Type Of Goiter Research Articles

Cancer of the thyroid; morphological and clinical study of two hundred six cases.

Terminology Our terminology incorporates all types of thyroid cancer listed in American and European classifications. The terms used in the different thyroid clinics have been correlated. Geographic Pathology The incidence of the different goiter types is given for American and European localities. Papillary carcinoma is the commonest type in America, but rare in Switzerland. Proliferant adenoma is the commonest type in Switzerland, but almost unknown in America. Frequency, Age, and Weight Our 206 cases were found in 3,029 goiter operations, giving a percentage of 6.8; 13.8% of the solitary adenomas were malignant, but only 1.1% of diffuse goiters. The average age was lower in the less malignant types than in highly malignant goiters (45 vs. 56 years). The weight of the surgical specimens was three times as much in highly malignant goiters as in less malignant (140 vs. 53 gm.). Preoperative Diagnosis Cancer was suspected in 14.3% of thyroid cancer

The syndrome of congenital goiter with butanol-insoluble serum iodine

Clinical and laboratory data on five patients suffering from one variety of congenital hypothyroidism with goiter are reported, and similar cases from the literature are reviewed. In these patients hypothyroidism and goiter develop early in life. They may suffer permanent physical and mental retardation unless the disorder is detected and adequate replacement therapy is given. There is increased RaI 131 uptake by the thyroid and no release of I 131 upon administration of potassium thiocyanate. The deiodinase activity is normal. An abnormal iodinated polypeptide or protein is secreted by the thyroid. It is detected by its failure to extract into n-butanol from acidified serum. A similar complex is present in the urine. Abnormalities in the distribution of I 131 in the thyroid subcellular particulate fractions and in the thyroidal proteins have been detected in the two glands which have been available for analysis. This syndrome may be the expression of a congenital defect in thyroglobulin synthesis. Similar observations in certain patients with adenomatous colloid goiter suggest that this type of congenital goiter and a type of adenomatous colloid goiter may represent different levels of expression of a common genetic defect.

Effect of desiccated thyroid in lymphocytic (Hashimoto's) thyroiditis.

A total of 97 patients with nontoxic goiters were treated at the Mayo Clinic with physiologic closes of desiccated thyroid. Of these 97 patients, 36 had histologically proved lymphocytic thyroiditis; 48 were thought to have lymphocytic thyroiditis on the basis of strong clinical and laboratory evidence; 7 had surgically proved adenomatous goiters and 2 others were thought to have this type of goiter; 3 had regenerative hyperplasia after thyroidectomy for Graves' disease; and 1 had proved colloid goiter. Most of the goiters that were caused by lymphocytic thyroiditis responded to treatment with desiccated thyroid, whereas most of those which were adenomatous did not.

Observations in the treatment of hyperthyroidism with I131.

Article1 August 1957OBSERVATIONS IN THE TREATMENT OF HYPERTHYROIDISM WITH I131ROBERT E. BECK, M.D., ARTHUR A. HOBBS JR., M.D.ROBERT E. BECK, M.D.Search for more papers by this author, ARTHUR A. HOBBS JR., M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-47-2-241 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptINTRODUCTIONWithin the last decade radioactive iodine has become the therapeutic agent of first importance in the treatment of hyperthyroid disease. It is commonly accepted as the treatment of choice in Graves's disease,1, 2 and has been used in the treatment of other types of hyperthyroidism.There continues to be disagreement as to the advisability of its use for younger people, in certain types of goiter, and with reference to exophthalmos.3, 6Dosage is still somewhat empiric, though related mathematically to the estimated size of the thyroid and the tracer dose uptake.7, 12It is our purpose to relate briefly...Bibliography1. HamwinGoldberg GJRF: The modern treatment of thyrotoxicosis, Arch. Int. Med. 97: 453-465, 1956. CrossrefGoogle Scholar2. FeitelbergKaunitzSolomonWassermanYohalem SPSSNLRSB: Hyperthyroidism; treatment with radioactive iodine, Arch. Int. Med. 85: 471-478, 1950. CrossrefGoogle Scholar3. CookJonesMcCullagh JRRWEP: Treatment of toxic adenomatous goiters by large doses of radioactive iodine, J. Clin. Endocrinol. and Metabolism 15: 1512-1517, 1955. CrossrefGoogle Scholar4. BeierwaltesJohnson WHPC: Hyperthyroidism treated with radioiodine, Arch. Int. Med. 97: 393-402, 1956. CrossrefGoogle Scholar5. ChapmanEvans EMR: Treatment of toxic goiters with radioactive iodine, M. Clin. North America 33: 1211-1223, 1949. CrossrefMedlineGoogle Scholar6. WernerQuimbySchmidt SCEHC: Clinical experience in diagnosis and treatment of thyroid disorders with radioactive iodine, Radiology 51: 564-581, 1948. CrossrefMedlineGoogle Scholar7. ClarkRuleTrippleCofrin DEJHOHDA: Five year experience with radioactive iodine in treatment of hyperthyroidism, J. A. M. A. 150: 1269-1272, 1952. CrossrefMedlineGoogle Scholar8. SeedJaffe LB: Comparison of tracer dose and therapeutic dose of I131 as to thyroid uptake, effective half life and roentgen dosage, Radiology 63: 551-561, 1954. CrossrefMedlineGoogle Scholar9. StoneCatzPetitStarr HBDP: Therapeutic studies in hyperthyroidism; use of radioactive iodine, California Med. 81: 4-6, 1954. MedlineGoogle Scholar10. BallsChamberlainRoseGorsonBlount KFRHEROHC: The treatment of thyrotoxicosis with radioiodine, Radiology 64: 858-866, 1955. CrossrefMedlineGoogle Scholar11. HainesKeatingPowerWilliamsKelsey SFFRMHMMMP: Use of radioiodine in treatment of exophthalmic goiter, J. Clin. Endocrinol. and Metabolism 8: 813-825, 1948. CrossrefGoogle Scholar12. WilliamsToweryJaffeRogersTagnon HBTHWFR: Radiotherapeusis, Am. J. Med. 7: 702-717, 1949. CrossrefMedlineGoogle Scholar13. Kelly FJ: Observations on the calculation of thyroid weight using empirical formulae, J. Clin. Endocrinol. and Metabolism 14: 326-335, 1954. CrossrefGoogle Scholar14. QuimbyWerner EHSC: Late radiation effects in roentgen therapy for hyperthyroidism; their possible bearing on the use of radioactive iodine, J. A. M. A. 23: 1046-1947, 1949 (Letter to the Editor). CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Evansville, Indiana*Received for publication October 15, 1956.From the Department of Radiology, Protestant Deaconess Hospital, Evansville, Indiana.Requests for reprints should be sent to Robert E. Beck, M.D., The Protestant Deaconess Hospital, 600 Mary Street, Evansville, Indiana. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySuccessful Treatment of Solitary Toxic Thyroid Nodules with Relatively Low-Dose Iodine-131, with Low Prevalence of HypothyroidismDOUGLAS S. ROSS, M.D., E. CHESTER RIDGWAY, M.D., GILBERT H. DANIELS, M.D.Die Strahlentherapie gutartiger Erkrankungen innersekretorischer DrüsenDie Strahlentherapie gutartiger Erkrankungen innersekretorischer DrüsenDie Behandlung der Hyperthyreose mit RadiojodTHE TREATMENT OF TOXIC NODULAR GOITER WITH RADIOACTIVE IODINE: 10 YEARS' EXPERIENCE WITH 436 CASES*MILTON ELLER, M.D., SOLOMON SILVER, M.D., F.A.C.P., STEPHEN B. YOHALEM, M.D., F.A.C.P., ROBERT L. SEGAL, M.D.VARYING RESPONSES TO RADIOACTIVE IODINE (I131) THERAPY IN HYPERTHYROID PATIENTS*MELVIN D. CHEITLIN, ROBERT BERNSTEIN, EDWARD A. LANGDON 1 August 1957Volume 47, Issue 2Page: 241-247KeywordsDiagnostic radiologyGeneticsHyperthyroidismThyroidThyroidectomy ePublished: 1 December 2008 Issue Published: 1 August 1957 PDF downloadLoading ...

Effect of estrus and estrogen on thyroid uptake of I131 in rats.

HYPERTHYROIDISM, nodular goiter and other types of thyroid disease are more frequently found in women than in men. Goiter, also, often becomes strikingly manifest during puberty, pregnancy and the menopause. This apparent relationship between ovarian function and thyroid pathology has been studied by many investigators. Unfortunately the results have been conflicting. Some have reported that ovarian hormones depress thyroid function (Franck, 1937; Gardner, 1949; Heyl et al., 1934; Karp and Kostkiewicz, 1934; Kreitmar and Sieckman, 1939; Miiller and Aeppli, 1949); others, that ovarian hormones increase thyroid activity (Andersen, 1935; Chouke et al., 1935; De Amilbia et al., 1936; Desclin and Ermans, 1951); and still others have observed no distinct influence upon thyroid structure and physiology (Arnold et al., 1938; Paschkis et al. 1948). A few reports have indicated that estrogens both stimulate and depress thyroid function, depending upon the dose and period of administration (Freudenberger and Clausen...

GOITERS IN CHILDHOOD

CHILDREN with various types of goiter presently constitute approximately 16 per cent of the new admissions for primary endocrine disease seen in the Adolescent Endocrine Clinic at the Massachusetts General Hospital. Hence, it is evident that these conditions are by no means uncommon. In all fairness to the non-endocrinologist, however, the frequency of occurrence should be put in a second frame of reference. Such perspective is gained by noting that only about 1 per cent of the total new admissions to this hospital are comprised of patients with primary endocrine disorders. Thyrotoxic goiter and 5 other types will be given consideration; the latter include neonatal goiter, the goiters of adolescence and lymphocytic infiltration, the goiter of defective thyroxin synthesis and, finally, thyroid carcinoma. Iodine deficiency goiter has become so rare in this country as a result of prophylaxis as to deserve no more than mention. In the past 5 years we have encountered only 1 case, that in a boy of 8 years, a recent immigrant from the Italian Alps. NEONATAL GOITER Goiters in newborn infants are not seen frequently but every pediatrician who deals with neonates should be in a position to recognize the syndrome, understand its causation and prognosis and to advise therapy. These goiters are seen most frequently in infants born of mothers receiving iodides for hay fever or asthma or of mothers being treated for thyrotoxicosis with one of the thyroid synthesis blocking agents. In the first instance, iodide or an iodide metabolite appears to cross the placenta and block the fetal TSH secretion.

Thyroid cancer in a general hospital.

During the last decade there have been a number of reports dealing with the occurrence of cancer of the thyroid. These articles have placed particular emphasis upon the incidence of cancer in the nontoxic solitary thyroid tumor. Ward 1 in 1947 reported a 15.6% incidence in nontoxic solitary nodular goiter. Cole 2 in 1949 reported an incidence of 24.4%, and Crile 3 in the same year found an incidence of 24.5% in this type of goiter. Previous to this time the nodular goiter had been classified as toxic or nontoxic, and the importance of the solitary type of nontoxic nodular goiter had not been emphasized. This high incidence (24.5%) of cancer is in great contrast to the findings of Watt, 4 who in 1951 reported an incidence of 2.5% of cancer in nontoxic solitary nodular goiters from an Atlantic seaboard area. Sokal * in three recent articles has presented a statistical

Occurrence of thyroid cancer in San Francisco.

IN the literature, the occurrence of cancer of the A thyroid gland has been studied at numerous teaching hospitals and large clinics by comparison, over a period, with the type of goiter seen clinically, with the number of thyroid operations, with the number of deaths or with the number of autopsies. Sokal,1 after estimating prevalence and incidence by combining clinical data, mortality statistics and autopsy statistics, presents his conclusions in a more tangible and vivid manner. He states that in a hypothetical city of 1,000,000 there would be 25 patients with thyroid cancer at any given time, that on the . . .

Carcinoma of the thyroid gland.

IN 1945 we (1) presented a nine-year study of the incidence of thyroid carcinoma in goiter at the Illinois Research Hospital and found that in 192 patients with nontoxic nodular goiter having thyroidectomy, the incidence of carcinoma was 17.1 per cent. This figure appeared unusually high because, prior to this time, investigators were reporting the incidence of thyroid carcinoma in all types of goiter without breaking down the figures to show the incidence in the different types of goiter. The present study, including all patients observed during the past seventeen years (1936–1952 inclusive), is presented to re-evaluate and compare the trends between our original report, 1936 to 1944 inclusive, and the subsequent period, 1944 to 1952 inclusive. During the seventeen years between 1936 and 1952 inclusive, 1,429 thyroidectonry operations for all types of goiter have been performed at the Illinois Research Hospital (Table 1). Seventy-five cases of carcinoma have been encountered—an incidence of 5.2 per cent ...

The iodine-deficient human thyroid gland; a preliminary report.

THE role of iodine deficiency in endemic goiter was established by the pioneer studies of Marine (1) and Chatin (2). Spectacular results have been achieved in the prophylaxis of this type of goiter by the use of iodized salt, and in many of the former endemic areas of the world the disease has now vanished; but this public health measure was begun before the introduction of modern tools of thyroid research. No reports are available in which radioisotope techniques were used in the study of the iodine-deficient thyroid gland in man, and the same is true of modern accurate chemical methods of iodine determination. It seemed reasonable that these techniques applied to a study of the deficient human thyroid would yield information of value, because such a gland, working in precarious equilibrium with the iodine supply, might allow measurements which would permit more precise definition of thyroid dynamics than does the semidormant gland abundantly supplied with iodide. With this objective, the iodine-deficien...

Histology of goiter and blood iodine.

TWENTY years ago we1studied the structure and function of goiter as observed in the Hertzler Clinic and, using the international classification of goiter, compared its histology with that described in other parts of the world (Table 1). From a study of 151 cases we concluded in 1929 that the goiter types in the Middle West were very different from those in mountainous regions of high endemicity. While Swiss surgeons see only 7% diffuse and 93% nodular goiters, we had 53% diffuse forms. While in Switzerland 70.7% of all goiters were fetal adenomas, only 13.9% of the surgical goiters in Kansas were of this type. Sixty-two per cent were colloid goiters, while Swiss surgeons report only 26.3%, and in Switzerland only 3% of all surgical goiters are toxic, compared with an incidence here of 65.6% (Table 2). It became evident from these comparative studies that Middle Western types of

MALIGNANCY IN ADENOMAS OF THE THYROID

Except for the rare case of the microscopic diagnosis of carcinoma in hyperplastic thyroid glands, it is now quite generally accepted that the origin of cancer of the thyroid is, for practical purposes, in the preexisting adenoma of the gland. While this premise has been repeatedly promoted by us and by many others, there is still a great variation in the reported percentage incidence of malignant disease in the various types of adenomatous goiter, and there is even mild disagreement by some that the incidence of malignant degeneration in adenomatous goiter is such as to make it worth while for a patient or a physician to concern himself with it. We should particularly like to give credit to Dr. Allen Graham for his interest and persistence in clarifying and promoting the above thesis. His work in connection with malignancy in adenoma of the thyroid has been of inestimable value to

INCIDENCE OF CARCINOMA OF THE THYROID IN NODULAR GOITER*

FOUR years ago we reviewed the data in the Illinois Research Hospital on carcinoma of the thyroid with particular reference to its incidence in goiter. We noted that carcinoma was found in 17.1 per cent of all our patients having thyroidectomy for nontoxic nodular goiter (1). One of the reasons why this figure appeared high was because other authors had failed to break down the types of goiter and had reported the incidence in all types of goiter, or in both types of nodular goiter combined. Our incidence of carcinoma in toxic and nontoxic nodular goiter was 7.2 per cent in the 1936–1944 series. Since this figure appeared quite high, we decided a few months ago to review our recent data. By a strange coincidence, the incidence of carcinoma in nontoxic nodular goiter was found to be almost identical, namely, 17.2 per cent. The incidence of carcinoma in toxic nodular goiter varies considerably, as would be expected, largely because there is considerable difficulty in determining whether or not certain mild ...

USE OF PROPYLTHIOURACIL IN THE TREATMENT OF TOXIC GOITER

FOR THE first time in the history of surgical treatment of the thyroid, it is now possible to operate on all types of toxic goiter with comparatively little risk. While effective in the preoperative and postoperative care of exophthalmic goiter, iodine has not been effective in lowering the operative risk in cases of advanced toxic adenoma. Thiouracil and propylthiouracil (thiourea derivatives), on the contrary, are extremely beneficial in preparing both exophthalmic goiter and toxic adenoma for operation. Thiouracil, because of its tendency to cause toxic reactions and, especially, granulocytopenia, has been largely abandoned for the much safer propylthiouracil. From a study of 170 cases of hyperthyroidism in which treatment was with propylthiouracil during the past two years, some conclusions have been reached. 1. After several months' treatment, patients with advanced multiple toxic adenoma with a serious cardiovascular condition may be operated on with almost as little risk as patients with

POTENTIAL DANGERS OF NONTOXIC NODULAR GOITER

Although the indications for surgical therapy are quite definite and generally agreed to in toxic diffuse goiter, the indications are less clear and urgent in nontoxic nodular goiter. Nevertheless it is well known that nontoxic nodular goiter may develop toxicity or be the site of carcinoma, although the incidence of these changes is not fully realized nor are the dangers appreciated. A study of patients in our clinic with carcinoma of the thyroid and nontoxic nodular goiter has convinced us that numerous complications (including particularly the two just mentioned) developing in this type of goiter may make surgical therapy quite urgent in this seemingly harmless lesion. TYPES OF COMPLICATIONS RESULTING FROM NONTOXIC NODULAR GOITER 1. Carcinoma.— It is now agreed that carcinoma of the thyroid gland arises in adenomatous growths in the majority of instances; some workers make the rather dogmatic statement that 80 to 85 per cent

Use and abuse of iodine in the management of goiter

The answers to this questionnaire reveal that 96 per cent of the physicians suggest the use of iodine in the form of Lugol's solution (10 drops weekly) or one 10 mg. idostrone tablet weekly, alone or with dessicated thyroid extract in the treatment of colloid goiter. Eighty-eight per cent find it necessary to correct mild diffuse (exophthalmic) goiter by subtotal thyroidectomy, and another 8 per cent suggest surgery if the condition is not cured in a reasonable period of time with iodine medication. The opinion is practically unanimous (99 per cent) that nontoxic nodular (adenomatous) goiter should not be treated with iodine medication. As many as 79 per cent of the physicians agree that the promiscuous administration of iodine produces activation or toxicity in this type of goiter. In toxic goiter, we note the greatest abuse in the use of iodine medication. Almost 90 per cent of the patients treated by goiter surgeons have had previous iodine medication, which produces an increase in the operative risk, and a very definite increase in the morbidity, especially since stage operations are often necessary in order to prevent an increased mortality. Practically all postoperative thyroid crises occur in patients who have had long continued iodine medication before consulting the goiter surgeon.

Goiter in surgical practice

In this series of consecutive cases of disease of the thyroid gland subjected to partial thyroidectomy there may be found what the author believes to be a fairly normal distribution of the different types of goiter. The pre- and postoperative care, the operation, the pathology and the post-operative complications have been discussed. There were no instances in the group of injury to the recurrent laryngeal nerve, nor of injury to the blood supply of the parathyroids. There were no fatalities and all patients were definitely improved on discharge from the hospital and when examined on return visits. Until a five year period has elapsed, no statement can be made concerning recurrences.

THE EFFECT OF IODINE IN ADENOMATOUS GOITER

There is some misunderstanding, even yet, among certain of the profession with regard to the action of in the various types of goiter. It is generally recognized that in any form (we use aqueous solution of iodine, Lugol's solution, as a routine) causes a very beneficial response when used in exophthalmic goiter. This occurs practically without exception, but the is especially useful in the preoperative treatment of exophthalmic goiter. We do find iodine fast cases of exophthalmic goiter or patients who have been overtreated with iodine. These patients, as a result either of a developed tolerance to or of excessive overactivity of the thyroid, finally reach a stage at which their toxic symptoms fail to recede with medication and may even progress. We do not know just how or why this occurs, but it does occur. To be entirely on the safe side, one should

CLINICAL ASPECTS OF STRUMA LYMPHOMATOSA (HASHIMOTO)

Struma lymphomatosa (Hashimoto) is a rare type of abnormality of the thyroid gland, first described by Hashimoto in 1912.1Because of the infrequency of its occurrence, this type of goiter has been discussed almost exclusively by pathologists who, following Hashimoto's work, occasionally have noted in certain cases the curious histology which he described. By clinicians this lymphoid infiltration of the thyroid is generally considered as a type of chronic thyroiditis, usually Riedel's struma, which it closely resembles in many respects.2Since, however, pathologists3occasionally report this rare condition, it is of importance that the clinical features of struma lymphomatosa be reviewed and the results of treatment noted. The fundamental picture in struma lymphomatosa is that of a degenerative change in the thyroid gland, unaccompanied by evidence of acute inflammatory process. Microscopically one sees a diffuse lymphoid infiltration between the follicles, with the frequent formation of secondary nodules.

Correct and incorrect use of iodine in the treatment of goiter

Iodine has an important relationship to the normal function of the thyroid gland in which it is constantly present and is stored as a normal constituent. Simple colloid goiter, the inactive type of parenchymatous goiter, commonly develops whenever there is a deficient intake or a faulty metabolism of iodine in the body. Simple colloid or endemic goiter may be prevented by the prophylactic administration of minute amounts of iodine. Iodine, in small amounts, together with small amounts of thyroid extract is advised in the treatment of simple goiter. This is the only type of goiter in which the therapeutic administration of iodine is indicated. The prolonged administration of iodine to the simple colloid goiter may however occasionally stimulate the gland with the consequent production of hyperthyroidism. A correct diagnosis as to the type of goiter is therefore of the greatest importance in order to institute correct therapy. A non-toxic goiter may be activated and the symptoms of a toxic goiter may be exacerbated by the indiscriminate administration of iodine. The administration of iodine during pregnancy is indicated only in case inactivity of the thyroid gland is present. The physiologically overactive thyroid gland in pregnancy may be stimulated to further activity resulting in a state of true clinical hyperthyroidism. The administration of iodine does not prevent the growth and development of true adenoma and has no place in the medical treatment of this condition. Non-toxic adenoma is commonly activated by indiscriminate treatment with iodine and the symptoms of toxic adenoma are exacerbated by its use. The preoperative intensive preparation of the majority of patients with toxic adenoma does not produce improvement comparable to that seen in the case of exophthalmic goiter. The acutely toxic adenomatous goiter particularly when the metabolic rate is high, is often favorably influenced by the use of iodine, whereas those cases of adenoma with lesser degrees of hyperthyroidism may show relatively little improvement. An appreciable number in this group may be made acutely worse. The hyperplastic thyroid gland has an extraordinary affinity for iodine which causes the hyperplasia to revert to the colloid or resting state. Accordingly when iodine is intensively administered to the patient with Graves' disease, previously untreated with iodine, a marked clinical remission in the course of the disease is produced. Operation should be and can be safely performed during this period of remission. The mortality of resection operations done during the period of remission has been reduced almost to nil, and stage operations are rarely necessary. If thyroid resection is not done at this favorable time of remission, the patient often relapses into a state of clinical exacerbation in the course of one to two or even three months. A condition of uncontrollable hyperthyroidism may thus result. Similarly, exacerbation may follow upon the administration of iodine even in small doses, over a prolonged period. The hyperplastic thyroid gland in the phase of reactivation following a previous period of treatment with iodine becomes relatively insensitive or refractive to the further administration of iodine. The preoperative treatment with iodine does not protect the iodized patient with toxic adenoma or Graves' disease in any way comparable to the protection afforded the patient not previously so treated. The patient suffering with an acute exacerbation following prolonged use of iodine may be a dangerous operative risk whether iodine is given preoperatively or not. It is particularly in these circumstances that recourse must be had to multiple operations such as preliminary ligation and single lobectomies to eliminate the increased risk involved in a primary double lobectomy. Iodine has little effect in controlling postoperative hyperthyroidism. There is no evidence that the postoperative administration of iodine reduces the incidence of recurrent hyperthyroidism. The spontaneous hyperthyroid crisis occurring occasionally in the course of severe Graves' disease may be effectively controlled by large doses of iodine given either orally or intravenously. When the crisis occurs as a result of the incorrect use of iodine, the further administration of iodine, even in large amounts, is ineffectual and a fatal outcome may ensue.