Multinodular Goiter Research Articles

A Lower Prevalence of Central Nervous System and Higher Prevalence of Cardiac Symptoms Characterises Indian Patients with Thyrotoxic Storm: A Retrospective Analysis.

Thyroid storm is an uncommon but life-threatening presentation of thyrotoxicosis with a mortality rate of 10%. Our objective was to study the demographics, clinical and biochemical characteristics, and outcomes of inpatients diagnosed with thyroid storm in the Indian context. This retrospective study was conducted by analysing the institutional electronic medical records (EMR) of all patients admitted with thyroid storm from 2004 to 2020 with a Burch-Wartofsky score (BWS) of ≥45. Thirty-five patients with a BWS ≥45 were included, of whom 71.4% were women, with a mean age of 44.9 ± 10.2 years. 43% did not have any prior history of thyrotoxicosis. Graves' disease was the most common underlying aetiology (71.4%), followed by toxic multinodular goitre (14.3%). Cardiovascular (94.3%) and gastrointestinal-hepatic dysfunction (88.6%) were the most common clinical manifestations. Features of Central nervous system (CNS) dysfunction were seen in only 42.3% of patients diagnosed with a thyroid storm. The Japanese Thyroid Association (JTA) criteria diagnosed only 26 patients (74.3%) with "definite" thyroid storm. The mortality rate was 8.6%, and all three patients expired within 48 hours of admission. Nearly one in every two patients with thyroid storm had previously undiagnosed thyrotoxicosis. Toxic multinodular goitre is a notable aetiology in Indians. Features of CNS dysfunction, considered relatively specific for thyroid storm, were less prominent in our series. The JTA criteria might alter the classification of some patients diagnosed with a thyroid storm, when compared to the BWS score due to fewer CNS features among Indian patients.

Long-Term Effects of 0.1 mg Recombinant-Human-Thyrotropin-Stimulated Fixed-Dose Radioiodine Therapy in Patients with Recurrent Multinodular Goiter after Surgery.

(1) Background: After thyroid malignancy is ruled out, treatment options for multinodular goiter patients include surgery, levothyroxine suppressive therapy, and 131-I therapy. Surgery effectively reduces goiter size but carries risks of surgical and anesthetic complications. 131-I therapy is the only nonsurgical alternative, but its effectiveness diminishes with goiter size and depends on iodine sufficiency. This study aimed to assess the efficacy and safety of 0.1 mg rhTSH as an adjuvant to a fixed dose of 131-I therapy in patients with a recurrence of large multinodular goiter, several years after the initial thyroidectomy. (2) Methods: 14 patients (13 females and 1 male), aged 59.14 ± 15.44 (range, 35-78 years) received 11mciu of 131-I, 24 h after the administration of 0.1 mg rhTSH. The primary endpoint was the change in thyroid volume (by ultrasound measurements) as well as in the diameter of the predominant nodule during a follow-up period of 10 years. Secondary endpoints were the alterations in thyroid function and potential adverse effects. (3) Results: A significant decrease in the volume of initial thyroid remnants (32.16 ± 16.66 mL) was observed from the first reevaluation (at 4 months, 23.12 ± 11.59 mL) as well as at the end of the follow-up period (10 years, 12.62 ± 8.76 mL), p < 0.01. A significant reduction in the dominant nodule was also observed (from 31.71 ± 10.46 mm in the beginning to 26.67 ± 11.05 mm). (4) Conclusions: Further investigation is needed since this approach could be attractive in terms of minimizing the potential risks of reoperation in these patients.

Selective Arterial Embolization for the Management of Large Multinodular Cervicomediastinal Goiter

In the surgical treatment of thyroid disease, surgery of cervicomediastinal goiters has always been a challenge, due to the high risk of intraoperative and postoperative complications, especially excessive bleeding. Case report Fifty-one-year-old female patient with multiple underlying diseases, presenting a large cervical mass resulting to be a large multinodular cervicomediastinal goiter. Underwent selective arterial embolization of vascular branches supplying irrigation to the mass and later a total thyroidectomy with minimum blood loss during the intraoperative time. Conclusion Even if preoperative selective artery embolization is far from being a routine technique in cervicomediastinal goiter surgery, in selected patients who have many underlying medical problems, very voluminous goiter, high bleeding risk or high intraoperative risk, it can be considered a useful and safe procedure.

The role of autoimmune thyroid disorders in patients with alopecia areata

Objective: The aim of this study was to investigate the association of thyroid autoimmunity with alopecia areata (AA) by examining thyroid stimulating hormone (TSH) and thyroid autoantibody levels. In addition, to compare the epidemiologic data obtained with the data of our country. Methods: Our study was organized as a cross-sectional, retrospective study. The study was performed on patients between the ages of 2-65 years who were admitted to our outpatient clinic between 01.01.2008 and 31.12.2011, who were clinically or histopathological diagnosed with AA, examined for etiology and thyroid autoantibodies were requested. Patients under two years of age and over 65 years of age, patients with no thyroid autoantibodies and pregnant patients were excluded. Results were expressed as mean±standard deviation and median values. Mann-Whitney U test was used to compare TSH, anti-TG antibody (Anti-TG) and anti-TPO (Anti-TPO) antibody values in the variables of nail involvement, psychiatry, comorbidity and family history. Spearman correlation analysis was used to examine the relationships between age and disease duration and TSH, Anti-TPO and Anti-TG variables. Results: In our study, 65 (42.8%) of 152 patients were female and 87 (57.2%) were male. The ages of the patients ranged between 2-65 years and the mean age was 26.5±14.6 years. The mean age of females was 27.5±14.4 and 25.7±14.9 in males. Elevated thyroid autoantibodies were found in a total of 29 patients, 21 of whom were female and 8 of whom were male. Of these 29 patients, 10 had hypothyroidism, 2 had chronic thyroiditis and 3 had toxic multinodular goiter. 14 patients did not return after the examination at the internal medicine outpatient clinic, so the diagnosis of thyroid disease could not be reached. The mean TSH, Anti-TG and Anti-TPO values were 2.27±1.57, 29.2±99 and 71.5±2.2, respectively. When these values were analyzed separately as men and women, they were found to be 2.6±2.02, 41.8±1.23 and 134±2.8 in women and 1.99±1.03, 19.8±75.6 and 24.5±1.32 in men. There was a significant difference between men and women in terms of Anti-TG and Anti-TPO values (p=0.011 and p=0.001, respectively). A significant correlation was found between disease duration and Anti-TPO positivity (p=0.045); however, a similar relationship was not found between disease duration and Anti-TG positivity (p=0.34). Conclusions: As a result of this study, although there was a significant correlation between anti-TPO and duration of AA, the association between thyroid autoimmunity and AA was not found to be statistically significant. This may be due to the fact that humoral autoimmunity plays a role in thyroid autoimmunity and primarily cellular autoimmunity plays a role in AA. In addition, the epidemiologic data of our study were similar to the data of studies conducted in our country.

Topical Use of Cannabis in Inflammatory Diseases in patients of the IPS Salud Social in Barranquilla, Colombia

To relate the topical use of cannabis as an analgesic therapeutic alternative in patients with some inflammatory diseases in Salud Social I.P.S during May to July 2023. An analytical, retrospective study was carried out. The population from which the sample was obtained corresponds to patients diagnosed with Arthrosis, Unspecified, Non-Toxic Multinodular Goiter, Epilepsy, Unspecified Type Venous Insufficiency (Chronic) (Peripheral), Unspecified Lumbago, Secondary Gonarthrosis, Rotator Cuff Syndrome, Carpal Tunnel Syndrome, in Salud Social I.P.S of Barranquilla, Atlántico. A sample of 23 patients diagnosed with these pathologies was obtained by non-probabilistic convenience sampling. All patients showed pain relief after two months of follow-up, two experienced adverse effects. Some studies suggest that cannabinoids present in cannabis, such as CBD and THC, may have analgesic and anti-inflammatory properties that could alleviate pain and inflammation associated with these conditions. This is consistent with the present study. Topical cannabis is presented as a therapeutic alternative in inflammatory diseases, however, it is important to highlight that research on the use of cannabis in these diseases is limited and more studies are needed to fully understand its effects and potential benefits.

Simultaneous operations in patients with combined pathology of the thyroid and parathyroid glands

The combination of thyroid and parathyroid gland pathology is a rather rare combination of diseases that occurs in 2.0–5.0 % of patients with thyroid pathology, and their combination in the population is less than 0.1 %. The aim of the study. To improve the diagnosis and treatment of patients with combined pathology of the thyroid and parathyroid glands. Materials and methods. The retrospective analysis covers the period from January 2013 to December 2023, during which 912 patients with thyroid pathology were examined and operated on. Examination of patients was carried out according to the method of diagnosis of combined surgical pathology developed by us (utility model patent No. 128139, Ukraine). The gender structure was dominated by female patients: 773 (84.8 %) and 139 (15.2 %). The average age of patients in the study group was 54.9 ± 11.7 years. Results. After the examination, combined surgical pathology was found in 201 (22.1 %) patients. In 36 (17.9 %) of them, the pathology of the prostate gland was detected as a concomitant disease. In the structure of parathyroid pathology in 35 (97.2 %) patients, a benign lesion of the prostate gland was detected, in 1 (2.8 %) – cancer of the parathyroid gland. In the structure of the main thyroid pathology, 14 (38.9 %) patients were diagnosed with multinodular euthyroid goiter, 4 (11.1 %) with mononodous euthyroid goiter, 9 (25.0 %) with diffuse toxic goiter, 3 (8, 3 %) – mononodous toxic goiter, 6 (16.7 %) – papillary thyroid cancer. Clinical symptoms of hypoparathyroidism were observed in 21 (58.3 %) patients after surgery. In 3 (8.3 %) patients, seroma of the neck wound was detected in the postoperative period. There were no fatalities. Conclusions. The use of the developed method of diagnosing combined surgical pathology makes it possible to detect concomitant surgical pathology in 22.1 % of patients with endocrine diseases, which requires simultaneous operative intervention. In the structure of combined surgical pathology, in 17.9 % of cases, a combination of diseases of the thyroid gland and parathyroid gland was observed. Simultaneous surgical intervention for combined thyroid pathology and diseases of the thyroid gland does not lead to an increase in perioperative complications and mortality.

The Resolution of Obstructive Sleep Apnea in a Patient with Goiter after Total Thyroidectomy: A Case Report

Obstructive sleep apnea (OSA) may be linked to various factors that narrow the upper airways, such as obesity, adenotonsillar hypertrophy and craniofacial abnormalities. Hypothyroidism has also been described as a risk factor for OSA. However, the implication of goiter independently of thyroid function in the occurrence of OSA remains unclear. We present the case of a 66-year-old woman with a large compressive multinodular goiter for whom total thyroidectomy was indicated. During the preoperative assessment, the patient had a body mass index (BMI) of 37.8 kg/m2 with symptoms of OSA. Respiratory polygraphy confirmed the diagnosis of severe OSA (apnea–hypopnea index (AHI) = 32), and treatment with continuous positive airway pressure (CPAP) was initiated prior to thyroid surgery. Surprisingly, after total thyroidectomy, OSA symptoms disappeared, and the patient abandoned CPAP therapy. Subsequent respiratory polygraphy after thyroidectomy showed a decrease in AHI to a normal value (AHI &lt; 5). Interestingly, there was no change in BMI or other factors explaining the resolution of OSA, except for thyroidectomy. This case report suggests that goiter can be considered a risk factor for OSA. However, prospective studies are needed to accurately assess the effects of goiter on the occurrence of OSA according to its dimensions and local extension.

Evaluation of Ultrasound Characteristics and Serum TSH Level in Predicting Malignancy among Patients Undergoing Thyroidectomy with FNAC-proven Diagnosis of Multinodular Goiter and Follicular Neoplasia: A Prospective Observational Study

Evaluation of Ultrasound Characteristics and Serum TSH Level in Predicting Malignancy among Patients Undergoing Thyroidectomy with FNAC-proven Diagnosis of Multinodular Goiter and Follicular Neoplasia: A Prospective Observational Study

Long-Term Follow-up of Patients With Autonomous Thyroid Nodules Treated With Radioiodine.

This article aims to describe the presentation of Plummer disease and its evolution after radioiodine treatment and determine factors that may influence treatment efficacy. The sample included retrospective medical records of 165 adult patients with toxic nodular goiter treated with radioiodine between 1997 and 2017, followed up at a single thyroid center. The efficacy of treatment with a single dose of radioiodine was higher than 90%. The mean radioiodine activity was 28.9 ± 3.4 mCi. The mean time between radioiodine performance and hyperthyroidism resolution was 3.6 ± 3.0 months, ranging from 1-12 months. After the first year, 33.9% of the patients were under hypothyroidism, 59.4% under euthyroidism, and 6.7% under hyperthyroidism. Among the nonresponders, the variables that showed statistical difference were the presence of multinodular goiter and the radioiodine activity (mean, 25.5 ± 6.5 mCi; median, 30 [15-30 mCi]). The cumulative rate of hypothyroidism was 48.9% over 20 years of follow-up. Radioiodine therapy is an effective and safe treatment. In Plummer disease, high rates of euthyroidism are expected after the radioiodine treatment. Therapeutic failure was observed mainly in patients with larger multinodular goiters treated with lower doses of radioiodine. The evolution to hypothyroidism was mostly observed in younger patients with larger and uninodular goiters.

Acupuncture Treatment with ST9, LI18, and Acupressure K27 for Multi Nodular Goitre: A Case Study

Acupuncture Treatment with ST9, LI18, and Acupressure K27 for Multi Nodular Goitre: A Case Study

The Incidence of malignancy in nodular goiter in endemic and non-endemic regions.

Aim: The purpose of this study is to look into the prevalence of thyroid cancer in Azerbaijan's endemic and non-endemic regions, as well as the effect of unmanaged iodine prophylaxis on the development of thyroid cancer. Material and methods: The study includes 352 patients who were treated operatively for nodular goiter between 2015 and 2022. Patients were separated into two groups based on endemic (n=126) and non-endemic (n=226) regions, as well as two subgroups based on the number of nodules in the thyroid: single nodule (169) and multinodule (183). Thyroid cancer was discovered in 20 patients (15.9%) in the endemic zone (p=0259). Malignancy was found in 11 (8.7%) of single-nodular goiter (SNG) patients and 9 (7.1%) of multi-nodular goiter (MNG) patients (p=0,259): 19 (15.1%) had the classic variation of papillary cancer and 1 (0.8%) had the follicular variant of papillary cancer. Cancer was discovered in 47 cases (20.8%) (p=0.259) in non-endemic regions: malignancy was detected in 23 (10.2%) cases of MNG patients and in -24 (10.6%) of SNG patients. In non-endemic areas, 2 patients (0.7%) had follicular cancer, 36 (15.9%) had the classic type of papillary cancer, 7 (3.1%) had microcarcinoma, and 2 (0.9%) had medullary cancer (p=0,220). Results: Although there was a decrease in the frequency of incidence of goiter disease in general in endemic regions due to the prohibition of iodized table salt, an increase in the frequency of occurrence of MNG (56.4%) was noted. Thyroid malignancy have been identified in 15.9% of endemic nodular goiter patients and 20.8% of non-endemic nodular goiter patients. The significant percentage increase in papillary carcinoma in our region study was consistent with the literature. Conclusions: According to data collected in endemic areas, the use of unregulated iodine prophylaxis resulted in a decrease in the prevalence of follicular carcinoma while increasing the frequency of papillary carcinoma. The prevention of iodized table salt under the conditions of sanitary-epidemiological follow-up under the control according to the endemic characteristics of the regions can lead to a decrease in the risk of follicular cancer

Subacute Granulomatous Thyroiditis Occurring after SARS-CoV-2 Infection: A Case Report

Subacute thyroiditis is a rare self-limited thyroid inflammatory condition characterized in the majority of cases by sudden onset of neck pain. It seems to be mostly linked, directly or indirectly, to viral infections. During the COVID-19 pandemic, several cases of thyroiditis were reported in the literature, occurring during or after infection by the SARS-CoV-2, suggesting that this virus is also linked to subacute thyroiditis. Therefore, knowledge of a possible association between these two entities is of the most importance. Several hypotheses explaining the mechanism of action of SARS-CoV-2 on the thyroid gland have been put forward. Clinical symptoms do not appear to be very typical, and thyroid hormonal dysfunction may not be present. Treatment is essentially based on corticosteroids and NSAIDs. The prognosis remains favorable. We report the case of a 46-year-old woman who presented with subacute thyroiditis 25 days after SARS-CoV-2 infection. Her workup showed elevated CRP, multinodular goiter, normal thyroid function and negative antibodies. She was treated with corticosteroids that resulted in improvement of her symptoms.

Use of a dosimetry-based RAI protocol for treatment of benign hyperthyroidism optimises response while minimising exposure to ionising radiation.

The optimal treatment strategy for radioiodine (RAI) treatment protocols for benign hyperthyroidism remains elusive. Although individualised activities are recommended in European Law, many centres continue to provide fixed activities. Our institution implemented a dosimetry protocol in 2016 following years of fixed dosing which facilitates the calculation of individualised activities based on thyroid volume and radioiodine uptake. This was a retrospective study comparing success rates using a dosimetry protocol targeting an absorbed dose of 150 Gy for Graves' disease (GD) and 125 Gy for Toxic Multinodular Goiter (TMNG) with fixed dosing (200MBq for GD and 400MBq for TMNG) among 204 patients with hyperthyroidism. Success was defined as a non-hyperthyroid state at 1 year for both disease states. Results were analysed for disease specific or patient specific modulators of response. This study included 204 patients; 74% (n = 151) received fixed activities and 26% (n = 53) of activities administered were calculated using dosimetry. A dosimetry-based protocol was successful in 80.5% of patients with GD and 100% of patients with TMNG. Differences in success rates and median activity administered between the fixed (204Mbq) and dosimetry (246MBq) cohort were not statistically significant (p = .64) however 44% of patients with GD and 70% of patients with TMNG received lower activities following treatment with dosimetry as opposed to fixed activities. Use of dosimetry resulted in successful treatment and reduced RAI exposure for 36% of patients with GD, 70% of patients with TMNG, and 44% of patients overall. This retrospective clinical study demonstrated that treatment with a dosimetry-based protocol for TMNG and GD achieved comparable success rates to fixed protocols while reducing RAI exposure for over a third of patients with GD and most patients with TMNG. This study also highlighted that RAI can successfully treat hyperthyroidism for some patients with activities lower than commonplace in clinical practise. No patient or disease specific modulators of treatment response were established in this study; however, the data supports a future prospective trial which further scrutinises the individual patient factors governing treatment response to RAI.

IJCM_145A: A Clinico-Epidemiological Profile of Patients with Thyroid Disorders Admitted to Tertiary Care Hospitals in Mangalore

Background: Thyroid ailments are frequently encountered endocrine disorders next to diabetes. They arise either due to functional aberrations of the thyroid gland resulting in over or under secretion of thyroid hormone or due to structural anomalies. People have varied constitutional, non-specific manifestations that cause abnormal metabolic functioning of the thyroid gland. Objectives: 1. To describe the socio-demographic characteristics of patients with thyroid disorders. 2. To analyze the clinical features, laboratory findings, and clinical outcomes of these patients. Methodology: This hospital-based descriptive study was conducted at the Government Wenlock Hospital in Mangalore. The study included patients admitted with thyroid disorders in the last 2 years. Data extraction sheet was developed from patient medical records. The sheet comprised three sections: socio-demographic information, clinical features at admission, and investigations and outcomes. Results: Most of the patients (52.8%) belonged to the 20-40 age group, followed by 30.5% in the 40-60 age group. Females comprised 81.5% of the study population, males -18.5%. 74.8% had swelling, 3.2% had facial puffiness. 1.8% had weight gain, only 1.2% had weight loss .16.3% had other comorbid conditions. 31.5% had low TSH levels 49.3% had normal TSH levels, 64.5 % - normal T3 levels, 63.2% - normal T4 levels. Anaemia was reported in 15.2% o, while 7.2% developed oedema. 34.2% had multinodular goitre, 20.2% - hypothyroidism 9.5 % - hyperthyroidism and 11.1% - malignancy. Out of the total 97% recovered 1% died 1% had discharge against medical advice and 1 % got discharged on request. Conclusion: Majority were females in the 20-40 age group. Majority of them had swelling followed by facial puffiness. Most of them had normal TSH, T3 and T4 levels, anaemia and oedema was also reported in few. Majority had multinodular goitre followed by hypothyroidism, malignancy, and hyperthyroidism. Majority had recovered.

Incidental Thyroid Carcinoma in Thyroidectomy Specimen with Clinical Correlation in Iraqi Patients

Abstract Background: Incidental thyroid carcinoma is a clinically unsuspected carcinoma that was discovered by histopathological examination of a thyroidectomy specimen removed for benign diseases. Objectives: To evaluate the frequency of incidental thyroid carcinoma in the thyroidectomy specimens and how to avoid its sequel in Iraq. Materials and Methods: A retrospective study of 104 cases of total and subtotal thyroidectomy for benign diseases was collected from Al-Sader teaching hospital during 2019–2022, reviewed by two pathologists for incidental primary malignancy, and analyzed using SPSS version 27. Results: Incidental thyroid malignancy was detected in 10.54% of all cases. It had been found in 13.8% of multinodular goiter (MNG) cases. Eight cases out of eleven (72.7%) of incidental malignancies were detected in total thyroidectomy specimens and the same percentage of them were detected in MNG cases. Ten out of eleven cases (90.9%) of incidental carcinoma were papillary carcinoma type (six cases were micropapillary type and four cases were conventional type of papillary carcinoma) with one case of follicular carcinoma. Conclusion: MNG does not mean the absence of carcinoma in the thyroid gland. Total thyroidectomy is the best surgery to avoid complications of unsuspected carcinoma and the sequel of another surgery.

Optimizing Thyroxine Dosage After Total Thyroidectomy: Understanding the Factors at Play.

Total thyroidectomy is evolving as the choice of treatment for non-malignant thyroid conditions. Therefore, an ideal method of thyroxine replacement is necessary to avoid the ill effects of under- and over-replacement in such patients. To assess the correlation between optimal thyroxine dose and potential variables like lean body mass (LBM), body surface area (BSA), body mass index (BMI), body weight, age, and sex in patients who underwent total thyroidectomies for benign multinodular goiters in our institute. A longitudinal cohort study was undertaken at the Government Medical CollegeThrissur, a tertiary care provider in India, between October 2018 and September 2019. One hundred adult patients who underwent a total thyroidectomy for various benign thyroid conditions were included. They were initially given thyroxine 75 µg upon discharge and received follow-up doses every two months until they achieved euthyroid status on two consecutive visits. The variables evaluated at this stage included age, sex, actual body weight, lean body weight, BMI, and biochemical data (triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH)). Correlation, multiple step-wise regression, and variance were carried out using EPI INFO version 7.2.2.6. The best predictors for optimum thyroxine dose were BSA (0.923, P < 0.01) and LBM (0.921, P < 0.01), compared with body weight (0.833, P < 0.01) and BMI (0.523, P < 0.01). In our study, the least significant factor was the age of the patient (r = 0.117, P < 0.01). There was no significant association between gender and thyroxine dose. The mean thyroxine dose was 1.87 µg/kg of the patient's body weight. The optimum thyroxine replacement based on BSA or LBM is a more ideal method than based on BMI or body weight alone.

Surgical Management and Predictors of Postoperative Complications of Retrosternal Goiters: A Retrospective Study.

The preferred standard treatment for retrosternal goiter (RSG), a slow-growing, often benign tumor, remains thyroidectomy. An alternative strategy may be required when the goiter is intrathoracic. Data on the results of RSG procedures are rarely reported. Careful patient selection and assessment are critical to avoiding an unexpected sternotomy during surgery and postoperative complications. This study aims to examine the clinical findings and treatment outcomes of RSG and to identify the variables affecting postoperative complications in a resource-limited setting. A retrospective study was conducted at Al-Thawra Modern General Hospital in Sana'a, Yemen, on 69 patients diagnosed with RSG and undergoing thyroidectomy between April 2019 and February 2023. Initial clinical characteristics, radiological and laboratory findings, treatment approach, and outcome were collected from the patient's medical profile and analyzed. To determine the variables influencing postoperative complications, a bivariate analysis was carried out. The mean age was 51.0 ± 13.6 years, and 45 (65.2%) were female. The most commonly reported symptoms were palpable masses (66; 95.7%), difficulty breathing (45; 65.2%), and neck discomfort (20; 29.0%), with 7 (10.1%) patients being asymptomatic. Previous thyroid surgery was reported in 10 (14.5%) cases. According to the grading classification, grade 1 was the most prevalent (42; 60.9%). Total thyroidectomy was the predominant surgical procedure in 59 (85.5%) cases. Using a cervical approach, all patients underwent thyroidectomy, and a sternotomy was required in one case. Histopathological analysis revealed benign multinodular goiter in 79.7%, followed by papillary thyroid cancer in 10.1% and thyroiditis in 6.7%. The postoperative complication occurred in 22 (31.9%), and the most common complication was transient hypocalcemia (11, 15.9%). There was no mortality during or after the surgery. In bivariate analysis, advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology were associated with postoperative complications and were statistically significant (all p<0.05). RSG is a rare disease that may require challenging surgical intervention. In this study, the cervical approach was the most practical and least intrusive surgical method. In addition, postoperative complications were associated with advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology. Low postoperative complication rates can be achieved by understanding the surgical architecture of the neck, essential clinical RSG presentation, thyroid pathology, and necessary surgical treatment.

Diagnostic and prognostic utility of TROP-2, SLP-2, and CXCL12 expression in papillary thyroid carcinoma.

Papillary thyroid carcinoma (PTC) is the most frequent thyroid malignancy. Histopathological examination is widely accepted as the gold standard test for the diagnosis of PTC. However, the histopathological examination sometimes can't differentiate PTC from other thyroid diseases. Differentiating PTC from other thyroid diseases is essential for a therapeutic approach and prognosis. The current study was performed to investigate the utility of TROP-2, SPL-2, and CXCL12 mRNA and protein expression in discriminating PTC from other thyroid diseases that mimic PTC. The current study was performed on 75 cases of surgically resected thyroid glands. The cases were distributed in two groups: the PTC group and the non-PTC group. The PTC group consisted of 35 cases (25 patients of the classic PTC variant and 10 patients of the PTC follicular variant). The non-PTC group consisted of 40 cases (10 cases were multinodular goiter, 5 cases were Graves' disease, 5 cases were Hashimoto thyroiditis, 15 patients were follicular adenoma (FA) and 5 cases were follicular carcinoma). TROP-2, SPL-2, and CXCL12 mRNA expression were estimated by qRT-PCR, and protein expression was estimated by immunohistochemistry. There were upregulated TROP-2, SPL-2, and CXCL12 mRNA and protein expressions in PTC compared to non-PTC (P< 0.001, for each). There was a statistically significant upregulation in the mRNA expression of the three genes among PTC cases with larger tumor sizes (P< 0.001, for each), those with tumor stages III and IV (P= 0.008, 0.002 and < 0.001 respectively), and those with LN metastasis (P< 0.001, for each). Moreover, there was a statistically significant upregulation in CXCL-12 gene expression among PTC cases with extra-thyroid extension (P< 0.001). mRNA expression of TROP-2, SPL-2, and CXCL12 among PTC cases increased in larger tumor size, tumor stages III and IV, and LN metastasis. Moreover, there was an increase in CXCL-12 gene expression among PTC cases with extra-thyroid extension. Thus, TROP-2, SPL-2, and CXCL12 expressions could be possible diagnostic and prognostic markers in PTC.

Clinical features and Surgical Outcomes of Thyroid Goitre Presenting to Ear, Nose and Throat Department of Queen Elizabeth Central Hospital, Blantyre, Malawi.

In Malawi there is a perception that goitre is common and causes significant public health and economic burdens. The purpose of this study was to assess the demographic distribution, clinical presentation, investigations, management, outcomes and complications of goitre seen at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. A single hospital-based descriptive retrospective study from January 2017 to December 2018 for all patients presenting with goitre. Out of 9073 patients who presented to ENT department, 105 patients presented with goitre representing 1% of all patients seen during the study period. The Male: Female ratio was 1:25. The mean symptom duration with goitre was 4 years (SD +/- 6.4). Thyroid function test results were available in 54 patients and out of these, 53(98%) patients were euthyroid. Ultrasound scan (USS) reports were available in 44 patients, of these 32(73%) were multinodular goitres. In 70 cases, pathology results were available and showed that 20% were thyroid cancers and that papillary thyroid carcinoma was the commonest cancer (64%). Two recurrent laryngeal nerve injuries were recorded in 79 surgical procedures representing 2.5% of patients (6.3% overall complication rate). Inpatient stay ranged from 2 days to 49 days (median 3 days). Goitre at our centre is more common in women than in men. One in five patients in this cohort had thyroid cancers. This prevalence is higher than other areas in the world highlighting the need for cytology services on every patient before surgery and histology services after surgery. Recurrent laryngeal nerve injury and other complications were infrequent demonstrating local high safety of thyroid surgery, despite late presentation to the ENT department.

Evaluation of the prevalence and laboratory test results of overt thyrotoxicosis cases.

The frequency of thyrotoxicosis may vary between countries and some laboratory test results may be used in etiology research. This study aimed to evaluate the prevalence of thyrotoxicosis diagnoses and laboratory test results. 3246 patients with overt thyrotoxicosis were included in this study. Laboratory test results, epicrisis, thyroid ultrasonography, thyroid scintigraphy, and radioactive iodine uptake test reports of the patients were examined in the study. Thyrotoxicosis was found due to levothyroxine overdose in 58.1% of the patients. When this group was excluded, 36.1% of the patients were diagnosed with toxic multinodular goiter most frequently. TRab levels were 8.5 times higher in Graves' disease than in other diagnostic groups. Anti-TPO levels were found to be the highest in the Graves' disease and Hashitoxicosis groups compared to other diagnostic groups (p<0.001). Anti-Tg levels were found to be highest in Graves' disease, Postpartum thyroiditis, and Hashitoxicosis patients (p<0.001). The free triiodothyronine / free thyroxine ratio was significantly higher, a cut-off value of >2.94 provided a sensitivity of 66% and specificity of 64% in diagnosing Graves' disease. The causes of thyrotoxicosis show some differences between countries. Patients using levothyroxine should be informed about drug use and dose titration. The free triiodothyronine / free thyroxine ratio can be used in addition to other tests during diagnosis.