Euthyroid Multinodular Goiter Research Articles

Prevalence of upper airway obstruction in patients with apparently asymptomatic euthyroid multi nodular goitre

Aims:To study the prevalence of upper airway obstruction (UAO) in “apparently asymptomatic” patients with euthyroid multinodular goitre (MNG) and find correlation between clinical features, UAO on pulmonary function test (PFT) and tracheal narrowing on computerised tomography (CT).Materials and Methods:Consecutive patients with apparently asymptomatic euthyroid MNG attending thyroid clinic in a tertiary centre underwent clinical examination to elicit features of UAO, PFT, and CT of neck and chest.Statistical Analysis Used:Statistical analysis was done with SPSS version 11.5 using paired t-test, Chi square test, and Fisher's exact test. P value of <0.05 was considered to be significant.Results:Fifty-six patients (52 females and four males) were studied. The prevalence of UAO (PFT) and significant tracheal narrowing (CT) was 14.3%. and 9.3%, respectively. Clinical features failed to predict UAO or significant tracheal narrowing. Tracheal narrowing (CT) did not correlate with UAO (PFT). Volume of goitre significantly correlated with degree of tracheal narrowing.Conclusions:Clinical features do not predict UAO on PFT or tracheal narrowing on CT in apparently asymptomatic patients with euthyroid MNG.

Terminal ligature of inferior thyroid artery branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels

To evaluate the impact of truncal versus terminal branch ligature of the inferior thyroid artery (ITA) on postoperative calcium and PTH plasma levels in patients undergoing total thyroidectomy for multinodular goiter. A prospective randomized study was performed comparing a group of patients that underwent either truncal ligature of the ITA (group 1) or terminal ligature of ITA branches (group 2). A series of 126 consecutive patients with non-toxic euthyroid multinodular goiter underwent total thyroidectomy. Truncal ligature of the ITA was performed in 63 patients (group 1) and terminal branch ITA ligature in 63 patients (group 2). Postoperative ionized serum calcium (mmol/L) at 24 hours was significantly lower in group 1 than in group 2 patients (1.22 ± 0.06 vs. 1.25 ± 0.05, P<0.05) and at 48 hours (1.20 ± 0.05 vs. 1.23 ± 0.05, P<0.05). Mean postoperative PTH levels (pg/mL) at 4 hours after thyroidectomy were significantly lower in group 1 than in group 2 patients (22.32 ± 11.64 vs. 25.82 ± 12.87, P=0.044). Mean hospital stay (hours) was higher in group 1 than in group 2 patients (87.47 ± 41.04 vs. 70.34 ± 24.82, P<0.05). This study shows that terminal ligature of ITA branches during total thyroidectomy for multinodular goiter is associated with higher mean postoperative calcium and PTH levels, and shorter hospital stay. However, no significant difference in terms of permanent hypoparathyroidism was observed between the two groups.

A report of ten patients with thyroid hemiagenesis: ultrasound screening in patients with thyroid disease.

Thyroid hemiagenesis (TH) is a rare congenital abnormality of the thyroid gland, characterised by the absence of one lobe. The true prevalence of this congenital abnormality is not known because the absence of one thyroid lobe usually does not cause clinical symptoms by itself. This study aims to identify the frequency of TH and associated diseases in outpatients referred to our clinic for the first time. 6242 outpatients, who were referred to our thyroid clinic between January 2008 and March 2009 and underwent thyroid ultrasonography, were retrospectively analysed. For patients with TH, demographic data, family history of thyroid disorders, drugs administered, thyroid function parameters, thyroid autoantibodies were examined and thyroid sonography was carried out. Tc99m pertechnetate scintigraphy was performed to confirm the diagnosis of hemiagenesis and to rule out coexisting ectopic thyroid tissue. We identified 10 cases of TH in 6242 outpatients with various thyroid disorders, 8 women and 2 men (ratio 4:1), age 21-63 years, indicating a prevalence of 0.16%. Associated thyroid disease in these patients included: 1 patient with nodular Graves' disease, 1 with Hashimoto's thyroiditis, 4 with euthyroid nodular goiters and 2 with euthyroid multinodular goiters. Nine patients were clinically asymptomatic. However, the patient with nodular Graves' disease presented thyrotoxicosis. TH is a rare congenital anomaly and prevalence of TH in thyroid patients is 0.16%. In our study, the most frequently seen thyroid disease accompanying thyroid hemiagenesis was nodular goiter.

A report of ten patients with thyroid hemiagenesis: ultrasound screening in patients with thyroid disease.

Thyroid hemiagenesis (TH) is a rare congenital abnormality of the thyroid gland, characterised by the absence of one lobe. The true prevalence of this congenital abnormality is not known because the absence of one thyroid lobe usually does not cause clinical symptoms by itself. This study aims to identify the frequency of TH and associated diseases in outpatients referred to our clinic for the first time. 6242 outpatients, who were referred to our thyroid clinic between January 2008 and March 2009 and underwent thyroid ultrasonography, were retrospectively analysed. For patients with TH, demographic data, family history of thyroid disorders, drugs administered, thyroid function parameters, thyroid autoantibodies were examined and thyroid sonography was carried out. Tc99m pertechnetate scintigraphy was performed to confirm the diagnosis of hemiagenesis and to rule out coexisting ectopic thyroid tissue. We identified 10 cases of TH in 6242 outpatients with various thyroid disorders, 8 women and 2 men (ratio 4:1), age 21-63 years, indicating a prevalence of 0.16%. Associated thyroid disease in these patients included: 1 patient with nodular Graves' disease, 1 with Hashimoto's thyroiditis, 4 with euthyroid nodular goiters and 2 with euthyroid multinodular goiters. Nine patients were clinically asymptomatic. However, the patient with nodular Graves' disease presented thyrotoxicosis. TH is a rare congenital anomaly and prevalence of TH in thyroid patients is 0.16%. In our study, the most frequently seen thyroid disease accompanying thyroid hemiagenesis was nodular goiter.

Thyroid Function and Insulin Sensitivity Before and After Bilio-pancreatic Diversion

Bilio-pancreatic diversion (BPD) induces permanent weight loss in previously severe obese patients through a malabsorptive mechanism. The aim of the study was to evaluate the modifications of circulating thyroid hormones after BPD, a surgical procedure which interferes with the entero-hepatic circulation of biliary metabolites. Forty-five patients were studied before and 2 years after BPD. Thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), anti-thyroid antibodies, iodine urinary excretion, lipid profile, insulin and glucose plasma levels were assessed. The insulin-resistance HOMA IR index was calculated, and colour Doppler ultrasonography of the neck was performed. The subjects (23%) had subclinical hypothyroidism prior to BPD (TSH levels above the normal range with normal fT3 and fT4 levels). After 2 years 40.42% of the population showed subclinical hypothyroidism, while 6.3% became frankly hypothyroid, all of them with no evidence of auto-immune thyroiditis. Most of the patients, who became sub-clinically hypothyroid only following BPD, had already thyroid alterations at the sonogram (multi-nodular euthyroid goiter and thyroidal cysts) prior to surgery. BPD increases the prevalence of subclinical or even frank hypothyroidism, without causing a defect in thyroid function itself, through several integrated mechanisms. (1) It induces iodine malabsorption, which is partially compensated by iodine excretion contraction. (2) The entero-hepatic open circulation determines fT3 loss, which induces subclinical or frank hypothyroidism in patients with pre-existing thyroid alterations, interfering also with the weight loss progress. Iodine supplementation should be recommended in those patients reporting thyroid alterations at the sonogram prior to BPD, LT4 therapy should be strictly monitored in patients suffering of subclinical hypopthiroidism and T3 therapy should eventually be considered for patients diagnosed with frank hypothyroidism prior to BPD.

Primary thyroid paraganglioma presenting with double thyroid nodule: a case report

Paragangliomas (PGs) are exceptionally rare tumors. Only 24 cases have previously been reported. Both preoperative and postoperative differential diagnosis is very difficult. Due to interesting nature in diagnosis and differential diagnosis, we describe the case 58-year-old euthyroid woman with a thyroid PG. The patient had presented with euthyroid multinodular goiter to a secondary hospital. The patient was treated with right lobectomy, isthmectomy, and left partial lobectomy without any imaging procedures. No complication had been developed during and following the operation. Initial pathological examination suggested medullar thyroid carcinoma (MTC) in a nodule of 4.5cm in diameter on right thyroid lobe and a nodule of 2.5cm in diameter on the left thyroid lobe without amyloid stroma and referred to our third-stage hospital. Repeated pathological examination involving immunohistochemistry revealed that the tumor was stained positively to neuron-specific enolase, chromogranin A, synaptophysin, and S-100 protein. No immunoreactivity was detected against thyroglobulin, calcitonin, parathormone, carcino-embryonic antigen, thyroid transcription factor-1, and cytokeratin. A diagnosis of thyroid PG was finally made. Laboratory analyses and imaging procedures excluded any neck or extracervical tissues metastasis or multiple endocrine neoplasia. In conclusion, thyroid PG is an elusive tumor. We present this interesting nature thyroid PG case to highlight importance of careful evaluation of clinical and pathological findings to correctly identify paragangliomas which anatomically mimic MTCs. This report is the first case of thyroid PG presenting with multinodular goiter in the literature.

Hyperthyroid Graves' disease after radioiodine therapy for non-toxic multinodular goiter

Background: Radioiodine treatment has been used to reduce the size of euthyroid multinodular goiter (MNG) as an alternative to surgery. Postradioiodine Graves’ disease is a rare side effect which can occur several months after radioiodine treatment for non-toxic multinodular goiter. Objective: To report two patients who developed hyperthyroid Graves’ disease after radioiodine therapy for non-toxic multinodular goiter. Methods: We report the clinical and laboratory findings of Graves’ disease which occurred after radiotherapy. The literature was reviewed for the incidence and pathogenesis of Graves’ disease after radioiodine therapy. Results: The first case describes a 39-year-old woman presented with hyperthyroidism after repeated radioiodine therapy for non-multinodular goiter. The second case describes a 45-year-old woman who presented with hyperthyroidism after the first dose of radioiodine therapy for non-multinodular goiter. Graves’ disease was confirmed in both cases by the presence of thyrotropin receptor antibody (TRAb). Both patients respond well to methimazole. Conclusion: We demonstrate the rare occurrence of Graves’ disease as the side effect of radioiodine treatment for non-toxic multinodular goiter. They highlight the importance of recognizing patients with hyperthyroidism after radioiodine treatment as they could develop hyperthyroid Graves’ disease following this treatment.

Clinical and epidemiological characteristics of thyroid hemiagenesis: ultrasound screening in patients with thyroid disease and normal population

Thyroid hemiagenesis is a rare form of thyroid dysgenesis, in which one thyroid lobe fails to develop. The true prevalence of this rare abnormality is about 0.05-0.2% in normal population. We aimed to determine prevalence of thyroid hemiagenesis in patients with various thyroid disorders and a normal population in a mild to moderate iodine-deficient area. The clinical and thyroid ultrasonography records of 4,833 patients who presented with various thyroid disorders were reviewed. In addition, ultrasonographic data of two large surveys carried out for the community screening of iodine status of children (n = 4,772) and thyroid disorders of adult subjects (n = 2,935) were analyzed. In patients with thyroid disorders, we found 12 cases with thyroid hemiagenesis (0.25%). Thyroid hemiagenesis was due to the agenesis of the left lobe in all cases. The underlying thyroid diseases were Hashimoto's thyroiditis (n = 4), euthyroid multinodular goiter (n = 4), and toxic adenoma (n = 1). Three subjects have no underlying thyroid disease. In ultrasonography screening of normal population, altogether, the absence of the left lobe was detected in only two cases, indicating a true prevalence of thyroid hemiagenesis of 0.025%. None of the reviewed patients had thyroid dysfunction. Our community-based data is in accordance with previous studies in terms of prevalence and male-to-female ratio.

Graves' Disease and Thyroid Associated Ophthalmopathy following Radioiodine Therapy in Euthyroid Multinodular Goiter

Graves' Disease and Thyroid Associated Ophthalmopathy following Radioiodine Therapy in Euthyroid Multinodular Goiter

The incidence rate of thyroid microcarcinoma during surgery benign disease

Thyroid microcarcinoma are well-differentiated tumors less than 1 cm in diameter. A retrospective analysis was performed on patients operated of benign thyroid disease at the Center for endocrine surgery, Institute of endocrinology, Clical Center of Serbia in Belgrade, from January 1st to December 31st 2004, in order to establish the incidence of microcarcinoma. Indications for surgery were euthyroid multinodular goiter in 201 patients, thyroiditis in 31, thyroid adenoma in 178, Graves disease in 89 and Plummers disease in 79 patients. The results of this study, demonstrate that in 13.4% of the patients operated for goiter, 6.4% operated for thyroiditis, 5.6% for thyroid adenomas, 9.0% for Graves disease and 7.0% of the patients operated for Plumers disease, the presence of a microcarcinoma was noticed in the definitive histopathologic examination. The results obtained are in line with the current knowledge of high incidence of thyroid microcarcinoma.

Diagnostic Value of Dynamic Contrast Medium–Enhanced Magnetic Resonance Imaging in Preoperative Detection of Thyroid Carcinoma

To assess the diagnostic value of dynamic contrast medium-enhanced magnetic resonance imaging (DCE-MRI) in detection of thyroid carcinoma compared with fine-needle aspiration biopsy and frozen section analysis in multinodular goiter. Prospective clinical study. University hospital. Thirty consecutive patients with nodular goiter without any clinical risk and symptoms associated with thyroid carcinoma were studied. Twenty-five patients had euthyroid multinodular goiter, and 5 had toxic nodular goiter. Scintigraphy, ultrasonography, and DCE-MRI were performed preoperatively in all patients, as well as fine-needle aspiration biopsy and frozen section analysis in 17 patients with dominant cold nodules. Contrast enhancement patterns on DCE-MRIs and histopathologic results of thyroidectomy specimens were correlated. The sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of DCE-MRI and the results of fine-needle aspiration biopsy and preoperative frozen section analysis to detect thyroid carcinoma were compared. Thyroid carcinoma was found in 11 patients (36.7%), but was clinically significant in only 4 (13.3%). Delayed washout pattern of contrast enhancement significantly correlated with a histologic diagnosis of thyroid carcinoma (P < .001). The conditional probability of thyroid cancer in a patient with multinodular goiter with a delayed washout pattern was 0.78. The sensitivity and diagnostic accuracy of DCE-MRI to detect thyroid carcinoma was higher compared with fine-needle aspiration biopsy and frozen section analysis (100% vs 50% and 85.7%, and 90% vs 70.6% and 87.5%, respectively). The negative predictive value of DCE- MRI was 100%, ruling out thyroid carcinoma in all patients with benign goiter. Dynamic contrast-enhanced magnetic resonance imaging is useful to detect or exclude thyroid carcinoma with high diagnostic accuracy in patients with multinodular goiter when results of other diagnostic methods are inconclusive.

High incidence of thyroid cancer in toxic multinodular goiters

AbstractAim: The aim of this study is to analyse the incidence of carcinoma thyroids in toxic multinodular goiters (MNG) and the pathological pattern of these cancer nodules.Methods: This is a retrospective review of 2344 patients, operated for MNG over a period of 10 years from January 1993 to December 2002 at Lourdes Hospital, Kochi, Kerala, India.Results: We operated on 2344 patients for MNG, out of whom 160 patients presented to us in a toxic state and the remaining 2184 in a non‐toxic state. Of the patients operated for MNG 4.5% were found to have associated thyroid cancer. The incidence of thyroid cancer in toxic MNG patients was 26.25% whereas in non‐toxic MNG patients it was 2.5%. All the malignant nodules detected were papillary cancers of the thyroid and relatively large nodules (range 0.6 cm−4.1 cm) were found in toxic MNG compared to non‐toxic MNG.Conclusion: Patients with toxic MNG showed a very high incidence of coexisting thyroid cancer. Thyroid cancers can coexist in toxic MNG despite the suppression of thyroid stimulating hormone (TSH). The coexisting thyroid cancer size is larger in toxic MNG than euthyroid MNG. A total thyroidectomy is the treatment recommended for toxic MNG in an endemic area.

A swollen, red scar

In April, 2006, a 55-year-old woman was referred to our department with redness, swelling, and severe pain at the front of the neck, below the cricoid cartilage. Her symptoms had started a few months previously, and had gradually worsened since. In 1982, the patient had been diagnosed with a euthyroid multinodular goitre; one nodule had compressed her trachea, so she had undergone a partial thyroidectomy. She had been prescribed thyroxine ever since. She had no other medical history of note. The patient's previous thyroid disorder, anterior neck pain, and swelling led to a provisional diagnosis, on referral, of acute thyroiditis.

Familial partial lipodystrophy due to the LMNA R482W mutation with multinodular goitre, extrapyramidal syndrome and primary hyperaldosteronism

Objective To describe new data about the wide phenotypic variability of diseases due to mutations in the lamin A/C gene (LMNA). Design We report a complex phenotype in a patient with familial partial lipodystrophy of the Dunnigan type (FPLD) and study the frequency of her unusual clinical signs in 19 other LMNA-mutated lipodystrophic patients from 8 different families and 14 non-mutated family members. Case Report The patient was diagnosed with FPLD due to the R482W LMNA mutation after familial screening. Surprisingly, she had no biological signs of insulin resistance. The presence of hypertension with hypokalaemia led to the diagnosis of primary hyperaldosteronism. Thyroid investigations showed a euthyroid multinodular goiter. In addition, the patient exhibited a juvenile akineto-hypertonic syndrome. Results Goiter was identified with a similar frequency (55%) in LMNA-mutated lipodystrophic patients (11 out of 20, originating from 5 families among 8) compared to non-mutated family controls (35%; 5 patients out of 14, all originating from the same family). No case of primary hyperaldosteronism or extrapyramidal syndrome was identified in other studied subjects, either LMNA-mutated or not. Conclusions This R482W-LMNA mutated patient showed an association of features (primary hyperaldosteronism, euthyroid goiter and extra-pyramidal syndrome, raising the question of a link with her laminopathy. Prevalence of goiter tended to be higher in LMNA-mutated than in non-mutated subjects. Hyperaldosteronism seems coincidental. Although extrapyramidal syndrome has never been reported in lipodystrophic patients, it may nevertheless be linked to the LMNA mutation since multiple neurological features have been associated with alterations in lamins A/C.

Management of multinodular goiter in Germany (Papillon 2005)

Large-scale survey to focus on management of multinodular goiter and to compare the approaches of practitioners in primary care and thyroid specialists in Germany. Replies to a questionnaire were received from 2,191 practitioners and 297 thyroid specialists between June 1 and September 30, 2005. The hypothetical cases and their modifications described multinodular goiters of different sizes with and without toxic nodules. In the workup, TSH determination and thyroid sonography were found to be standard procedures. Scintigraphy was selected by 80.2% of practitioners and 92.9% of specialists (p < 0.001), in preference to fine needle aspiration cytology (17.9% of practitioners and 34.5% of the specialists, p < 0.001). Only 6.1% of practitioners and 24.4% of specialists (p < 0.001) advocated calcitonin screening. Euthyroid multinodular goiter (50-80 ml) was treated medically by 67.1% of practitioners and 65.6% of specialists, the combination of levothyroxine with iodine being clearly preferred (54.5% of practitioners, 52.3% of specialists). For toxic nodular goiter the preference for radioiodine therapy was significantly higher (p < 0.001) among specialists (67.7%) than among practitioners (47.5%). Referral to surgery was recommended for cold nodules with negative cytology by 64.9% of practitioners and 73.5% of specialists (p = 0.004). Treatment and diagnostic procedures are used to nearly the same extent in primary care and specialist institutions, but the opinions diverge over the issues of calcitonin screening and referral for radioiodine therapy.

The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter

In recent years, total or near-total thyroidectomy has emerged as a surgical option to treat patients with multinodular goiter, especially in endemic iodine-deficient regions. The aim of this study was to compare the complication rates of total and near-total thyroidectomy in multinodular goiter and the incidence of thyroid cancer requiring radioactive iodine ablation and completion thyroidectomy between groups. Patients with euthyroid multinodular goiter without any preoperative suspicion of malignancy, history of familial thyroid cancer, or previous exposure to radiation were randomized (according to a random table) to total thyroidectomy (group 1, n = 104) and near-total thyroidectomy leaving less than 2 g (group 2, n = 112). There were no persistent complications. The incidence of transient hypoparathyroidism in group 1 (26%) was significantly higher than in group 2 (9.8%) (p < 0.001). The rate of asymptomatic hypocalcemia in group 2 (7.4%) was lower than in group 1 (27%) (p < 0.001). The incidence of papillary cancer was 9.6% in group 1 and 12.5% in group 2 (p > 0.05). None of the patients underwent completion thyroidectomy before ablative therapy. Ten patients were found to have the histological criteria for radioactive iodine ablation. Of these 10 patients, four were in group 1 and six were in group 2 (p > 0.05). In conclusion, we recommend near-total thyroidectomy in multinodular goiter instead of total or subtotal thyroidectomy. While near-total thyroidectomy and total thyroidectomy obviate the need for completion thyroidectomy in incidentally found thyroid cancer, and while there is no difference in the rate of recurrent laryngeal nerve palsy between the two methods, near-total thyroidectomy causes a significantly lower rate of hypoparathyroidism compared to total thyroidectomy.

A new form of familial multi-nodular goitre with progression to differentiated thyroid cancer

We report a kindred with euthyroid multi-nodular goitre (MNG) of adolescent onset. Two of the seven subjects with MNG have progressed to papillary thyroid cancer. One affected male had nodular kidney disease, and breast cancer occurred in one affected female. Genes that were candidates on the basis of the associated kidney (PAX8) and breast diseases (sodium iodide symporter (NIS)), were sequenced. No mutations were found in the coding region, intron/exon splice sites or in the promoter sequences (from -1248 relative to the translation initiation codon) of PAX8. Similar results were obtained for NIS. Subsequently, microsatellite analyses were performed on 14 informative family members. We used 2 to 3 markers per locus for 6 loci (on chromosomes 1,2,3,14,19,X) previously reported to predispose to MNG and/or familial non-medullary thyroid cancer (FNMTC). On the basis of non-significant logarithm of the odds ratio (LOD) scores or inheritance of different alleles in affected individuals, all loci have been excluded. Thyroidectomy specimens from three members of the kindred show multiple benign lesions, with papillary cancer in two. The morphological features do not resemble those seen in familial adenomatous polyposis, Cowden syndrome, or in multiple oxyphil lesions. From these findings and from the absence of any linkage to any of the known loci associated with MNG or FNMTC, we suggest that this represents a new form of inherited MNG with a significant risk of progression to papillary carcinoma.

Thyroxine in Goiter,Helicobacter pyloriInfection, and Chronic Gastritis

Malabsorption of thyroxine has been described in patients treated with drugs that modify an acidic environment. We determined whether there is an increased need for thyroxine in patients with euthyroid multinodular goiter and impaired secretion of gastric acid. We assessed the dose of thyroxine required to obtain a low level of thyrotropin (0.05 to 0.20 mU per liter) in 248 patients with multinodular goiter. Of these 248 patients, 53 also had Helicobacter pylori-related gastritis and 60 had atrophic gastritis of the body of the stomach (31 with evidence of H. pylori infection and 29 without such evidence). The reference group comprised 135 patients with multinodular goiter and no gastric disorders. In addition, variation in the level of serum thyrotropin was prospectively studied in 11 patients treated with thyroxine before and after H. pylori infection and both before and during treatment with omeprazole in 10 patients treated with thyroxine who had gastroesophageal reflux. The daily requirement of thyroxine was higher (by 22 to 34 percent) in patients with H. pylori-related gastritis, atrophic gastritis, or both conditions than in the reference group. In prospective studies, the occurrence of H. pylori infection in the 11 patients treated with thyroxine led to an increase in the level of serum thyrotropin (P=0.002), an effect that was nearly reversed on eradication of H. pylori infection. In a similar way, omeprazole treatment was associated with an increase in the level of serum thyrotropin in all 10 patients treated with thyroxine, an effect that was reversed by an increase in the thyroxine dose by 37 percent. Patients with impaired acid secretion require an increased dose of thyroxine, suggesting that normal gastric acid secretion is necessary for effective absorption of oral thyroxine.

Thyroid scintigraphy in diagnosis of multinodular euthyroid goiter and functional thyroid autonomy

Aim of the study. To estimate the meaning of thyroid suppression test as the method for diagnosis of functional thyroid autonomy (FA). Materials and methods. The main group consisted of 50 patients (46 females, 4 males) older 40 yrs with multinodular euthyroid whose basal scintigraphy demonstrated one or more areas of increased Tc 99m thyroid uptake. Twenty two individuals of control group (27.5 [23; 38.75] yrs) with no thyroid abnormalities underwent only basal thyroid scintigraphy. Thyroid suppression test protocol for the main group included 10 - 14 days of 2 μg/kg L-thyroxin (L-T4) intake prior to repeated scintigraphy under suppression. Results. Basal TcTU in control group was significantly lower (1.51% [1.16; 1.76]) than in the main group (1.67% [1.4; 2.2]). TcTU of the main group did not correlate with thyroid volume (r = 0.012; p = 0.9), “hot” nodule volume (r = 0.08; p = 0.5), TSH (r = 0.026; p = 0.9), and thyroid hormones levels. Thyroid suppression test reviled FA in 62% (31/50) patients. TcTU under suppression (TcTUs) in the main group of 50 patients was 0.87% [0.76; 0.87]; it was significantly lower than TcTU (W = 1275; p &lt; 0.001). TcTUs did not depend upon thyroid volume (r = -0.097; p = 0.501), in contrast to TcTU it was a weak negative correlation with basal TSH level (r = -0.328; p = 0.020), a weak positive correlation with basal fT4 (r = 0.38; p = 0.007) and fT3 levels (r = 0.54; p &lt; 0.001), moderate positive correlation with “hot” nodules volume. Comparing the patients who developed thyrotoxicosis with those who stayed euthyroid showed that the usage of Tc 99m uptake decrease degree (%) while suppression from the basal, but not TcTUs, is more effective for individual prognosis of thyrotoxicosis development. Patients who demonstrate the decrease of Tc 99m uptake less than 30-35% while thyroid suppression test have the biggest risk of FA decompensation and thyrotoxicosis development independently of absolute TcTUs values.

Impact of Surgical Treatment on Respiratory Muscle Dysfunction in Symptomatic Hyperparathyroidism

We hypothesized that surgical treatment would improve respiratory muscle strength in symptomatic hyperparathyroidism (HPT). Prospective clinical trial. A tertiary referral center. Fifteen consecutive patients with symptomatic HPT and 10 with euthyroid multinodular goiter (control group) without a history of obstructive or restrictive lung disease. Forced vital capacity and forced expiratory volume in 1 second were measured before and 6 months after surgery to estimate respiratory muscle involvement. These measurements were compared with the reference values estimated individually in each patient. Mann-Whitney and Wilcoxon signed rank tests were used for statistical analysis, and P<.05 was considered statistically significant. Respiratory dysfunction in patients with symptomatic HPT, pulmonary function after parathyroidectomy, and the correlation between the preoperative serum parathyroid hormone and total serum calcium values and the impairment in pulmonary function. Preoperative forced vital capacity and forced expiratory volume in 1 second measurements were below the reference values in 11 (73%) and 9 (60%) patients, respectively. All the patients were normocalcemic, and forced vital capacity and forced expiratory volume in 1 second measurements significantly improved at postoperative month 6 (P = .001). No significant difference was detected in the control group. Improvement in pulmonary function correlated with preoperative serum calcium and parathyroid hormone values in patients with HPT (P<.05 and P<.001, respectively). Symptomatic HPT impairs inspiratory and expiratory components of respiratory function, and normalization of serum calcium levels after surgical treatment is associated with a significant improvement in lung function.