Family History Of Goiter Research Articles

The Spectrum of Thyroid Nodules at Kinshasa University Hospital, Democratic Republic of Congo: A Cross-Sectional Study.

We analyzed the spectrum of thyroid nodules in patients attending the endocrinology unit care of the Kinshasa University Hospital and assessed their associated factors. We conducted a cross-sectional study, performing descriptive statistics and logistic regression. From the 888 enrolled patients, thyroid nodules were detected in 658 patients (74.1%), as mononodules in 22.5% and multiple nodules in 77.5%. Thyroid function was normal in 71.3% cases, while hyperthyroidism and hypothyroidism were found in 26.1% and 2.6% of cases, respectively. Women were more affected than men (75.1% vs. 63.6%; p = 0.03). Patients with thyroid nodules were older (44 ± 12 vs. 38 ± 12 years; p < 0.001), with a family history of goiter (38.3% vs. 27.4%; p = 0.003) and residence in the iodine-deficient region (51.7% vs. 38.8%; p = 0.012); they had a higher proportion of longer delays to consultation (47% vs. 20%; p < 0.001), but a higher rate of normal thyroid function (85.5% vs. 3 1.3%; p < 0.001). Thyroid nodules were associated with the delay to consultation (for duration ≥ three years, OR: 6.560 [95% CI: 3.525−12.208)], multiparity (present vs. absent: 2.863 [1.475−5.557]) and family history of goiter (present vs. absent: 2.086 [95% CI:1.231−3.534]) in female patients alone. The high frequency of thyroid nodules observed requires measures aimed at early detection in the population, the training of doctors involved in the management and the strengthening of technical platforms in our hospitals.

Thyroid storm induced congestive heart failure

Background: Uncontrolled thyrotoxicosis is known to lead to a state of prolonged tachycardia that may then progress to the onset of reversible congestive heart failure. Case: The patient is a 36-year-old female with a history of Asthma, bilateral ovarian benign cysts, chronic goiter presented due to persistent cough, wheezing, and shortness of breath for about two days duration, echocardiogram had been done for respiratory failure, showing reduced ejection fraction, diastolic dysfunction, and dilated cardiomyopathy. She was subsequently admitted to the MICU for treatment of respiratory failure due to asthma exacerbation. Then began feeling symptoms of anxiety, palpitations, tremulousness, facial flushing. Evaluation of her labs showed elevated T3 at &gt;650, elevated T4 at 22.6, with diminished TSH level at 0.01. The patient was diagnosed with thyroid storm in consideration of lab values with clinical features. TSI was ordered, which returned at 674. Endocrinology was consulted; the patient added a history of tremors for three weeks and weight loss of about 5 pounds over several months, with symptoms of generalized anxiety and dysphagia; she also reported diarrhea in the past weeks. She refers to a family history of goiter in her aunt. The recommendation from an endocrinology perspective was to obtain TSI level and ESR, continue methimazole. The patient was clinically stabilized, discharged on medications for heart failure and methimazole. However, she developed a rash on methimazole, and this was stopped. The patient went for radioactive iodine ablation, and a repeat echo showed an improvement of her ejection fraction. The patient was asymptomatic at a one-year cardiology follow-up, and cardiology medications were discontinued. Conclusion: Hyperthyroidism is a known cause of congestive heart failure secondary to tachycardia-induced cardiomyopathy if untreated. After the proper treatment, this heart failure can be reversed if tachycardia is controlled.

Prevalence of Goiter and Associated Factors among Women of Reproductive Age Group in Demba Gofa Woreda, Gamo Gofa Zone, Southwest Ethiopia: A Community-Based Cross-Sectional Study.

Background Iodine deficiency disorder is a major public health problem in Ethiopia that is more common in women of reproductive age. However, it is not well addressed and there is a lack of information on its prevalence and associated factors in women of reproductive age group. Therefore, the objective of this study was to assess goiter prevalence and associated factors among women of reproductive age in the Demba Gofa woreda, Gamo Gofa Zone, Southwest Ethiopia. Methods A community-based cross-sectional study was used among 584 randomly selected women in the reproductive age group from February 05 to April 20, 2016. A simple random sampling technique was used to select the study kebeles, and a systematic random sampling technique was used to select the study samples. Data were collected through a pretested questionnaire, and the goiter examination was done clinically for each participant. The collected data were coded and entered into a computer for statistical analysis using EpiData version 3.2 and analyzed using SPSS version 20. Variables with a P value ≤0.25 in bivariate logistic regression analysis were entered into multivariate logistic regression analysis, and finally, variables with a P value <0.05 in multivariate logistic regression were considered significantly associated with the dependent variable. Results The total goiter rate was 43%, 95% CI = 39.2–46.9. Cassava consumption (AOR: 2.02, 95% CI: 1.03–4), salt wash before use (AOR: 3.14, 95% CI: 1.1–11.3), salt use after >2 months of purchase (AOR: 11, 95% CI: 5–26), family history of goiter (AOR: 4.6, 95% CI: 1.4–15.8), and poor knowledge of iodized salt (AOR: 2.7, 95% CI: 1.4–5.5) were significant factors associated with goiter. Conclusion Iodine deficiency was found to be severe in women of reproductive age in the study area. This showed that women of reproductive age, especially during pregnancy, are exposed to iodine deficiency and its adverse effects at delivery. Thus, they need urgent supplementation with iodine, improved access to foods rich in iodine, and intake of iodized salt. Additionally, health education should focus on the importance of iodized salt, the proper method of use, and the prevention of iodine deficiency, which are highly recommended to minimize the problem.

Goiter and Its Associated Factors among Adolescent High School Girls at Tach Armachiho District, Northwest Ethiopia: An Institution-Based Cross-Sectional Study.

Introduction In Ethiopia, iodine deficiency disorder (IDD) is a major public health problem. The most visible effect of IDD is the appearance of goiters, and 28 million people are affected by goiter. Therefore, this study aimed to assess the prevalence and associated factors of goiter among high school adolescent girls at Tach Armachiho district, Northwest Ethiopia. Methods An institution-based cross-sectional study was conducted from October to November 2018. A total of 620 high school adolescent girls were selected using the simple random sampling technique, and structured questionnaires having observational check-list were used for data collection. The presence of goiter was estimated using criteria set by World Health Organization. Iodine content of the salt was estimated by using spot testing kits. Both bivariable and multivariable logistic regressions were used to identify associated factors. The degree of association between independent and dependent variables was assessed by using odds ratio with 95% confidence interval. Those variables having p value of less than 0.05 in the multivariable analysis were considered as significant factors for goiter. Results A total of 614 adolescent girls gave a complete response. The prevalence of goiter among adolescent girls was 24.1%. In the multivariable logistic regression analysis, age of adolescent girls (adjusted odds ratio (AOR) = 1.57, 95% CI: 1.01–2.46), residence (AOR = 1.91, 95% CI: 1.04–3.51), family history (AOR = 4.96, 95% CI: 3.19, 7.72), low dietary diversity (AOR = 8.39, 95% CI: 4.36–16.14), and medium dietary diversity (AOR = 2.26, 95% CI: 1.36–3.77) were significantly associated with adolescent girls goiter. Conclusions Goiter among high school adolescent girls in this study was high. Age of adolescent, residence, family history of goiter, and dietary diversity were statistically significant factors for goiter. Therefore, more emphasis will be given for late adolescent age, having family history of goiter, low dietary diversity, and rural residence to improve the burden of adolescent goiter.

Prevalence of Goiter and Associated Factors Among Adolescents in Gazgibla District, Northeast Ethiopia.

BackgroundAlthough goiter is a major public health problem in Ethiopia and affects a large number of people, there was little evidence among adolescents particularly in Northern Ethiopia. This study was, therefore, aimed at investigating the prevalence of goiter and associated factors among adolescents in Gazgibla District, Northeast Ethiopia.MethodsA community-based cross-sectional study was conducted among 596 adolescents from August 5–30, 2019. Data were collected using a structured questionnaire. Adolescents were assessed for goiter based on World Health Organization criteria. The level of iodine in household salt samples was tested using rapid test kit. Data were entered into EpiData version 3.1 and exported into Statistical Package for the Social Sciences version 22.0 for statistical analysis. Multivariable logistic regression analysis was done to control for all possible confounders and to identify predictors of goiter. Odds ratio along with 95% confidence interval (CI) was estimated to measure the strength of the association. Level of statistical significance was declared at P ≤ .05.ResultsThe prevalence of goiter among adolescents was 42.5% (95% CI: 38.4%, 46.7%). Being a female (adjusted odds ratio [AOR] = 1.83, 95% CI: 1.18, 2.85), family history of goiter (AOR = 3.63, 95% CI: 2.31, 5.69), cabbage consumption at least once per week (AOR = 4.6, 95% CI: 2.42, 8.74), not consuming meat at all (AOR = 2.5, 95% CI: 1.17, 5.32), not consuming milk at all (AOR = 2.19, 95% CI: 1.19, 4.03), and inadequate iodine level of household salt (AOR = 7.05, 95% CI: 3.83, 12.97) were significantly associated with the development of goiter among adolescents.ConclusionsThe prevalence of goiter was very high in the study area. Therefore, the health sector of the district should invest efforts on improving the community’s awareness through disseminating key messages about iodized salt and iodine-rich foods.

Prevalence of goiter among children in Ethiopia and associated factors: a systematic review and meta-analysis

BackgroundThe distribution of goiter among children and its risk factors are not well investigated in Ethiopia. Therefore, this systematic review and meta-analysis was designed to determine the pooled prevalence of goiter and its associated factors among children in Ethiopia.MethodsElectronic web-based searches of PubMed, Google Scholar, EMBASE, and the World Health Organization’s Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases) were conducted to find primary studies. Relevant data were extracted and descriptive summaries of the studies were presented in tables. The I2 statistic was used to assess heterogeneity across studies. Funnel plot asymmetry and Egger’s tests were used to check for publication bias. A random effects model was used to estimate the pooled prevalence of goiter. Odds ratios (OR) with 95% Confidence Intervals (CI) were also used to determine the association of identified variables with goiter. All statistical analyses were conducted using Stata version 14 software.ResultsOur search identified 982 studies, of which, 19 articles were eligible for inclusion in the final meta-analysis. The pooled estimate of goiter among children in Ethiopia was 40.50% (95% CI: 33.6–47.40). The regional distribution of goiter ranged from 44.22 (95% CI: 17.44–71) in Southern Nations Nationalities and Peoples’ Region, to 32.79% (95% CI: 19.86–45.73) in Benishangul Gumez region. The prevalence of goiter among female children (44.34%) was higher than among male (32.88%) children. Goiter prevalence was also significantly higher among children who consumed vegetables three or more times per week OR = 1.3 (95% CI: 1.02–1.66); those who had family history of goiter, OR = 2.38 (95% CI: 1.9–2.99); and those whose family stored salt near to fires, OR = 1.4 l (95% CI: 1.1–1.79).ConclusionThe prevalence of goiter among children in Ethiopia was high, and endemic according to the WHO criteria. Our findings suggest the need for interventions to improve salt iodization, and for improved health education on appropriate salt storage. In addition, more research may be needed to improve our understanding of foods that increase the risk of goiter among children.

Increasing of Iodine Intake Decrease the High Risk of Goitre in Smoking Men

Background: An association between smoking and the risk of goitre is reported in some, but not all studies. We investigated the association between smoking, goitre and iodine intake, with respect to different risk factors in 483 healthy men in Germany. Methods: A total of 483 healthy male employees of 4 institutions in Essen in Western part of Germany, aged between 17 and 68 years (43.1 ± 9.6 y) were examined by ultrasound of the neck to determine the thyroid volume between April 2001 and April 2002. Information on age, BMI, smoking, daily use of iodized salt, and familial history of thyroid disorders were assessed by standardized questionnaires. Logistic regression analysis was performed to adjust for smoking, age, iodine status and familial history of goitre. Results: The overall prevalence of goitre was 25.7%. Median thyroid volume among smokers, (23.4 ± 10.1 ml), was higher (p<0.001) as compared with non-smokers (19.4 ± 7.8 ml). Goitre was present in 77 out of 204 smokers (37.7%) vs. 47/279 (16.8%) in non-smokers (odds ratio: 3.0; p<0.001). Smoking (p<0.001) and increasing age (p<0.001) was associated with goitre prevalence, but not BMI and the family history of goitre. Iodine status alone failed just to reach the significance level but revealed a clear trend. And there was significant prevalence of goitre in smoking men who did not take iodine salt compared to smoking men with regular intake of iodine salt (p=0.018). Conclusions: Smoking increase the risk of goitre in men that can be decreased by taking iodine.

Prevalence and associated factors of goiter among rural children aged 6-12 years old in Northwest Ethiopia, cross -sectional study

BackgroundGoiter, an indicator of chronic iodine deficiency, is a major public health problem for populations living with iodine deficient environment, particularly for young children. It is a threat to the social and economic development of many developing countries including Ethiopia. The aim of the study was to assess the prevalence and associated factors of goiter among rural children aged 6-12 years, Northwest Ethiopia.MethodsA community based cross-sectional study was employed from July to December 2012 in Lay Armachiho district. A total of 698 children aged 6-12 years were included in the study. Multistage sampling was used. Children were examined for the presence/absence of goiter using a criterion set by World Health Organization. The level of Iodine of the salt was estimated by using spot testing kits. Descriptive and summary statistics were employed. Bivariate and multivariate logistic regressions were used to identify associated factors. The degree of association was assessed by using Odds ratio with 95% confidence interval were computed to see the presence and strength of association.ResultsTotally 694 children were included in the analysis. The prevalence of goiter was found to be 37.6%. Goiter of grade 1 was 28.5% and that of grade 2 was 9.1%. 29.7% of the samples had adequate iodine content. The age of child (AOR: 1.24,95% CI: 1.12, 1.36), being female (AOR = 1.98, 95% CI: 1.38-2.85), salt iodine level (AOR = 0.44, 95% CI: 0.27, 0.71), family history of goiter (AOR = 3.18, 95% CI: 2.08, 4.858), fish consumption (AOR = 0.42, 95% CI; 0.22, 0.80) were factors associated with goiter.ConclusionChronic iodine deficiency was a severe public health problem in the study communities. Ensuring the consumption of iodized salt and promotion of fish intake at the household level are highly recommended.

Inflammatory myofibroblastic tumor of the thyroid in its sclerosing subtype: the first case report

Inflammatory myofibroblastic tumor (IMT) is a rare entity. It is usually found in the lung and upper respiratory tract. Its location in the thyroid is exceedingly rare. Only seven cases of IMT of the thyroid were reported in the literature, mostly after the age of 50 years. The predominant histological pattern in all previously reported cases is that of marked plasma cell infiltrate. We report the detailed clinico-pathological and immunophenotypical features of a case of IMT of the thyroid in an 18-year-old girl with a family history of goiter. Our case is unique because it is the first and only known case of IMT of the thyroid in its alternative sclerosing subtype.

Prevalence of Goiter among Children Aged 11–16 Years in Ahwaz, Iran

Objective: This cross-sectional study was conducted in Ahwaz, Iran to find out the prevalence of goiter among schoolchildren ages 11–16 years. Subjects andMethods: Multistage sampling methodology was followed for selecting the study population. A total of 1,950 children (1,050 males, 900 females) were clinically assessed for thyroid gland enlargement. Data were collected on age, sex, weight, height, iodized salt consumption, family history of goiter, and thyroid size by palpation. Results: One hundred forty-six of the 1,950 children showed various grades of goiter, giving a prevalence of overall goiter of 7.48%. Of the 146 persons with goiter, 46 (31.5%) were male and 100 (68.5%) were female. Prevalence of goiter among male and female students was 4.4 and 11.1%, respectively. Prevalence of grade 1, 2, and 3 goiters was 56.8% (83 cases), 37.7% (55 cases), and 5.5% (8 cases), respectively. A significant difference existed between height of students with grade 1 goiter and those with grade 2 and 3 goiter (p < 0.001). A significant difference also was found between weight of students with grade 1 goiter and students with grade 2 goiters (p < 0.002). Conclusion: These results indicate that Ahwaz City is not an endemic area for iodine deficiency, probably because of its geographic location (the low altitude of sea level) or nutritional habits of its population (consumption of fish and iodized salt).

Unresolved questions in managing hypothyroidism during pregnancy

Diagnosing and managing hypothyroidism during pregnancy can be problematic. The scenario box on this page illustrates some typical problems encountered and raises pertinent questions concerning good medical practice. In this...

Gender-Specific Determinants of Goiter

Despite the strong implications of differences between females and males in the risk of goiter, gender-specific issues have not been extensively addressed in investigations of goiter prevalence. The objective of our analysis was to investigate the gender-specific determinants of goiter. Between April 2001 and April 2002. A total of 853 healthy employees from 4 institutions in the western part of Germany between 18 and 68 yr of age were examined by ultrasound of the neck to determine the thyroid volume. Information on sex, age, daily use of iodized salt, the history of goiter in the first-degree relatives, type and amount of smoking, oral contraceptives, and number of pregnancies were assessed by standardized questionnaires. Gender-specific predictors of goiter prevalence were assessed by multivariate logistic regression. The overall prevalence of goiter among study subjects was 204/853 (23.9%). Goiter was present in 80 out of 370 females (21.6%) vs 124/483 (25.7%) in males. In general, smoking (p < 0.0001), increasing age (p < 0.0001), and lack of daily intake of iodized salt (p = 0.004) were associated with goiter prevalence, but not sex (p = 0.39) and family history of goiter (p = 0.16). In 370 females, parity (p = 0.004) and lack of daily intake of iodized salt (p = 0.01) were the major determinants for goiter, whereas age (p = 0.18), oral contraceptives (p = 0.82), family history of goiter (p = 0.33), and smoking (p = 0.09) did not affect goiter prevalence. In 483 males, smoking (p < 0.0001) and age (p < 0.001) affected goiter prevalence, but not family history of goiter (p = 0.39), and the iodine status failed just to reach the significant level (p = 0.08) in this analysis. Gender-specific determinants of goiter are parity and iodine status in females and smoking and increasing age in males.

The influence of smoking habits on thyroid gland volume: an ultrasonic approach.

The effects of smoking habits on thyroid function, echo-texture (nodules and/or cysts) and thyroid gland volume were determined by using ultrasound and measuring serum Thyroxin (T4), Triiodothyronine (T3), Thyrotropin (TSH) and TPO antibodies (ab-TPO) in 189 healthy smokers and non-smokers, randomly selected (111 females and 78 males) among the employees of our hospital and their relatives. When the entire group of subjects was considered the mean ratio of thyroid gland volume/body weight was found to be significantly higher in male (P < 0.05) and female (P < 0.05) smokers compared with non-smokers. In female smokers, mean serum thyroid-stimulating hormone (TSH) was lower (P < 0.05) and the degree of smoking was positively correlated with the ratio of thyroid gland volume/body weight (P < 0.05). However, when the subjects with a family history of goitre in first degree relatives were excluded from our study (14 females and 9 males), no significant differences in mean ratio of thyroid volume/weight or TSH between the remaining smokers and non-smokers were detected. In both sexes, the correlation between the degree of smoking and thyroid volume, although positive, did not reach statistical significance. No difference in prevalence of abnormal echogenicity and echo-texture (nodules and cysts) between smokers and non-smokers was detected. It is concluded that smoking habits present a goitrogenic effect only in subjects with a family history of goitre but have no influence on thyroid gland texture.

Determinants of Papillary Cancer of the Thyroid

Determinants of papillary thyroid cancer were evaluated in a questionnaire-based case-control study from southeastern Sweden. A total of 104 cases, diagnosed from 1977 to 1987, and 387 randomly selected controls were included in the analyses. Female subjects with papillary cancer reported a work history as dentists/dental assistants, telephone operators, teachers, and day nursery personnel, and an occupational contact with chemicals and video display terminals more often than did controls. The 11 male cases more often reported working as mechanics and metal workers and having occupational contact with solvents. Other factors associated with increased risk for female papillary cancer were having private well water at the birth address; leisure time exposure to combustion smoke; low intake of cruciferous vegetables and seafood; and a family history of goiter, heart disease, biliary disorder, or female genital cancer. Diagnostic radiographic examinations, especially to the head, neck, or upper back/chest area, or repeated dental examinations, were also found to be associated with this form of cancer. With regard to the possible influence from hormonal factors among women less than age 50 years at time of diagnosis, an increased risk was found for a pregnancy soon after puberty. Tendencies toward a decreasing risk with increasing age at first pregnancy as well as an increasing risk with increasing number of pregnancies were found as well. Multiparity seemed to potentiate the effect from prior radiographic examinations.

Clinical parameters predictive of malignancy of thyroid follicular neoplasms

Needle aspiration biopsy is commonly employed in the evaluation of thyroid nodules. Unfortunately, the cytologic finding of a “follicular neoplasm” does not distinguish between a thyroid adenoma and a follicular cancer. The purpose of this study was to identify clinical parameters that characterize patients with an increased risk of having a thyroid follicular cancer who preoperatively have a “follicular neoplasm” identified by needle aspiration biopsy. A total of 395 patients initially treated at Vancouver General Hospital and the British Columbia Cancer Agency between the years of 1965 and 1985 were identified and their data were entered into a computer database. Patients with thyroid adenomas were compared to patients with follicular cancer using the chi-square test and Student's t-test. Statistically significant parameters that distinguished patients at risk of having a thyroid cancer (p <0.05) included age greater than 50 years, nodule size greater than 3 cm, and a history of neck irradiation. Sex, family history of goiter or neoplasm, alcohol and tobacco use, and use of exogenous estrogen were not significant parameters. Patients can be identified preoperatively to be at an increased risk of having a follicular cancer and accordingly appropriate surgical resection can be planned.

Management of thyroid nodules in the elderly

Eleven malignant thyroid tumors were found in 100 consecutive patients more than sixty years old having thyroid operations. Based on preoperative findings, these 100 patients could be separated into two groups according to high and low risk for malignancy. Clinical manifestations in the high risk group were presence of a discrete cold thyroid nodule, hoarseness, dysphagia, an enlarging mass, or palpable ipsilateral cervical adenopathy; and in the low risk group, asymptomatic multinodular goiter, diffusely enlarged glands with elevated antithyroid antibody titers, and a family history of goiter. All eleven patients with malignant thyroid tumors were found in the sixty-six patients considered at high risk, whereas no malignant lesions were found in the low risk patients. Six of the malignant thyroid tumors were undifferentiated and in three of these a thyroid nodule had been present for more than fifteen years. There were no operative deaths and only one significant complication, a recurrent laryngeal nerve injury. Thyroidectomy is indicated for elderly patients with thyroid nodules who have features of the high risk group, whereas patients in the low risk group can be safely followed.

The Study of Endemic Seashore Goiter in Hokkaido (The 1st Report)

In 1889, Takenaka first described prevalence of goiter in Esashi, the seashore district of Hokkaido. Further studies on pathological and endemic views have been reported by Takeda, Miyamoto, Shimpo and Inoue. According to these data, the prevalence of goiter in the Hidaka District, Rishiri-Rebun Islands and Shakotan Insula was 8.9%, 36.3% and 10.9%, respectively. The goiterous patients in these areas take large amounts of Kombu, a sort of seaweed which is rich in iodine, as a sidedish or as seasoning for the usual diet.Since 1960, systematic investigations of this peculiar goiter have been carried out. In this paper, prevalence and geographical distribution, the nutritional environment, intake and output of iodine, and therapy are reported as the first part of our study. 1. Prevalence and geographical distributionSeven thousand nine hundred and seventy schoolchildren, 7 to 18 years of age, including 4,726 in the Hidaka District, 2,298 in Rishiri Isl. and 946 in Rebun Isl., were investigated. Size of goiter was classified according to Shichijo's criteria, Dieterle's modification.The incidence of goiter was calculated 6.6%, 8.9% and 2.7% in Hidaka District, Rishiri Isl. and Rebun Isl., respectively. In each area, girls were predominant : the ratio of female to male was from 2 : 1 to 10 : 1. Control studies were performed on school children of Sapporo city, and the incidence of goiter was 1.3%.The 2nd degree size of goiter was found in 75.2% among 539 goitrous patients, 3rd degree in 21.5% and over the 4th degree in 3.3%, but in the Hidaka District the enormous goiter, over the 4th degree, was found in 16 cases.The incidence of the goitrous patients with family history of goiter was 4 to 5%.The incidence of goiter reached the peak at 12 to 14 years of age in both sexes.The thyroid gland was diffuse on palpation in 97.4% of 539 cases, and nodular in only 2.6%.2. Clinical findingsAll of the 539 patients revealed clinically euthyroid states : hyperthyroidism or hypothyroidism, hoarsness and dyspnea ; congenital deafness or mutism was not found.3. Histological pictureHistological picture of the thyroid gland of 7 goitrous patients in Hidaka District was examined. The findings of Struma colloides macrofollicularis, that represent a enlargement of follicles and colloid storage without abnormal cell-infiltration, were seen in 6 cases, and Struma colloides microfollicularis or Struma foetalis in the other case.4. Nutrition SurveyIntake of foodstuffs was investigated in 8 families whose occupation was fishing, chiefly seaweed “Kombu” collecting. Five families had a history of goiter and 3 had not. Daily intake of nutriments throughout the four seasons were calculated according to the method of National Nutrition Survey of Welfare Ministry. It was found that most nutritional materials such as protein, carbonhydrate and Vitamin-A, were sufficient. The seaweed, chiefly Kombu, of 16.1 gm. which amounts to three times the average of Hokkaido Nutritional Survey in 1961 was taken. Excessive intake of other foodstuffs containing a goitrogen were not recognized.5. Urinary inorganic iodine excretionFive cases of goitrous patients in Hidaka District were examined for urinary inorganic iodine excretion, that was measured by Gross's method, under the usual diet in this area. These patients excreted up to 23mg. of inorganic iodine per day, whearas control non-goitrous patients on a normal diet at Hokkaido University Hospital excreted 1.5mg. and those on a iodide-restricted diet excreted 150, μmg.6. Response to treatmentFifty cases of goitrous patients in the Hidaka District were administrated desiccated thyroid or L-Triiodothyronine. In 72.5%, a disapperance or decrease in size of goiter was obtained. A more effective response was noted in the 10-to 15-year old or those having a smaller size of goiter.

Goitrous Hypothyroidism Simulating Thyrotoxicosis

SummaryA case of goitrous hypothyroidism in a boy of 13 is described which has been successfully treated with 260 mg of thyroid daily. The defect in this case may have been due to a failure in the coupling of iodotyrosines. For four years the patient was regarded as suffering from thyrotoxi‐cosis. This was largely due to the association of goitre with nervous manifestations, viz. excitability, tremor and moist palms. An incorrectly interpreted radio‐iodine uptake and an apparently raised B.M.R. were thought to support the diagnosis. Indications of the true diagnosis were the family history of goitre without iodine deficiency, the retarded physical development and bone age, the normal temperature of the palms, the failure to confirm the presence of the thyroid murmur, the absence of eye signs, the discrepancy between the sleeping and the waking pulse, the failure to respond antithyroid treatment and the good response to treatment with thyroid 30 mg three times daily before the diagnosis was established. The finding of a low P.B.I. clinched the diagnosis of hypothyroidism.

Defective iodination of tyrosine a cause of nodular goiter?

Twenty patients with colloid nodular goiter, 7 patients with Hashimoto's struma, and 15 patients without thyroid disease (all non-deaf) were tested with radioactive iodine and potassium thiocyanate for a thyroidal defect in iodination of tyrosine. In the cases of colloid nodular goiter with a family history of goiter there was a higher incidence and more severe degree of defective iodination of tyrosine than in the cases of colloid nodular goiter without a family history of goiter. Defective iodination of tyrosine was demonstrated in 1 sibling with proved colloid nodular goiter and in 1 with Hashimoto's struma. Iodination of tyrosine was impaired in 1 patient with her fourth recurrence of colloid nodular goiter. These data suggest that defective iodination of tyrosine is not uncommon in euthyroid non-deaf subjects with colloid nodular goiter, and may occur on a familial basis. ATRACER dose of radioactive iodine (I131) is normally incorporated into the tyrosine molecule shortly after entering the thyroid gland (1). If an oral dose of potassium thiocyanate (KSCN) is given to a person with a normal thyroid gland two hours after the administration of a tracer dose of I131, the resultant decrease in concentration differential for ionic iodide across the follicular cell membrane does not result in an exodus of I131 from the thyroid gland because the I131 already incorporated into the tyrosine molecule does not leave the follicular cell. If the process of iodination of tyrosine is impaired, however, nonorganified I131 leaves the thyroid gland after the administration of KSCN. Defects in the organification of iodine have been noted during administration of thiouracil (2), and in goitrous cretins (3), congenitally nerve-deaf siblings in whom goiter later developed (4), and patients with Hashimoto's struma (5).

Goitrous Hypothyroidism Simulating Thyrotoxicosis

SummaryA case of goitrous hypothyroidism in a boy of 13 is described which has been successfully treated with 260 mg of thyroid daily. The defect in this case may have been due to a failure in the coupling of iodotyrosines. For four years the patient was regarded as suffering from thyrotoxicosis. This was largely due to the association of goitre with nervous manifestations, viz. excitability, tremor and moist palms. An incorrectly interpreted radio‐iodine up‐take and an apparently raised B.M.R. were thought to support the diagnosis. Indications of the true diagnosis were the family history of goitre without iodine deficiency, the retarded physical development and bone age, the normal temperature of the palms, the failure to confirm the presence of the thyroid murmur, the absence of eye signs, the discrepancy between the sleeping and the waking pulse, the failure to respond antithyroid treatment and the good response to treatment with thyroid 30 mg three times daily before the diagnosis was established. The finding of a low P.B.I. clinched the diagnosis of hypothyroidism.