Benign Nodular Goiter Research Articles

Overexpression of NR1D1 portends disease recurrence in thyroid cancer.

Dysregulation of circadian rhythms has been linked to cancer susceptibility. Thyroid cancer cells demonstrate altered circadian oscillations in endogenous clock transcripts. Our previous research identified NR1D1, a component of the circadian clock, as one of the recurrence-associated genes in papillary thyroid cancer. The objective of this study was to investigate the expression pattern of NR1D1 in thyroid cancer and explore its prognostic and translational implications. We assessed NR1D1 expression using immunohistochemical analysis and examined its correlation with clinicopathological parameters. In vitro and in vivo experiments were performed to elucidate the oncogenic roles of NR1D1 and potential mechanisms. Nuclear NR1D1 expression was present in thyroid follicular epithelial-derived cancers, whereas normal thyroid tissue and benign nodular goiter showed no detectable NR1D1 immunoreactivity. Patients with high expression of NR1D1 had more advanced disease stages, extrathyroidal extension, lymphovascular invasion, and shorter recurrence-free survival compared to those with low levels of NR1D1. Through gain- and loss-of-function studies, we demonstrated that NR1D1 modulation affected the growth of organoids, resistance to anoikis, and the invasive and migratory capacity of thyroid cancer cells. The invasion-promoting effect of NR1D1 was regulated by the β-catenin/ZEB1 axis. Moreover, the overexpression of NR1D1 accelerated xenograft growth and lung metastasis in vivo. NR1D1 is overexpressed in malignant thyroid tumors and has prognostic significance. Our findings suggest therapeutic potential in targeting NR1D1 for thyroid cancer.

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.

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.

Is hemithyroidectomy sufficient in unilateral benign nodular goitre?

Multinodular goiter is a common disease. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to reduce complication and hormone replacement therapy. However, completion thyroidectomy may be required later. The aim of the study was to evaluate the role of completion thyroidectomy in patients who develop nodules after hemithyroidectomy, and we aimed to find the ratio of patients who required hormone replacement for permanent hypothyroidism. Patients who underwent hemithyroidectomy for benign nodular goitre between January 2012 and June 2017 were analyzed. The age of the patients, gender, number of nodules and dimension of the largest nodule, preoperative fine needle aspiration biopsy results, and postoperative histopathology findings were recorded. The need for completion thyroidectomy and need for postoperative L-thyroxine treatment were based on these parameters. A total of 170 patients were included in the study. During the follow-up period new nodule or progression in existing nodule was observed in 23% (39 patients) of the cases. Permanent hypothyroidism requiring L-thyroxine treatment was observed in 31% (53 patients) of the cases. In this study, young age, multiple nodules and toxic nodular goitre diagnosis were noted to be independent risk factors that contributed to progression diseases in cases operated for benign nodular goitre. Due to low reoperation risk and acceptable permanent hypothyroidism rates, hemithyroidectomy is a viable option for benign goitre cases. The patients should be on follow-up for possible complications, especially hypothyroidism, for at least a year.

Value of Contrast-Enhanced Ultrasound in Partially Cystic Papillary Thyroid Carcinomas.

Partially cystic papillary thyroid carcinomas (PCPTCs) are rarely reported papillary thyroid carcinomas (PTCs) and are usually misdiagnosed as benign nodules. The objective of this study was to provide the various sonographic characteristics of partially cystic thyroid nodules for differentiation between malignant and benign nodules, including those for conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Twenty-three PCPTC patients and 37 nodular goiter patients were enrolled in this study. We evaluated the size, cystic percentage, solid echogenicity, calcification, vascularity, and CEUS parameters for each nodule. The final diagnosis of all patients was confirmed via surgery. Univariate analysis demonstrated that compared with benign nodular goiters, PCPTCs more frequently presented with calcification, hypoechogenicity of the solid part, hypoenhancement, heterogeneous enhancement, centrifugal perfusion, peak intensity index <1, time to peak index ≥1, and area under the curve index <1 on preoperative US and CEUS. Binary logistic regression analysis demonstrated that heterogeneous enhancement, centrifugal perfusion, and peak intensity index <1 are independent CEUS characteristics related to malignant PCPTCs and can be used for their differentiation from benign nodular goiters (all p < 0.05). Our study indicated that preoperative CEUS characteristics may serve as a useful tool to distinguish malignant PCPTCs from benign thyroid nodules.

Radiofrequency Ablation a Safe and Effective Treatment for Pediatric Benign Nodular Thyroid Goiter.

Purpose: To evaluate the effectiveness of radiofrequency ablation (RFA) for benign thyroid nodules in pediatric patients.Materials and Methods: Twelve pediatric patients (11 female, 1 male; mean age 15.54 ± 2.8 years, range 10–19 years) with benign thyroid nodules (mean longest diameter 4.1 ± 1.4 cm, range 1.5–5.9 cm) treated by RFA from 2017 to 2020 were evaluated. The inclusion criteria for RFA therapy were (i) age < 20 years; (ii) benign cytological confirmation by 2 separate ultrasound guided fine-needle aspiration cytology (FNAC) or core needle biopsies; (iii) pressure symptoms or cosmetic problems caused by thyroid nodules; (iv) absence of any sonographic suspicious feature; and (v) follow-up for >6 months. Under local anesthesia, RFA was performed with the use of an RF generator and an 18-gauge internally cooled electrode. Volume changes in nodules on follow-up ultrasonography (US), changes in symptomatic and cosmetic scores, and complications arising during or after RFA were evaluated.Results: Mean follow-up period was 24.9 ± 13.9 months (range 6–43 months). At the last follow-up visits, volume of the nodule had decreased significantly (15.34 ± 11.52 mL vs. 4.07 ± 4.99 mL; P < 0.05), whereas volume reduction rate was 74.31% ± 19.59%. Both cosmetic and compressive symptoms were also significantly improved (2.91 ± 0.79 vs. 0.92 ± 0.67 and 1.5 ± 1.93 vs. 0.17 ± 0.39; P < 0.05). The mean number of ablation sessions was 1.4 ± 0.6 (range 1–3 sessions), and one of the patients suffered from transient vocal cord palsy which was spontaneously resolved 53 days later.Conclusions: RFA is a safe and effective treatment for benign thyroid nodules in pediatric patients, and can thus serve as an alternative treatment for thyroidectomy.

Homoeopathic treatment of nodular goitre: A Case report

The normal thyroid gland is a fairly homogenous structure, but nodules often form within its substance. These nodules may be only the growth and fusion of localized colloid-filled follicles, or more or less discrete adenomas, or cysts. Benign nodular goitre is one of the most common endocrine disorders, especially in countries where iodine deficiency is endemic [1]. Management of thyroid nodules depends upon an assessment of thyroid function, fine needle aspiration cytology and imaging. Nodular goitre presents rarely before middle age and maximum found in females than in males [2]. Adenomatous or colloid multinodular goitre (MNG) are common, occurring in three to five percent of the general population, haemorrhage, fibrosis and calcification is found within goiters. Though a few cases records can be seen in past where the success gain by homoeopathic medicines, but proper assessment does not define the case was presented here which is treated by homoeopathic medicine Lycopodium over a period of 6 months with steady improvement.

Non-neoplastic Lesions among Lateral Neck Mass Specimens in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Lateral neck masses present clinically as neoplastic or non-neoplastic lesions of lymph nodes, salivary glands, and thyroid. Non-neoplastic lesions, if evaluated timely, may not transform into malignancy thus reducing clinical burden. A cytomorphological study using fine needle aspiration is a reliable method for the diagnosis of such masses. The aim of this study was to find out the prevalence of non-neoplastic lesions of lateral neck mass specimens received in the Department of Pathology in a tertiary care center. This descriptive cross-sectional study was carried out in the Department of Pathology among lateral neck mass specimens of a tertiary care center from January 2019 to December 2020 after obtaining ethical approval from the Institutional Review Committee (Reference no: 155/19). A convenience sampling method was used and data analysis was done in Microsoft Excel 2019. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 300 lateral neck mass specimens, non-neoplastic lesions were found in 246 (82%) (77.7-86.3 at 95% Confidence Interval). The involvement of lymph nodes in 117 (47.6%) was the most common finding followed by thyroid 112 (45.5%). Among non-neoplastic lesions, the cytomorphological features of benign nodular goiter 93 (37.8%) was the most common lesion followed by reactive lymphoid hyperplasia 73 (29.7%). The study showed that the prevalence of non-neoplastic lesions was similar to that of other national and international studies.

Differences in Surgical Outcome in Near Total Thyroidectomy for Benign Nodular Goiter: A Comparison of LigaSure Vessel Sealer versus Conventional Clamp Knot Tie Technique

Objective: To compare the efficacy of LigaSure Vessel Sealer in Near Total Thyroidectomy versus Conventional Clamp Knot Tie Technique in terms of bleeding, operative time and postoperative drainage.&#x0D; Methodology: This comparative cross sectional study was conducted at Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro. Study duration was one year from November 2019 to October 2020. All patients of any age with benign multinodular goiter and either of gender were included. The study subjects were grouped into two categories by randomization (odd / even). The odd numbers were given to patients operated for ligasure and even numbers were given to patients operated with conventional clamp knot tie technique. Outcomes were observed with respect to post-operative calcium level, intra-operative bleeding, operative time, post-operative pain &amp; post-operative hospital stay. All the data was recorded via study proforma. Data was analyzed by using SPSS version 20.&#x0D; Results: Total 55 patients were observed. Mean age was 33.25±10.60 years in clamp knot tie procedure group and 35.16±07.96 years in ligasure technique group; without significant difference (p-0.448). Pre and post-operative calcium levels were statistically insignificant among both groups (p-0.358 and 0.163), while loss of blood, hospital stay, post-operative pain and operative duration were significantly greater in clamp knot tie technique group in comparison to ligasure technique group (p-&lt;0.001).&#x0D; Conclusion: LigaSure Vessel Sealer is a feasible and reliable surgical technique and significantly more effective as compared to conventional clamp knot tie technique in terms of post-operative bleeding, operative time, post-operative pain and post-operative hospital stay. However, calcium level was statistically insignificant.

Tiroidectomía y paratiroidectomía endoscópica transoral con abordaje vestibular (TOETVA TOEPVA): Experiencia inicial en el Hospital Universitario Austral

Background:Kocher’s cervicotomy has been the classic approach for thyroid and parathyroid surgery. The greater concern about neck scarring has generated an increasing interest in reducing scar size or leaving the scar in less visible places. In 2016 Anuwong published 60 cases of TOETVA/TOEPVA with optimal outcomes.Objectives: The aim of this study is to report the initial experience with transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach in Hospital Universitario Austral.Material and methods: We conducted a retrospective analysis of 18 prospective procedures performed between May 2019 and March 2020. The procedures performed were 2 parathyroidectomies, 13 lobectomies, 4 total thyroidectomies, 1 with central lymph node dissection; one patient presented a parathyroid adenoma and a benign thyroid nodule. Cytology report according to the Bethesda system: category II in 7 cases, VI in 9 and indeterminate in 1.Results: 18 female patients. Median age: 41 years. Mean nodule size: 30 mm. Mean gland volume: 24 mL. Conversion. 1 case. Mean operative time: lobectomy, 260 minutes; total thyroidectomy, 262 minutes. Definite histology: papillary thyroid carcinoma,11; benign nodular goiter, 6; parathyroid adenoma, 2. Complications: mild ecchymosis, 12 patients; temporary hyperparathyroidism, 1 case; temporary recurrent laryngeal palsy, 1 case; temporary numbness of the mental region in 1 case.In the two cases undergoing total thyroidectomy due to cancer, thyroglobulin level 6 weeks after surgery was < 0.1 μIU/mL.Conclusions: 1) The transoral approach is a safe and feasible procedure that offers excellent cosmeticresults. 2) It can be implemented using conventional endoscopic equipment,

Inadvertent Excessive Soy Intake as Part of a Weight Loss Program Leading to Rapid Growth of Multinodular Goiter

Background: Over the past few decades consumption of soy products has gained popularity in the U.S. in part due to reports of potential health and weight loss benefits. However, concerns have emerged regarding soy as a potential endocrine-disrupting chemical (EDC) leading to thyroid dysfunction amongst other health issues. Studies have shown a potential association of high soy intake with risk of hypothyroidism and simple goiter (1), but less is known regarding its impact on multinodular goiter. Clinical Case: A 33-year-old female originally from Bolivia without significant medical history presented to our endocrine clinic with complaints of right-sided neck swelling. The swelling was insidious in onset, had gradually increased in size over the past 3-4 months, and become uncomfortable. She denied dysphagia, cough, or shortness of breath. Prior to the onset of symptoms, she had enrolled in a commercial weight loss program. The diet program consisted of limiting caloric intake to multiple meal replacement bars during the day followed by a light dinner of fish and non-starchy vegetables. Examination revealed a palpable right-sided thyroid mass and enlarged thyroid gland. Lab work showed normal TSH, fT4, and T3 levels, positive anti-thyroid peroxidase antibody (anti-TPO Ab) 588 (<=35.0 IU/ml), and negative thyroid-stimulating immunoglobulins (TSI). Ultrasound of the thyroid confirmed the presence of a 4 cm dominant right thyroid nodule and multinodular goiter. Subsequent fine-needle aspiration of thyroid nodule was consistent with benign nodular goiter. Upon further investigation, it was discovered that the meal replacement bars contained a significant amount of soy protein resulting in an excessive intake of 20-40 grams of soy protein daily. We discussed treatment options, and the patient declined thyroid surgery in favor of surveillance following discontinuation of the weight loss products. The patient was advised to consume a varied diet and given follow-up appointments for monitoring. Conclusion: Inadvertent excessive soy intake via meal replacement bars may have triggered the rapid growth of a multinodular goiter in our patient despite reported adequate dietary iodine intake. Soy products often contain isoflavones that may exert an adverse effect on the thyroid by inhibition of TPO, disruption of iodine metabolism, and/or estrogenic activity. We advise that caution be exercised with high soy protein consumption especially in patients with underlying risk factors for multinodular goiter.

Long Term Follow-Up of Patients with Nontoxic Benign Nodular Goiter Treated with 131Iodine Therapy

Background: With the advancement of diagnostic modalities, there is an increase in the number of individuals detected with thyroid nodules. There are multiple treatment options for the management of nontoxic benign nodular goiter. Radioactive iodine results in effective goiter size reduction which can be administered as out-patient basis and is an appropriate alternative for patients with higher risk for surgery. Our group have shown the effectiveness of 131Iodine therapy for nodular nontoxic goiters. We aim to determine the long-term effectiveness of radioactive iodine therapy among patients with nodular nontoxic goiter. Methods: This is a retrospective cohort study of patients with nontoxic benign nodular goiter, negative for malignancy on biopsy who underwent radioactive therapy with a follow-up of ≥36months using ultrasound studies. Thyroid size, number of nodules and size of nodules pre-treatment and ≥36months post-treatment were compared. Results: 63 patients were included with an average follow-up of 73.14 ± 34.87 months. Mean age during radioactive therapy and last follow-up was 41 ± 14 and 47 ± 14 respectively. Significant thyroid size reduction was noted in 92.06% of patients (right thyroid lobe: 47.54 ± 31.25%, left thyroid lobe 47.44 ± 31.82%) while significant reduction in number and size of nodules were noted in 96.82% and 98.41% of patients respectively. No increase in the number of nodules and no development of new nodules were noted among all patients. Conclusion: Radioactive iodine therapy for nontoxic benign nodular goiter produces a sustained reduction in thyroid size, number and size of nodules even after a long follow-up period. Hence, it is a viable alternative to surgical removal of the thyroid offering a lower risk for complication especially among patients who refuse surgery or has a contraindication to surgical management.

The Ablation of Thyroid Nodule's Afferent Arteries Before Radiofrequency Ablation: Preliminary Data.

Induced radiofrequency thermal ablation is the cytoreductive treatment of symptomatic benign thyroid nodules, metastatic and recurrent thyroid tumors and papillary thyroid microcarcinomas. It is a safe and effective alternative to surgery and it allows to obtain satisfactory results in terms of volumetric reduction of the nodule with significant improvement in the quality of life. The trans-isthmic approach and the moving shot technique are the two basic techniques; however, an advanced technique, artery-first feeding radiofrequency ablation, has been developed and validated. We have prospectively included 29 consecutive patients who have undergone radiofrequency ablation (Group A) or artery- first vRFA (Group B). All included patients had a diagnosis of benign nodular goiter and they underwent a single session of radiofrequency ablation. All patients followed a follow-up program at 1 month, 3 months, and 6 months. Continuous variables (age, TSH value, basal volume of nodule, used Joule, time in second of the procedure, nodules’ volume at 1-, 3-, and 6- months of follow-up and percentage of volume reduction at 1-, 3-, and 6- months of follow-up) were described as mean, standard deviation and range, while categorical variables (gender, nodule structure and nodule vascularization) were described as number of cases and percentage. Independent samples t-test were performed to compare the continuous variables. A Test of Proportions was applied to the categorical variables. The Fisher’s exact test was used to analyze the gender. Statistical significance was considered in case of p-value <0.05. Solid structure and spongiform structure showed statistic differences with p-values of 0.022 and 0.023 respectively between two groups. The percentage of reduction at 1 month did not show a significant difference between two groups; instead, the percentage of volume reduction was decreased mostly in the Group B at 3 months and 6 months of follow-up with a p-value of 0.003 and 0.013, respectively. The Joules/energy used showed a statistically significant difference (p-value=0.05), more energy must be used in vascular radiofrequency ablation. These data allow us to hypothesize that vRFA may improve the effectiveness of the procedure, allowing for a reduction in volume more quickly. They were preliminary but promising results, clearly a larger series of cases and prolonged follow-up are needed to clarify and confirm our observations.

Effects of Metformin on TSH Levels and Benign Nodular Goiter Volume in obese and non-obese diabetic patients

Objectives: To evaluate the impact of metformin (MTF) use on thyroid stimulating hormone (TSH) levels, thyroid volume and volume of benign thyroid nodules (TN) in diabetic patients. Methods: A total of 24 euthyroid diabetic patients with benign-looking NT on cervical ultrasound and benign TN, diagnosed by fine needle aspiration biopsy, were treated by MTF at least for 6 months. The sample was divided into 2 groups with and without obesity. There were 12 patients in each group. Serum TSH, body mass index (BMI) and waist circumference (WC) were evaluated. Ultrasound was used to evaluate TN and thyroid volumes throughout the study. Patients undergoing levothyroxine replacement, and/or using thyroid- or insulin level-influencing drugs apart from MTF were excluded. Results: Serum TSH decreased significantly after MTF (−0.26 vs 0.08 mUI/L in the group without obesity; p = 0.022). At 6 months, no significant variations were found between groups with respect to TN volumes and thyroid volumes. However, a protective effect of MTF on growing TN (OR: 0.28; CI 0.07-1.40) was detected. The reduction on TSH levels with MTF maintained was accentuated in patients with obesity and higher WC (−0.82; p = 0.032). A protective effect of MTF on growing TN was suggested (OR: 0.23; IC: 0.06–0.81) in those with higher WC. Conclusions: This study demonstrated that MTF caused a reduction in TSH levels in benign nodular goiter. This effect was more accentuated in patients with higher levels of WC and was accompanied by a suggested protective effect on TN enlargement.

Impact of the Coronavirus Disease Pandemic on the Annual Thyroid, Parathyroid, and Adrenal Surgery Volume in a Tertiary Referral Endocrine Surgery Center in 2020.

Objective:The purpose of the study was to evaluate the impact of the coronavirus disease (COVID-19) pandemic on endocrine surgical volumes.Methods:There were periodic surgical restriction sin our country in 2020 due to the pandemic. Endocrine surgery volumes at the Division of Endocrine Surgery, Istanbul Medical Faculty were compared between 2019 and 2020.Results:The surgical volume reduction in 2020 compared to 2019 was 20%, 54.5%, and 40% for thyroid, parathyroid, and adrenal surgery, respectively. Surgical volume for thyroidectomy for benign nodular goiter and parathyroidectomy significantly decreased, whereas adrenal surgery showed no significant difference in 2020 compared to 2019. No significant difference was found in the rates of thyroid cancer and adrenocortical cancer surgery in 2020compared to 2019.Conclusion:The COVID-19 outbreak led to a significant reduction in the annual rates of parathyroidectomy and thyroidectomy for benign goiter, whereas the volume of thyroid cancer and adrenal surgeries were similar to the previous year.

Positive Thyroid Peroxidase Antibody and Thyroglobulin Antibody are Associated With Better Clinicopathologic Features of Papillary Thyroid Cancer

ObjectiveTo compare the thyroid autoantibody status of patients with papillary thyroid cancer (PTC) and benign nodular goiter as well as possible associations between thyroid autoantibodies and clinicopathologic features of PTC. MethodsA total of 3934 participants who underwent thyroidectomy were enrolled in this retrospective study. Patients were divided into PTC and benign nodule groups according to pathological diagnosis. Based on the preoperative serum antibody results, PTC patients were divided into thyroid peroxidase antibody (TPOAb)-positive, thyroglobulin antibody (TgAb)-positive, dual TPOAb- and TgAb-positive, or antibody-negative groups. ResultsOf the 3934 enrolled patients, 2926 (74.4%) were diagnosed with PTC. Multivariate regression analyses suggested that high thyroid-stimulating hormone levels (adjusted odds ratio [OR] = 1.732, 95% CI [1.485-2.021], P < .001), positive TgAb (adjusted OR = 1.768, 95% CI [1.436-2.178], P < .001), and positive TPOAb (adjusted OR = 1.452, 95% CI [1.148-1.836], P = .002) were independent risk factors for predicting malignancy of thyroid nodules. Multinomial multiple logistic regression analyses indicated that positive TPOAb alone was an independent predictor of less central lymph node metastasis in PTC patients (adjusted OR = 0.643, 95% CI [0.448-0.923], P = .017), whereas positive TgAb alone was significantly associated with less extrathyroidal extension (adjusted OR = 0.778, 95% CI [0.622-0.974], P = .028). PTC patients with dual-positive TPOAb and TgAb displayed a decreased incidence of extrathyroidal extension (adjusted OR = 0.767, 95% CI [0.623-0.944], P = .012) and central lymph node metastasis (adjusted OR = 0.784, 95% CI [0.624-0.986], P = .037). ConclusionAlthough preoperative positive TPOAb and TgAb are independent predictive markers for PTC, they are also associated with better clinicopathologic features of PTC.

Is hemithyroidectomy sufficient in unilateral benign nodular goitre?

Multinodular goiter is a common disease. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to reduce complication and hormone replacement therapy. However, completion thyroidectomy may be required later. The aim of the study was to evaluate the role of completion thyroidectomy in patients who develop nodules after hemithyroidectomy, and we aimed to find the ratio of patients who required hormone replacement for permanent hypothyroidism. Patients who underwent hemithyroidectomy for benign nodular goitre between January 2012 and June 2017 were analyzed. The age of the patients, gender, number of nodules and dimension of the largest nodule, preoperative fine needle aspiration biopsy results, and postoperative histopathology findings were recorded. The need for completion thyroidectomy and need for postoperative L-thyroxine treatment were based on these parameters. A total of 170 patients were included in the study. During the follow-up period new nodule or progression in existing nodule was observed in 23% (39 patients) of the cases. Permanent hypothyroidism requiring L-thyroxine treatment was observed in 31% (53 patients) of the cases. In this study, young age, multiple nodules and toxic nodular goitre diagnosis were noted to be independent risk factors that contributed to progression diseases in cases operated for benign nodular goitre. Due to low reoperation risk and acceptable permanent hypothyroidism rates, hemithyroidectomy is a viable option for benign goitre cases. The patients should be on follow-up for possible complications, especially hypothyroidism, for at least a year.

An unusual presentation of large colloid goiter – A case report

Benign nodular goiter is a frequently encountered endocrine disorder during routine clinical practice, especially in countries like India where iodine deficiency is endemic. Here, we present the case history of a 55-year- old male who presented with a large thyroid swelling. Investigations revealed it to be colloid goiter. The right hemithyroidectomy under general anesthesia was done. Post-operative period was uneventful. Hence, in this article, we discuss management of thyroid nodules which depend on assessment of thyroid function, fine-needle aspiration cytology, and imaging. For such nodules, surgery is the most common method of treatment.