patients experience profound improvements in QoL after surgery for benign nodular goiter. However, early post-thyroidectomy neck stretching and movement exercises did not result in further QoL improvement, reduction in pain or less impacted subjective voice function for patients primarily undergoing thyroid lobectomy.Trial Registration Number NCT04645056 (https://clinicaltrials.gov)

Thyroid Cancer Screening Using Tumor-Associated DN T Cells as Immunogenomic Markers.

BackgroundThyroid nodules are an extremely common entity, and surgery is considered the ultimate diagnostic strategy in those with unclear malignant potential. Unfortunately, strategies aiming to predict the risk of malignancy have inadequate specificity. Our group recently found that the microenvironment of thyroid cancer is characterized by an enhanced immune invasion and activated immune response mediated by double-negative T lymphocytes (DN T) (CD3+CD4-CD8-), which are believed to enable or promote tumorigenesis. In the present work, we try to use the DN T cells’ proportion in thyroid fine-needle aspiration (FNA) material as a predictor of the risk of malignancy.MethodsWe recruited 127 patients and obtained ultrasound-guided FNA samples from subjects with cytology-positive or suspicious for malignancy and from those with benign nodular goiter associated with compressive symptoms (such as dysphagia, shortness of breath, or hoarseness), Hashimoto thyroiditis, and Graves’ disease. Out of 127, we investigated 46 FNA samples of patients who underwent total thyroidectomy and for which postoperative histological diagnosis by the academic pathologists was available. We specifically measured the number of cells expressing CD3+CD4-CD8- (DN T) as a function of total CD3+ cells in FNA samples using flow cytometry. We correlated their FNA DN T-cell proportions with the pathological findings.ResultsThe DN T cells were significantly more abundant in lymphocytic infiltrates of thyroid cancer cases compared to benign nodule controls (p < 0.0001). When the DN T-cell population exceeded a threshold of 9.14%, of total CD3+ cells, the negative likelihood ratio of being cancer-free was 0.034 (96.6% sensitivity, 95% CI, 0.915–1.000, p < 0.0001). DN T cells at <9.14% were not found in any subject with benign disease (specificity 100%). The high specificity of the test is promising, since it abolishes a false-positive diagnosis and in turn unnecessary surgical procedures.ConclusionThe present study proposes DN T cells’ proportion as a preoperative diagnostic signature for thyroid cancer that with integration of RNA transcriptomics can provide a simplified technology based on the PCR assay for the ease of operation.

Maternal thyroid disease in pregnancy and timing of pubertal development in sons and daughters

To study whether maternal thyroid disease in pregnancy is associated with pubertal timing in sons and daughters. Cohort study. National birth cohort and health registers. A total of 15,763 mothers and children from the Danish National Birth Cohort and its Puberty Cohort. Register-based and self-reported information on maternal thyroid diseases during pregnancy (hyperthyroidism, hypothyroidism, benign goiter, or no thyroid disease [reference group]). The adjusted mean age difference (months) at attaining several self-reported pubertal milestones collected every 6 months using an interval-censored regression and the average difference in age at attaining all pubertal milestones using the Huber-White robust variance estimation (primary outcome). Sons of mothers with hyperthyroidism had earlier pubertal development (average difference, -2.9 [95% confidence interval (CI), -5.0 to -0.7] months) than unexposed sons. Maternal hypothyroidism was not associated with pubertal development in sons (average difference, -1.2 [95% CI, -5.1 to 2.7] months). We observed nonstatistically significant indications of earlier pubertal development in sons of mothers with benign goiter (average difference, -1.9 [95% CI, -4.6 to 0.9] months). Maternal thyroid disease was not associated with pubertal development in daughters (average difference (months), hyperthyroidism, -0.8 [95% CI, -2.8 to 1.2]; hypothyroidism, 0.3 [95% CI, -3.1 to 3.8]; and benign goiter, 0.7 [95% CI, -2.0 to 3.4]). We found indications of earlier pubertal development in sons of mothers with hyperthyroidism. More research is needed to further investigate the observed sex-specific association.

Heavier Weight of Resected Thyroid Specimen Is Associated With Higher Postoperative Morbidity in Benign Goiter.

The impact of heavier weight of resected thyroid specimen on postoperative morbidity after total thyroidectomy for multinodular benign goiter remains unclear. Data from the prospective StuDoQ|Thyroid registry of the German Society of General and Visceral Surgery were analyzed regarding the weight of the resected thyroid specimen and perioperative morbidity (vocal cord palsy, hemorrhage, surgical site infection, and hypocalcemia). To achieve a homogeneous patient population, only patients with total thyroidectomy for multinodular benign goiter were included. A total of 7911 patients from 105 departments underwent total thyroidectomy for benign conditions (January 2017-July 2020). The median resected weight of the thyroid specimen in all patients was 53 g (interquartile range 32-92). In 1732 patients, the specimen weight exceeded 100 g. Intraoperative neuromonitoring was used in 99.5% of patients. Postoperative laryngoscopy revealed vocal cord dysfunction in 480 of 15 822 (3.03%) nerves at risk, with unilateral dysfunction in 454 (2.87%) of patients and bilateral dysfunction in 13 patients (0.08%). In multivariable analysis, a thyroid weight >100 g was an independent predictor of early postoperative vocal cord dysfunction [odds ratio (OR) 1.462, 95% CI 1.108-1.930, P = 0.007). Heavier (>100 g) thyroid weight was an independent predictor of surgical site infection (OR 1.861, 95% CI 1.203-2.880, P = 0.005) and also predicted postoperative hemorrhage in the univariate analysis (OR 1.723, 95% CI 1.027-2.889, P = 0.039). On the contrary, postoperative parathyroid function was not affected. Heavier (>100 g) resected thyroid weight independently predicts higher postoperative morbidity, including early vocal cord palsy and surgical site infection after total thyroidectomy for benign multinodular goiter.

Characteristics of thyrotoxicosis among thyroid patients and their quality of life in a teaching hospital in Jordan: A cross-sectional study.

Aim:This study aimed to describe the general characteristics of thyrotoxicosis patients, evaluate their quality of life and adherence to medications as an outpatient at endocrine clinic in Jordan.Method:This was a descriptive cross-sectional study. The eligible participants, who were patients from endocrine outpatient clinics at JUH were recruited. The inclusion criteria limited the study to patients aged 18 years and older who were newly diagnosed with or had a past diagnosis of hyperthyroidism disease for any cause. Data were analyzed using Statistical Package for Social Sciences version 24.0 (SPSS® Inc., Chicago, IL, USA).Result:Most participants were females (81.3%) and married (87.9%). The majority were educated and had a bachelor’s degree or higher (41.8%). The average reading for T3 was 6.80±8.26 pmol/l, T4 16.87±7.98 pmol/l, TSH 3.49±11.51 Mu/L, Anti thyroglobulin 2.37±1.73, and Anti thyroglobulin peroxidase 4.80±1.13. There were no significant findings in assessing the effect of treatment types on lab tests (p-value >0.05). The majority of thyrotoxicosis cases were caused by Graves’ disease (64.7%), followed by 17.60% from benign multinodular goiter, 11.80% thyroiditis and 5.90% toxic adenoma. There was no significant correlation (p>0.05) between the type of treatments and the following health related quality of life (HRQOL) sub-domains: generally unwell, social problem, muscular skeletal problems, eye problem, classical symptoms of hyperthyroidism(CSH) hand tremor, CSH palpitation, decreased appetite and constipation.Conclusion:Thyrotoxicosis is understudied in the Middle East, particularly Jordan. The main findings revealed that thyrotoxicosis is more prominent in females, mainly in their 4th decade. Future work should focus on the main possible methods to improve the HRQOL. In addition, awareness programs are required to encourage patients to obey the advice of their physician and increase their self-care towards improving the quality of their life.

Endoscopic management of retrosternal goitres through cervical approach: a single centre experience

&lt;h1&gt;&lt;strong&gt;Background:&lt;/strong&gt; Retrosternal extension of thyroid poses a significant challenge due to its size and high vascularity. The objective of this study was to assess the outcomes of endoscopic approach via cervical approach for retrosternal thyroid removal.&lt;/h1&gt;&lt;h1&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a hospital based retrospective cross-sectional study, conducted among&lt;strong&gt; 12 patients of goitres with retrosternal extension who fulfilled the inclusion criteria for endoscopic excision via cervical approach from January 2016 to December 2020. The &lt;/strong&gt;data was collected using patient record sheet. STATA 15.0 was used to analyse the data. &lt;strong&gt;Results:&lt;/strong&gt; The median age of the participants was 62 (18.5) years. Approximately 66.7% (N=8) and 33.3% (N=4) of the patient’s respectively presented with the complaint of unilateral and bilateral swelling in the neck. The majority of the patients reported due to cosmetic reasons (58.3%), breathlessness (33.3%), hoarseness and dysphagia (8.3%). Among the patients all were euthyroid. There was no incidence of haemorrhage, tracheal and esophageal injury in the patients intraoperatively. Postoperative histopathology showed benign multinodular goiter (41.7%) and colloid formation (58.3%).&lt;/h1&gt;&lt;h1&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;strong&gt;The traditional thyroidectomy is widely accepted by the surgeons for retrosternal goitres however the results of our study suggest that &lt;/strong&gt;the endoscopic technique is minimally invasive and safe procedure that offers excellent cosmetic satisfaction. With the careful selection of cases and surgeon expertise endoscopic thyroidectomy can yield results similar with the traditional approach however, with less complication rates and morbidity.&lt;/h1&gt;