Thyroid Goiter Research Articles

Contribution of Glycation and Oxidative Stress to Thyroid Gland Pathology-A Pilot Study.

The patho-mechanism of changes in the thyroid gland, including carcinogenesis, is a complex process, which involves oxidative stress. The goal of our investigation was to verify the extent of stress in the thyroid gland related to glycation. The study samples were comprised of blood sera, thyroid, and adipose tissue sections probed from 37 patients diagnosed with thyroid cancers and goiter. Using immuno-enzymatic and fluorometric assays we analyzed the content of advanced glycation end-products (AGEs), pentosidine, receptors for advanced glycation end-products (RAGE), scavenger receptor class (SR)-A, SR-B, glutathione, malondialdehyde and nitric oxide synthase. In addition to classic AGEs, a recent study detected the melibiose-derived glycation (MAGE) product. We demonstrated the presence of AGEs, MAGE and their receptors of the RAGE and SR-A. In addition, in the control samples of thyroid glands SR-B groups were detected as well as of pathological groups without noticeable tendency to antigen concentration in the area of carcinogenesis. Fluorescent AGEs correlate positively with glutathione, which supports the assumption that glycation stress leads to augmentation of oxidative stress and increase of the intensity of antioxidant mechanisms.

Zaburzenia funkcji poznawczych u chorych z pierwotną nadczynnością przytarczyc

Introduction: Primary hyperparathyroidism (PHPT) is one of the most common endocrine diseases. Somatic problems may be preceded by psychopathological symptoms, especially apathy, fatigue, sleep disorders, affective and anxiety disorders, impairment of cognitive functions, and most significantly — memory deterioration. The aim of the study was to assess the incidence and severity of cognitive impairment in patients with PHPT, as well as a possible relationship between the severity of these disorders and calcium and parathyroid hormone concentrations in serum. Material and methods: The study using the Montreal Cognitive Assessment (MoCA) included 101 patients diagnosed with PHPT. The control group consisted of 50 patients diagnosed with non-toxic thyroid goitre. Results: The analysis of results showed a higher incidence and intensity of cognitive dysfunctions in the group of patients with PHPT, both in the whole population and among women included in the study, and the differences were statistically highly significant. There was no statistically significant difference regarding cognitive dysfunctions incidence between men in the two groups; however, the intensity of these dysfunctions was higher in the group of patients with PHPT. Conclusions: PHPT is associated with a significantly higher incidence of cognitive functions impairment. There was no correlation between the severity of these disorders and calcium or parathyroid hormone levels in serum.

The correlation of thyroid diseases with anemia among Iraqi patients

Objective: To assess the relation between types of thyroid diseases with types of anemia. Methods: This prospective study of 123 cases of patients with different thyroid goiters. The blood samples were collected and complete blood count was done for them, each patient with low PCV (<35%) the blood film was done for them to classify the type of anemia. Surgical operation thyroidectomy, paraffin block and hematoxylin and eosin stain was performed, the slides assess and read by pathologist to classify the thyroid goiter to (thyroiditis, thyroid tumor, multinodular goiter) other the causes of anemia are excluded by history like (vaginal bleeding, gastric bleeding, hemorrhoid). Results: Among 123patients, 84 patients with thyroid diseases without anemia, 39 patients with thyroid diseases had anemia, 21 patients with thyroid diseases had iron deficiency anemia, 18 patients with thyroid diseases had anemia of chronic diseases. Conclusion: Most common type of anaemia in different thyroid diseases is iron deficiency anaemia (IDA), the common age group of anaemia and thyroid diseases is middle age (40-49) years. The female incidence of anemia and thyroid diseases is more in female than male and the multinodular goiter (MNG) is the common thyroid diseases.

Total thyroidectomy of a large thyroid goiter

Total thyroidectomy of a large thyroid goiter

Gynecological malignancy mimicking a thyroid lymph node metastasis.

SummaryWe present the case of a 69-year-old woman who attended the Endocrinology Unit of Modena for a suspicious lymph node in the left cervical compartment discovered during the follow-up of a recurrent gynecological malignancy. At neck ultrasonography, a thyroid goiter was detected, and the further cytological examination was inconclusive for thyroid nodule and compatible with a localization of an adenocarcinoma with papillary architecture for the lymph node. The histological examination after a left neck dissection confirmed the presence of an intracapsular metastasis of a papillary carcinoma immunohistochemically focally positive for thyroid transcription factor 1 and paired box 8 and negative for thyroglobulin. Subsequently, in the suspicion of a thyroid primitiveness, a total thyroidectomy was performed, revealing an intraparenchymal follicular variant of papillary thyroid carcinoma of 2 mm in the right lobe. During the follow-up, the appearance of a suspected cervical metastatic lesion led to another neck dissection, histologically compatible with a papillary carcinoma localization, immunohistochemically focally positive for thyroid transcription factor 1 and paired box 8, and negative for thyroglobulin. The histological revision of surgical specimens suggests the cervical recurrence of the prior gynecological cancer, rather than a thyroid carcinoma metastasis. The case described shows how carefully the cytological, histological and immunoistochemical results must be evaluated in oncological management, considering the whole patient’s history.Learning pointsNeck lymph node metastases occasionally originate from anatomically distant primary sites, such as breast, lung, gastro-intestinal tract, genito-urinary tract and CNS.Histological and immunohistochemical evaluations play an important role to identify the primary malignant site, although in some cases they could mislead the clinicians.A multidisciplinary approach and the evaluation of the whole medical history of the patient are mandatory to guide the diagnostic-therapeutic path and to avoid unnecessary treatments.

Is Statin Use Associated With Risk of Thyroid Diseases? Results of a Retrospective Cohort Study.

Given the ubiquity of statin use and prevalence of thyroid diseases, such as thyroid cancer, hyperthyroidism, and thyroiditis, understanding their association deserves further attention. To examine the association between statin use and thyroid cancer, thyrotoxicosis, goiter, and thyroiditis. Using Tricare data, 2 propensity score (PS)-matched cohorts of statin users and nonusers were formed: (1) a PS-matched general cohort (all patients aged 30-85 years) and (2) a PS-matched healthy cohort (excluded patients with cardiovascular diseases or severe comorbidities). Outcomes were thyroid cancer, thyrotoxicosis, goiter, and thyroiditis. Odds ratios (ORs) and 95% CIs of outcomes were estimated using conditional regression analysis. Of 43 438 patients, the PS-matched general cohort matched 6342 statin users to 6342 nonusers. The OR of thyroid cancer was 0.62 (95% CI = 0.39-0.996). There was no significant difference between statin users and nonusers in risk of thyrotoxicosis (OR = 0.88; 95% CI = 0.71-1.09), goiter (OR = 0.9; 95% CI = 0.77-1.03), or thyroiditis (OR = 0.78; 95% CI = 0.53-1.15). In the PS-matched healthy cohort (3351 statin users to 3351 nonusers), there was no difference between statin users and nonusers in any outcome. Limitations of the study include its retrospective observational design and use of administrative codes in outcomes ascertainment. This study did not demonstrate any association of statins with harmful effects on thyroid diseases, which offers assurance to clinicians and patients. Furthermore, statin use appears to be associated with a decreased risk of thyroid cancer, but more studies are needed.

Determination of Fifty Trace Element Contents in Normal and Goitrous Thyroid using a Combination of Instrumental Neutron Activation Analysis and Inductively Coupled Plasma Mass Spectrometry

Determination of Fifty Trace Element Contents in Normal and Goitrous Thyroid using a Combination of Instrumental Neutron Activation Analysis and Inductively Coupled Plasma Mass Spectrometry

Morphometry of the Thyroid Gland and its Correlation with Various Anthropometric Parameters in Asymptomatic Indian Young Adults- A Cross-sectional Study

Introduction: The volume, shape and size of the thyroid gland varies with age and sex. Morphometry of the thyroid with particular emphasis on its volume is an essential and most important parameter which must be evaluated. It is helpful in the diagnosis and monitoring of various thyroid diseases. Aim: To evaluate the volume of the normal thyroid gland and thickness of thyroid isthmus by ultrasonography and to observe its correlation with sex, height, weight, Body Mass Index (BMI), Neck Circumference (NC), Body Surface Area (BSA) and Lean Body Mass (LBM) in asymptomatic subjects. Materials and Methods: This was a cross-sectional study which included 100 volunteers (50 males and 50 females) from among 1st year MBBS/BDS students, who were attending classes in the Department of Anatomy, King George’s Medical University, UP, Lucknow during April 2019-March 2020. Detailed information (sex, height, weight, NC) was recorded for every subject. Also, BMI, BSA and LBM were calculated for each. Thereafter, ultrasound was performed to measure the dimensions of the thyroid gland. The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 24. Student t-test (to test the significance of two means), Analysis of Variance (ANOVA) and bivariate correlation using Karl Pearson correlation coefficient (r) were used as statistical tests; and p-value <0.05 was regarded as statistically significant. Results: The mean volume of the right lobe of the thyroid gland was found to be 3.89±1.28 mL and of left side was 3.59±1.09 mL. The mean total volume of thyroid gland was 7.48±2.22 mL. In males, it was found to be 8.32±2.30 mL and in females, it was 6.63±1.78 mL. The mean thickness of thyroid isthmus was 2.09±0.66 mm. The correlation of total thyroid volume with all the anthropometric parameters was significant, while correlation of isthmus thickness was statistically significant with LBM and NC only. Conclusion: Presentstudy provides a normative reference data for the physicians and surgeons to consider while dealing with everyday cases of thyroid hypoplasia or goiter in their Outpatient Department (OPD)/Inpatient Departments (IPDs).

A Case of Large Thyroid Goiter Operated Using Small Incision

A Case of Large Thyroid Goiter Operated Using Small Incision

Depressive and anxiety disorders in patients with primary hyperparathyroidism.

The objective of the study was to evaluate the prevalence and severity of anxiety and depression in patients with primary hyperparathyroidism (PHPT), and to determine a relationship between the severity of these disorders and the serum calcium ion and parathyroid hormone level, as well as to evaluate the usefulness of self-rating scales in screening for depressive disorders in PHPT patients. Using the 17-item Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory-II (BDI-II) and Hospital Anxiety and Depression Scale (HADS), study was performed on a group of 101 patients with PHPT. A control group included 50 patients diagnosed with non-toxic thyroid goiter. The HAM-D indicated higher prevalence and severity of depressive symptoms in the whole population of patients and in women with PHPT. Such a relationship was not observed in men. The BDI-II indicated higher prevalence and severity of depressive symptoms in the whole population of patients and in women with PHPT. Such a relationship was not observed in men. The HADS did not show significant differences in the prevalence of depressive and anxiety symptoms between the study and control groups in the whole population and after taking into account the gender division. A relationship between PHPT and depression was confirmed. Such a relationship was not confirmed for anxiety. A relationship between the severity of depression and the serum calcium ion and parathyroid hormone level was also not confirmed. A statistically significant negative correlation between the severity of anxiety and the serum calcium ion level in the whole population of patients, and an additional positive correlation between the serum parathyroid hormone level and the severity of anxiety in women were confirmed. Self-rating tests are not sufficient for screening for depressive disorders in PHPT patients.

MorbiNet Study: Hypothyroidism Comorbidity Networks in the Adult General Population.

Multimorbidity impacts quality of life. We constructed hypothyroidism comorbidity networks to identify positive and negative associations with other prevalent diseases. We analyzed data of 285 342 patients with hypothyroidism from 3 135 948 adults with multimorbidity in a population-based study in Catalonia, Spain, (period: 2006-2017). We constructed hypothyroidism comorbidity networks using logistic regression models, adjusted by age and sex, and for men and women separately. We considered relevant associations those with odds ratios (OR) >1.2 or <0.8 and P value < 1e-5 to identify coexistence greater (or smaller) than the expected by the prevalence of diseases. Multivariate models considering comorbidities were used to further adjust OR values. The conditions associated included larynx cancer (adjusted OR: 2.48), congenital anomalies (2.26), thyroid cancer (2.13), hyperthyroidism (1.66), vitamin B12/folate deficiency anemia (1.57), and goiter (1.56). The network restricted to men had more connections (mental, cardiovascular, and neurological) and stronger associations with thyroid cancer (7.26 vs 2.55), congenital anomalies (5.11 vs 2.13), hyperthyroidism (4.46 vs 1.69), larynx cancer (3.55 vs 1.67), and goiter (3.94 vs 1.64). After adjustment for comorbidities, OR values were more similar in men and women. The strongest negative associations after adjusting for comorbidities were with HIV/AIDS (OR: 0.71) and tobacco abuse (0.77). Networks show direct and indirect hypothyroidism multimorbidity associations. The strongest connections were thyroid and larynx cancer, congenital anomalies, hyperthyroidism, anemia, and goiter. Negative associations included HIV/AIDS and tobacco abuse. The network restricted to men had more and stronger associations, but not after adjusting for comorbidities, suggesting important indirect interactions.

Progress in the Pathogenesis, Diagnosis, and Treatment of TSH-Secreting Pituitary Neuroendocrine Tumor.

TSH-secreting pituitary neuroendocrine tumor (PitNET) is one of the causes of central hyperthyroidism. The incidence of TSH PitNET is far lower than that of other PitNETs. The clinical manifestations of TSH PitNETs mainly include thyrotoxicosis or thyroid goiter, secretion disorders of other anterior pituitary hormones, and mass effect on the pituitary gland and its surrounding tissues. The application of high-sensitivity TSH detection methods contributes to the early diagnosis and timely treatment of TSH PitNETs. Improvements in magnetic resonance imaging (MRI) have advanced the noninvasive visualization of smaller PitNETs. Treatments for TSH PitNETs include surgery, drugs, and radiotherapy. This review focuses on the progress in pathogenesis, diagnosis, and treatment of TSH PitNETs to provide more information for the clinician.

Superior mediastinal paraganglioma initially suspected of being a mediastinal thyroid goiter

Paraganglioma is a rare tumor arising from paraganglia. Few reports have described paragangliomas in the superior mediastinum. We report a case of superior mediastinal paraganglioma treated in our department. A 28-year-old woman visited our department because of suspected mediastinal tumor during a medical checkup. Contrast-enhanced CT showed a 39 × 35 × 65-mm tumor with a well-defined border extending from the lower pole of the left thyroid gland to the superior mediastinum. Laboratory tests showed no evidence of catecholamine overproduction. Mediastinal thyroid goiter was the most suspected preoperative diagnosis. We decided to perform a transcervical excision for both diagnosis and treatment. The tumor was easily detached from the lower pole of the left thyroid gland and was not continuous. The tumor capsule was brittle and bled easily. The operating time was 3 h and 11 min, and the amount of bleeding was 571 mL. The pathological diagnosis was paraganglioma. Paragangliomas are characterized by abundant blood flow and are likely to result in a high intraoperative bleeding volume. In addition, if the tumor is functional, circulatory abnormalities can occur during the perioperative period. Accurate preoperative diagnoses are important, and the possibility that paragangliomas can develop in the superior mediastinum should be considered.

Adenoma thyroid with supraclavicular tuberculous lymphadenitis Masquerading as malignancy thyroid with Metastasis - Diagnostic dilemma

Thyroid swelling or goitre is one of the commonest presentations among female patients more than males attending ENT out patients. The clinical importance of thyroid swelling is related to evaluating their functional status and assess,whether it is benign,malignant ,hypo or hyper active.Even if benign should look for pressure symptoms which justifies surgery.Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis.Coexistence of thyroid swelling with supraclavicular lymph node mimicking malignancy with metastatic deposit is unusual and always to be evaluated. We report a case of a 45-year female,who on outside initial evaluation was diagnosed as follicular carcinoma of thyroid. However clinical examination revealed a palpable supraclavicular lymph node. Thus subjected to a repeat FNA (fine needle aspiration) from thyroid which revealed benign thyroid follicular adenoma and FNA from supraclavicular lymph node revealed tuberculous lymphadenitis, which was further confirmed by histological sections post operatively. This case emphasizes the need for thorough clinical examination and utility of image guided FNA to rule out the biological nature of these lesions.

A case-control study on the association of mineral elements exposure and thyroid tumor and goiter

Thyroid tumor and thyroid goiter are prevalent disease around the world. In this case-control study, we investigated the association between exposure to a total of twelve mineral elements and thyroid disease as well as thyroid functions. Participants with thyroid tumor or goiter (N = 197) were matched with a healthy population (N = 197) by age (± 2 years old) and same sex. Questionnaires were used to collect data about the demographic characteristics and information of subjects. Serum and urine samples were collected simultaneously for each of the subjects. Mineral elements, iodine level of urine and levels of the total seven thyroid function indexes in serum were detected respectively. Conditional logistic regression was applied to estimate the associations between mineral elements and the risk of thyroid tumor and goiter through single-element models and multiple-element models. Multiple linear regression was used to evaluate relationships between mineral elements and percentage changes of thyroid functions. Higher concentrations of mineral elements in the recruited population were found in this study than other comparable studies, and the levels of chromium (Cr), manganese (Mn), nickel (Ni), arsenic (As), cadmium (Cd), selenium (Se), antimony (Sb), thallium (Tl) and lead (Pb) in the case group were lower than the control group. According to the single-element models, Cr, Mn, Ni, Sb and Tl showed significant negative associations with the risk of thyroid tumor and goiter, and, Cd showed nonmonotonic dose response. Cd and mercury (Hg) showed a nonmonotonic percentage change with T4, while Tl was associated with the increased FT4 in the control group. Therefore, Cd, Hg and Tl may disturb the balance of thyroid function to some extent, and Cr, Mn, Ni, Cd, Sb, and Tl may become potential influencing factors for the risk of thyroid tumor and goiter.

Defining Normative Sonographic Measurements of Neonatal Thyroid Volumes: Results of 165 Healthy Neonates from a Single Center in Northwest Malaysia.

Background:Congenital hypothyroidism is the most common cause of treatable mental impairment and growth retardation in newborns. Early diagnosis requires measurement of serum thyroid-stimulating hormone (TSH) and free T4 coupled with an ultrasound of the thyroid gland. However, detailed sonographic evaluation of the thyroid gland requires comparison to the local thyroid normative volumetric values, which is currently lacking.Methods:A cross-sectional study was conducted from November 10, 2015, to April 18, 2018, recruiting 165 healthy neonates with normal TSH in their 1st week of life, from a single center in Northwest Malaysia. Ultrasound thyroid was done by a single ultrasonographer (κ = 0.86, percent agreement = 92.4), and the thyroid volume (TV) was calculated using the Brunn formula.Results:All measurements showed skewed distribution with no significant difference between the right and left lobes. The local normative values for neonatal total TV was 0.61 (interquartile range [IQR] = 0.230) cm3, 0.31 (IQR = 0.150) cm3 for right TV, and 0.28 (IQR = 0.110) cm3 for left TV. There was a strong correlation between the right and left TVs, r = 0.767, P < 0.001. There were also no differences in the total TV across different genders and races.Conclusion:The normative values for TV determined in our study may be used accordingly in clinical practice to evaluate thyroid hypoplasia or goiter by other Asian countries due to the similarly shared biodemography.

The Keap1/Nrf2 Signaling Pathway in the Thyroid-2020 Update.

The thyroid gland has a special relationship with oxidative stress. On the one hand, like all other tissues, it must defend itself against reactive oxygen species (ROS). On the other hand, unlike most other tissues, it must also produce reactive oxygen species in order to synthesize its hormones that contribute to the homeostasis of other tissues. The thyroid must therefore also rely on antioxidant defense systems to maintain its own homeostasis in the face of continuous self-exposure to ROS. One of the main endogenous antioxidant systems is the pathway centered on the transcription factor Nuclear factor erythroid 2-related factor 2 (Nrf2) and its cytoplasmic inhibitor Kelch-like ECH-associated protein 1 (Keap1). Over the last few years, multiple links have emerged between the Keap1/Nrf2 pathway and thyroid physiology, as well as various thyroid pathologies, including autoimmunity, goiter, hypothyroidism, hyperthyroidism, and cancer. In the present mini-review, we summarize recent studies shedding new light into the roles of Keap1/Nrf2 signaling in the thyroid.

Ethnic disparities for thyroid surgery.

Significant health disparities exist between Māori and non-Māori patients in New Zealand. Māori patients treated medically for their thyroid disease are less likely to be euthyroid. The prevalence of thyroid disease and characteristics of Māori presenting for thyroid surgery has not been well studied. We aim to assess the differences in ethnic representation for thyroid surgery. A retrospective analysis of cases performed between 2009 and 2019 at the Otolaryngology/Head and Neck Department in Waikato District Health Board (DHB) was completed. All patients who received a thyroid operation were included and divided into Māori and non-Māori groups. Clinical and operation notes were reviewed and the duration of presenting symptoms, weight, volume and diagnosis of the thyroid gland were assessed. A total of 93 patients were included in our study, of whom 71 patients were female and 22 male with 37 being Māori and 56 non-Māori. Māori patients had significantly higher rates of retrosternal extension, compressive symptoms, post-operative complications, delayed presentation and larger thyroid goitres when compared to non-Māori (P < 0.05). Our study confirms that there is a significant ethnic disparity for Māori patients requiring thyroid surgery. This highlights an additional poor health outcome for Māori compared to non-Māori patients.

Primary headache subtypes and thyroid dysfunction: Is there any association?

Primary headaches, and particularly migraine and tension-type headache (TTH) as well as hypothyroidism are common medical conditions. To date, numerous studies have suggested a possible bidirectional relationship between migraine and hypothyroidism, although certain studies had contradictory results. To investigate whether there is any association between primary headache subtypes and thyroid disorders. A retrospective study of consecutive patients aged ≥18 years referred to the Headache Outpatient Clinic of Aeginition Hospital and diagnosed with primary headache and any thyroid disorder. Out of 427 patients (males/females=76/351), 253 (59.3%) were diagnosed with migraine without aura, 53 (12.4%) with TTH, 49 (11.5%) with migraine with aura, 29 (6.8%) with medication-overuse headache, 23 (5.4%) with mixed-type headache (migraine with/without aura and TTH), nine (2.1%) with cluster headache, and 11 (2.6%) with other types of primary headaches. The prevalence of any type of thyroid disorder was 20.8% (89/427 patients). In the total sample, 27 patients (6.3%) reported hypothyroidism, 18 (4.2%) unspecified thyroidopathy, 14 (3.3%) thyroid nodules, 12 (2.8%) Hashimoto thyroiditis, 12 (2.8%) thyroidectomy, three (0.7%) thyroid goiter, and three (0.7%) hyperthyroidism. Further statistical analysis between categorical variables did not reveal any significant association between headache subtypes and thyroid dysfunction. No specific association was found between primary headache subtypes and specific thyroid disorder. However, a high prevalence of thyroid dysfunction in general and specifically hypothyroidism was demonstrated among patients with primary headaches, which lays the foundation for further clarification in prospective longitudinal studies.

Iodine nutrition status of women after 10 years of Lipiodol supplementation: a cross-sectional study in Xinjiang, China.

This study examined the contribution of long-term use of Lipiodol capsules, as a supplement to iodised salt to the control of iodine deficiency disorders among women in Xinjiang of China. A total of 1220 women across Kashgar, Aksu, Turpan and Yili Prefectures were surveyed in 2017. Lipiodol capsules were administered twice yearly in Kashgar and once yearly in Aksu and Turpan, but not in Yili. Urinary iodine concentration (UIC), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroglobulin antibody, thyroid peroxidase antibody and thyroid volume values were assessed. All the women in the four areas were in a state of non-iodine deficiency by UIC. The UIC were higher than adequate in Kashgar and Aksu (619·4 v. 278·6 μg/l). Thyroid hormone levels differed significantly in Turpan and Yili (FT3: 4·4 v. 4·6 pmol/l, FT4: 13·8 v. 14·2 pmol/l, TSH: 2·0 v. 2·7 mIU/l), but did not differ significantly in Kashgar, Aksu and Yili. The four areas did not differ significantly with regard to thyroid nodules, autoimmune thyroiditis or goitre. However, the detection rates of subclinical hypothyroidism (16·6 %) and total thyroid dysfunction (25·4 %) were higher among women in Yili. The supplementation with Lipiodol capsules had improved the iodine nutrition status of women in iodine-deficient areas of Xinjiang since 2006. To avoid negative effects of excess iodine, we suggest a gradual discontinuation of Lipiodol capsules in women with special needs based on the existing iodine nutrition level of local women.