Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the "SERENA study", a randomized, double-blind, placebo-controlled trial.

PURPOSE: Selenium is frequently in nutraceuticals for pregnancy, given its role on fertility and thyroid metabolism. However, most evidence rise from non-controlled studies. We aimed to evaluate the protective effect of selenium against thyroid autoimmunity during and after pregnancy. METHODS: A multicenter, randomized, double-blind, placebo-controlled trial was performed and promoted by the Young Italian Endocrinologists Group (EnGioI)-Italian Society of Endocrinology. Forty-five women with thyroiditis in pregnancy were enrolled and randomly assigned to L-selenomethionine (L-Se-Met) 83 mcg/day or placebo (PLB) and evaluated at 10 ± 2 (T1), 36 ± 2 weeks of gestation (T2) and 6 months after delivery (postpartum, PP). RESULTS: We measured a significant reduction of autoantibodies after pregnancy in L-Se-Met group [at PP: TgAb 19.86 (11.59-52.60), p < 0.01; TPOAb 255.00 (79.00-292.00), p < 0.01], and an antibodies titer's rebound in PLB group (TgAb 151.03 ± 182.9, p < 0.01; TPOAb 441.28 ± 512.18, p < 0.01). A significant increase in selenemia was measured in L-Se-Met group at T2 (91.33 ± 25.49; p < 0.01) and PP (93.55 ± 23.53; p = 0.02). Two miscarriage occurred in PLB. No differences were found in thyroid volume, echogenicity, quality of life, maternal/fetal complications. CONCLUSIONS: SERENA study demonstrated a beneficial effect of L-Se-Met supplementation on autoantibody titer during pregnancy and on postpartum thyroiditis recurrence.

Trends of thyroid function and autoimmunity to 5 years after the introduction of mandatory iodization in Italy.

Background. Mandatory iodine fortification of salt was introduced in Italy in 2005. The purpose of our study is to estimate the trend of thyroid diseases in Italy before and after mandatory iodization in Italy. Methods. 7976 patients (6802 females; 1174 males) were examined between 2003 and 2010. We divided the patients into categories according to their clinical diagnosis. Later, we evaluated for each patient if there was the positivity for antibodies anti TPO. Finally, we collected data about TSH values of all patients who did not use therapy for thyroid disease at the time of the examination. To evaluate the differences percentages for categorical variables, χ2-Pearson test was used; to evaluate the percentage differences of TSH values we used the Kruskal-Wallis test. Values were considered statistically significant at p < 0.05. Results. We considered diagnosis of "toxic adenoma / goiter", diagnosis of "Graves' disease" and diagnosis of "hyperthyroidism / thyrotoxicosis" before and after the introduction of mandatory iodization in Italy, to demonstrate the possible presence of iodine-induced hyperthyroidism. Diagnosis of toxic adenoma / goiter before 2005 were 3.7%, while after 2005 they were reduced to 3.1%. Diagnosis of Graves' disease before 2005 were 2.4%, and they remained unchanged after 2005. Finally, diagnosis of hyperthyroidism / thyrotoxicosis decreased from 2.5% to 2.1%. Comparing these results, there were no significant differences (P = 0.261) between the percentages of diagnosis of hyperthyroidism before and after the introduction of mandatory iodization. We considered diagnosis of Hashimoto's thyroiditis before and after 2005 to demonstrate a link between the administration of iodine and thyroid autoimmunity. Prevalence of Hashimoto's thyroiditis between 2003 and 2005 was 37%; prevalence between 2006 and 2010 dropped to 34.7%. This small difference has a borderline statistical significance (P = 0.049). Stratifying TSH values from year to year, we found a small increase in TSH value, which, in any case, remains in the normal range. TSH values passed from 1.37 in 2003, to 1.61 in 2010. Although this increase is modest, it is statistically significant (P values < 0.001). Conclusion. In this study there isn't a connection between iodine fortification and iodine-induced hyperthyroidism, and between iodine fortification and Hashimoto's thyroiditis. This small increase of TSH values can not find a clear explanation yet. We considered several mechanisms to explain this phenomenon: alterations of Na/I symporter reduce intracellular levels of iodine, and cause a state of hypothyroidism; excessive levels of iodine can increase apoptosis of thyrocytes, as it is demonstrated by several studies; interference from external agents (endocrine disruptors).

Influence of thyrotropin and thyroid volume on basal serum calcitonin.

Thyroid volume was found to be a determinant of serum calcitonin levels in animal models and in thyroid-healthy subjects, as recently reported. This study aims to evaluate if this finding is confirmed in patients undergoing ultrasonography-guided fine-needle aspiration cytology of suspicious thyroid nodules. A dataset of 561 patients including basal serum FT4, FT3, TSH, calcitonin, thyroid volume, anti-thyroperoxidase antibodies (TPOAb), and cytology report, was retrospectively analysed. The median thyroid volume was 20.5 ml (14.5-26.8) in males and 12.0 ml (9.3-17.0) in females (p<0.001). The overall median serum calcitonin value was 2.00 pg/ml (2.00-3.10). A Spearman's correlation was performed between serum calcitonin levels and thyroid volume, showing a weak direct relationship (rs=0.173, p<0.001). This relationship is confirmed both in the smokers group (rs=0.337, p=0.003) and in non-smokers group (rs=0.115, p=0.012), and both in the TPOAb-positive patients (rs=0.419, p<0.001) and negative ones (rs=0.107, p=0.025). There is no correlation between serum TSH and calcitonin levels. In patients grouped according to morphologic diagnosis, calcitonin levels are slightly higher in the high-volume groups: the interquartile range was 2.00-2.00 pg/ml in the atrophy, 2.00-2.82 pg/ml in the normal volume, and 2.00-3.85 pg/ml in the goiter group (p=0.02). When males and females are computed separately, the statistical significance is lost. In conclusion, thyroid volume can mildly influence calcitonin levels. Gender acts as a "surrogate marker" of thyroid volume and the application of a gender-specific cut-off can probably overcome this issue in clinical practice.

Total thyroidectomy for Graves' disease treatment.

OBJECTIVES: Graves' disease (GD) is the most common cause of hyperthyroidism, and accounts worldwide for 60-80% of all cases. The diagnosis is based on clinical findings, and is confirmed by the presence of TRAB, suppression of TSH, and elevation of free thyroxin (free T4), and triiodinethyronin (free T3). GD can be treated by antithyroid drugs, radioactive iodine, or surgery. The aim of this study was to review retrospectively the surgical management, in terms of safety and efficacy, in 50 patients operated in the Department of Surgical Sciences since 2005 through 2010 and followed up at the Endocrinology Unit A of the Experimental Medicine Department. We assessed postoperative complications, which included the presence, persistence and development of ophthalmopathy, transient hypocalcemia, permanent hypoparathyroidism and recurrent laryngeal nerve palsy. MATERIALS AND METHODS: We analyzed data from 50 patients with GD who were eligible and underwent Total Thyroidectomy (TT). Thirty-nine patients underwent TT for recurrent hyperthyroidism after medical therapy and eleven patients for severe ophtalmopathy. The mean follow up was 41 months (range: 10-70). RESULTS: Eleven patients had ophtalmopathy before surgery. Four patients developed an ophtalmopathy after surgery. Eleven patients presented hypocalcemia, transient in ten patients and permanent in one patient. Five patients developed a transient disphony. Conclusions. Total thyroidectomy is a safe and radical procedure in Graves' disease treatment. Complications of TT are not different than subtotal thyroidectomy if it's performed by expert surgeons.

Minimally invasive thyroidectomy and the differentiated lesions: the way to follow.

BACKGROUND AND OBJECTIVES: Nowadays, the conventional thyroidectomy may appear an overly aggressive treatment in patients undergoing intervention for small suspicious lesions harboring in low volume glands. In these cases a minimally invasive approach may be a safe and appropriate option. This work aims to evaluate the effectiveness of minimally invasive thyroidectomy in patients indicated to surgery for small lesions with preoperative suspicion of malignancy. PATIENTS AND METHODS: 71 patients, undergoing minimally invasive total thyroidectomy as a single procedure between May 2005 and April 2009, were enrolled in this study. They were indicated to surgery for small suspicious or malignant lesions (up to 20 mm lenght by US; cT1 according to UICC 2002) and satisfied the inclusion criteria of minimally invasive thyroidectomy, with gland volume up to 25 ml, no evidence of locally advanced disease and no previous neck surgery. The outcomes were considered in terms of complication rate, postoperative pain, hospitalisation stay, cosmetic results and completeness of surgical resection in malignancies. RESULTS: A low complication rate was registered. The surgical completeness, with mean serum thyroglobulin of 4.41 +/- 4.03 ng/ml and radioiodine uptake of 2.91 +/- 2.46%, was considered acceptable if compared with other experiences reported in literature. Excellent results with respect to patient comfort, postoperative pain and cosmetic outcome were obtained. CONCLUSION: This study confirms, where a correct selection of patients is made, the safety and the effectiveness of minimally invasive approach in the treatment of small suspicious and malignant nodules, which seem to represent its best indication.

Thyroid diseases in women with breast cancer.

AIM: Several studies have been undertaken to investigate a possible link between breast cancer and thyroid diseases, notably thyroid carcinoma and autoimmune thyroid diseases, but the issue remains unresolved. The aim of this study is to evaluate, in thyropathic women with and without breast cancer, the following effects: the distribution of different thyroid diseases, the breast-cancer-related prevalence of anti-thyroperoxidase and anti-thyroglobulin antibodies and the role in thyroid pathology of breast-cancer post-surgery therapy with tamoxifene. MATERIALS AND METHODS: One-hundred-ninety thyropathic women with breast cancer (BC group) were recruited, and compared with a control group (C group) of one-hundred-ninety thyropathic women without breast cancer. RESULTS: Nodular disease is the most frequent pathology in both groups. The difference in the incidence of thyroid carcinoma is also not statistically significant. The biochemical increase in the positivity of autoantibodies in BC-group patients is confirmed, but there is no statistically significant difference in the rate of clinical autoimmune diseases between the two groups. No difference in the frequency of any particular thyroid disease is found between those patients who underwent post-operative tamoxifene therapy and those who did not. CONCLUSION: It can be concluded, on the basis of these results, that it is advisable to reduce the clinical weight of the issue. A routine thyroid screening is recommended in women with BC for the management of chronic comorbidities, as would be for women in the general population having the same age and coming from the same iodine-intake area.

Knowledge of iodoprophylaxis and iodized salt consumption among medical students in Italy.

OBJECTIVES: Iodine deficiency is still a notable health-care problem in several regions of Europe and can be responsible for maternal and fetal goiter, miscarriages, stillbirths, reduced fetal growth, congenital hypothyroidisms, damaged reproduction in adult life, and inadequate development and maturation of the fetal brain, which is the major preventable cause of mental defects. The aim of this study was to assess the medical students' knowledge and practices regarding the program of iodized-salt-use and active iodine prophylaxis program launched by the Italian Ministry of Health. MATERIALS AND METHODS: A self-administered, anonymous, 19 single-item questionnaire was developed. We have collected 294 filled forms: 86 from first-year, 118 from fourth-year and 90 from sixth-year medical students at the First Medical School of 'Sapienza' University of Rome, Italy, in May 2009. RESULTS: Two hundred eighty four students (96.6%) affirm that they know of the existence iodized salt, even though only 199 (67.7%) report personal consumption. This level is quite far from the target (consumption by almost 80% of the general population) suggested by the international literature. No statistically relevant difference was observed between the answers of male and female students. CONCLUSIONS: Our study proves that clinical students have a more detailed knowledge on iodized salt if compared with pre-clinical students, but such knowledge remains overall defective and in some cases absolutely incorrect. Additional education is probably needed to prepare physicians to play a critical role in counseling about iodine prophylaxis.

Medical treatment of hyperthyroidism: state of the art.

Methimazole (MMI) and propylthiouracil (PTU) are the main antithyroid drugs used for hyperthyroidism. They inhibit the synthesis of thyroid hormone at various levels and are used as the primary treatment for hyperthyroidism or as a preparation before radioiodine therapy or thyroidectomy. MMI is the drug of choice because of its widespread availability, longer half-life and small number of severe side effects. Drugs of second choice are potassium perchlorate, beta blockers, iodine, lithium carbonate and glucocorticoids. Rituximab, a monoclonal antibody directed against human CD20, was recently proposed as a biological therapy for cases of Graves' disease unresponsive to traditional drugs.

Diagnostic accuracy of rhTSH test with neck ultrasonography in differentiated thyroid cancer follow-up.

Serum thyroglobulin levels measurement after injection of recombinant human thyrotropin (rh-TSH) represents the most important advance in the follow-up of patients with differentiated thyroid cancer, obtaining TSH elevation without L-thyroxine withdrawal, avoiding marked hypothyroidism symptoms. During a 4-yr period (2004-2008), 66 consecutive patients with DTC (59 papillary and 7 follicular carcinomas) were examined after rh-TSH Tg test and neck ultrasonography. In all patients basal Tg was <0.25 ng/ml. In twelve (18.5%) examined patients rh-TSH Tg was >0.25 ng/ml, and in seven (58.3%) of these was demonstrated persistent or recurrent disease. These data indicate that rhTSH-Tg>0.25 ng/ml should be considered diagnostic for persistent or recurrent disease and suggests further exams (neck ultrasonography, whole body scan or cytology) to localize the disease. Furthermore, neck ultrasonography has demonstrated high accuracy in detecting lymph nodal metastases and should be always combined with rh-TSH test.

[Antithyroid drugs therapy]. / Terapia con farmaci antitiroidei.

Methimazole and Propylthiouracil are the cornerstones in the management of Graves' disease. Their primary effect is to inhibit thyroid hormone synthesis at different steps, i.e. in thyroid gland and in peripheral tissues. Antithyroid drugs can be used as the primary treatment for hyperthyroidism (long term therapy: 1-2 years) or as preparative therapy before radioiodine treatment or surgery (short term therapy: weeks or months). Generally, the starting dose of methimazole is 10-30 mg, as single daily dose, while that of PTU is 100-300 mg every 6 hours. Methimazole is the drug of choice, because major side effects are less common, it can be used as single dose, it's less expensive and more available. As far as the treatment of hyperthyroidism in pregnancy, MMI and PTU have same therapeutic efficacy and are both safe for the fetus, having similar placental transfer kinetics. The use of methimazole can be associated with aplasia cutis and choanal/esophageal atresia, while there are no data supporting the association between congenital anomalies and PTU. For this reason the latter is the drug of choice in the treatment of hyperthryroidism in pregnancy. Both thionamides are present in breast milk, but there are no controindications for their use during lactation.

The estimation of the thyroid volume before surgery--an important prerequisite for minimally invasive thyroidectomy.

INTRODUCTION: Actually, thyroid volume >25 ml, obtained by preoperative ultrasound evaluation, is a very important exclusion criteria for minimally invasive thyroidectomy. So far, among different imaging techniques, two-dimensional ultrasonography has become the more accepted method for the assessment of thyroid volume (US-TV). The aims of this study were: (1) to estimate the preoperative thyroid volume in patients undergoing minimally invasive total thyroidectomy using a mathematical formula and (2) to verify its validity by comparing it with the postsurgical TV (PS-TV). MATERIALS AND METHOD: In 53 patients who underwent minimally invasive total thyroidectomy (from January 2003 to December 2007), US-TV, obtained by ellipsoid volume formula, was compared to PS-TV determined by the Archimedes' principle. A mathematical formula able to predict the TV from the US-TV was applied in 34 cases in the last 2 years. RESULTS: Mean US-TV (14.4 +/- 5.9 ml) was significantly lower than mean PS-TV (21.7 +/- 10.3 ml). This underestimation was related to gland multinodularity and/or nodular involvement of the isthmus. A mathematical formula to reduce US-TV underestimation and predict the real TV was developed using a linear model. Mean predicted TV (16.8 +/- 3.7 ml) perfectly matched mean PS-TV, underestimating PS-TV in 19% of cases. We verified the accuracy of this mathematical model in patients' eligibility for minimally invasive total thyroidectomy, and we demonstrated that a predicted TV <25 ml was confirmed post-surgery in 94% of cases. CONCLUSIONS: We demonstrated that using a linear model, it is possible to predict from US the PS-TV with high accuracy. In fact, the mean predicted TV perfectly matched the mean PS-TV in all cases. In particular, the percentage of cases in which the predicted TV perfectly matched the PS-TV increases from 23%, estimated by US, to 43%. Moreover, the percentage of TV underestimation was reduced from 77% to 19%, as well as the range of the disagreement from up to 200% to 80%. This study shows that two-dimensional US can provide the accurate estimation of thyroid volume but that it can be improved by a mathematical model. This may contribute to a more appropriate surgical management of thyroid diseases.

The minimally invasive surgical approach in thyroid diseases.

AIM: The targets of minimally invasive thyroidectomy could be summarised by: achievement of the same results as those obtained with traditional surgery, better postoperative course and improved cosmetic RESULTS: In minimally invasive surgical approach the skin incision should not exceed 30 mm in length. In our experience this limit may be extended of 5 mm for thyroid between 25 and 50 mL in volume. This way allows more patients, excluded before, to take the advantages of minimally invasive approach. The aim of this work has been to demonstrate that the central neck minimally invasive approach is safe, less painful, better for cosmetic results and easily reproducible in surgical practice. METHODS: From January 2003 to June 2007, 75 patients have been selected for minimally invasive thyroidectomy. The procedure was carried out through a central skin incision performed ''high'' between the cricoid and jugular notch. Our ''modified Miccoli-procedure'' consists in five-easily repeatable steps. In the postoperative stay, all patients were asked to evaluate the pain that feel and the cosmetic result by means of a numeric scale. RESULTS: The skin incision performed was from 25 to 30 mm (mean 27.39 +/- 2.6 mm). We obtained in all cases excellent results about patients cure rate and comfort, few postoperative pain and attractive cosmetic CONCLUSION: In this study we demonstrate that the central neck minimally invasive approach is safe, less painful, better for cosmetic results, with less paresthetic consequences and easily reproducible in surgical practice. In our opinion a longer incision (up to 35 mm), does not affect negatively the advantages of minimally invasive procedure. This way allows more patients to take the advantages of minimally invasive approach.

Trend in thyroid carcinoma size, age at diagnosis, and histology in a retrospective study of 500 cases diagnosed over 20 years.

Recently, the Italian Network of Cancer Registries analyzed 5101 cases of thyroid carcinoma showing a reduction of mortality rate of 4%/year. This prompts us to evaluate the temporal trend in tumor size, age at diagnosis, and histology in a retrospective analysis of 500 thyroid cancers diagnosed over 20 years. Thyroid cancers were divided in two groups. The first included 193 cases diagnosed from 1985 to 1994, and the second 307 from 1995 to 2004. The size of all tumors was significantly reduced from 30 +/- 1.4mm in the first group to 15 +/- 0.8mm in the second group. In particular, papillary thyroid carcinoma (PTC) size decreased from 28 +/- 1.2mm to 14 +/- 0.8mm and follicular carcinoma from 40 +/- 6.3mm to 17 +/- 4.5 mm. Age at diagnosis of all carcinomas increased significantly from 40 +/- 1.3 years in the first group to 48 +/- 0.9 years in the second group. Analysis of the histological types revealed a significant increase of PTC rate in the second decade from 82% to 92% and a concomitant reduction of anaplastic thyroid carcinoma (ATC) from 3.7% to 1.0%. Moreover, a significant increase of micro-PTC rate, from 7.3% to 36.4%, was observed. In conclusion, it may be speculated that the above mentioned decreased mortality rate for thyroid carcinoma could be related to the significant reduction with time of cancer size, to the progressive increase of PTC rate and to the reduction of ATC rate. These data, if confirmed in other series, underscore the importance of evaluating thyroid nodules smaller than 10mm and corroborate recent findings suggesting that age be reconsidered as an independent prognostic factor for differentiated thyroid cancers.

Iodine supplementation restores fertility of sheep exposed to iodine deficiency.

The aims of the study were to monitor sheep iodine intake in different sheep breeding farms in Abruzzo and to evaluate the effects of iodine supplementation on ovine fertility. The urinary iodine concentrations (UIC) in animals of 8 out of the 11 breeding farms analyzed were borderline (UIC 100-150 microg/l) or very low (UIC < or = 50 microg/l). Only animals bred in 3 farms showed an adequate iodine intake with a mean UIC > or = 300 microg/l. Animals with very low iodine intake had lower T4 and T3 (p < 0.01) serum levels, compared to those with adequate iodine intake. To investigate the effects of iodine supplementation on ovine fertility, 32 ewes and 20 rams, characterized by low UIC, were randomly divided into 2 groups. One group (16 ewes and 10 rams) received a sc injection of 1 ml of Lipiodol, containing 480 mg of iodine, while the remaining animals were employed as control. This treatment was able to maintain UIC above 300 microg/l for 3 months and to increase T4 and T3 serum levels (p < 0.01). After 9 months, the fertility of control and treated animals was assessed by monitoring the rate of successful matings by ultrasonography. The results showed that 100% of treated ewes mated with treated rams were pregnant vs 37% of the control ewes mated with control rams (p = 0.007). The iodine content was 4-fold higher in milk from treated ewes (2393 +/- 453 microg/l), compared to controls (675 +/- 154 microg/l). The results demonstrated that iodine supplementation restores fertility of sheep living in iodine deficient areas and may represent a means to achieve a silent iodine prophylaxis of local populations.

Structural organization and chromosomal localization of the human type II deiodinase gene.

OBJECTIVE: The selenoenzyme type 2 iodothyronine 5' deiodinase (DII) catalyzes the conversion of thyroxine into its active form tri-iodothyronine (T3), modulating thyroid hormone homeostasis in a local, tissue-specific manner. The amphibian, rodent and human cDNAs encoding this enzyme have been recently cloned and expressed. At present, little information regarding the genomic structure of mammalian DII is available. DESIGN AND METHODS: The complete structure, including intron-exon junctions, of the human DII (hDII) gene was obtained by long PCR and rapid amplification of cDNA ends (RACE). Chromosomal assignment of the hDII gene was performed by fluorescence in situ hybridization using a highly specific probe. RESULTS AND CONCLUSIONS: Our data demonstrated that hDII is a single copy gene located on chromosome 14, position 14q24.3. The gene spans over 15 kb, and the 7 kb transcript is encoded by three exons of 149 bp, 273 bp and 6.6 kb separated respectively by two 274 bp and 7.4 kb introns. A restriction map of the hDII gene is also reported. These data will help in further studies of the role of DII in the maintenance of peripheral thyroid hormone homeostasis.

Increased plasma levels of endothelin-1 in patients with hyperthyroidism.

Plasma concentrations of endothelin-1 (ET-1) were measured in 25 hyperthyroid subjects, 15 hypothyroid subjects, and 21 age-matched normal controls. In hyperthyroid patients, plasma concentrations of ET-1 were significantly higher than in the control group (P < .0001) and in hypothyroid patients (P < .0001). In contrast, no differences were found between hypothyroid patients and controls. Plasma levels of ET-1 were similarly elevated as in patients with Graves' disease and those with toxic adenoma. No correlations were found between plasma ET-1 levels, thyroid hormones, and thyrotropin (TSH) in hyperthyroid, hypothyroid, and euthyroid groups. The results of our study clearly indicate that in hyperthyroidism, circulating levels of ET-1 are strongly increased, although the pathogenesis of the increase is unclear.

[The autonomous nodule. Clinical aspects]. / Il nodulo autonomo. Aspetti clinici.

Autonomously functioning thyroid nodule (AFTN) includes a wide spectrum of unique or multifocal diseases, either hyper or euthyroid, which share the same independence from thyroid stimulating hormone (TSH) regulation in terms of growth and function. The pathological basis and the recent molecular implications of the disease are briefly discussed. Clinical and epidemiologic data of 1572 patients with AFTN, out of a population of 14107 patients with thyroid diseases, sequentially evaluated from 1974 to 1992, have been retrospectively examined. The mean age of AFTN occurrence is 41 years and it appears more frequently in women (F/M = 5.3/1). Clinical hyperthyroidism occurs only in 17% of patients and is more frequently observed in men over 40 years of age. The presence of sonolucent area inside the nodule is detectable in 8.6% of cases and may be associated with spontaneous arrest of growth. When AFTN is submitted to cytologic evaluation, patterns similar to those observed in nodular goiter are shown (colloid lesion, cyst and nodular hyperplasia). Signs of hyperactivity are also shown by follicular cells. In the presence of a cyst, a fine needle aspiration was performed and a complete resolution was observed in 40% of cases. When cyst recurred after aspiration, a solution of tetracycline was inserted into the cavity. Sclerosing therapy was efficient in evacuating the volume of the nodule in 50% of the cases. Patients with AFTN were followed for a mean period of 61 months and 84.7% of them did not show any morphological or functional change, while the remaining 15.3% of cases became hyperthyroid.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of color Doppler in the evaluation of the hyperfunctioning thyroid nodule treated with ethanol injection]. / Ruolo del color Doppler nella valutazione del nodulo iperfunzionante della tiroide trattato con alcolizzazione.

Color Doppler gives us the possibility to study autonomous thyroid nodules and their qualitative and morphological aspects and allows us to hit session by session the most vascular area of the nodule with alcohol (Percutaneous ethanol injection). The use of color gives an easier flowmeter analysis reducing its time of performance. Today this method with the latest up to date echographs can provide very good clinical pathology at relatively low costs. We studied 18 patients, with autonomous thyroid nodules. They were all treated by percutaneous echo-guided ethanol injection (PEI). Before the beginning we make sure that the rest of the thyroid gland may function normally. The color Doppler test was carried out by using the multidisciplinary ecotomograph AU 560 CFM supplied with a linear probe 7.5 mHz, AL 35 by Esaote Biomedica. Before the PEI treatment, with the eco color Doppler test we noticed that the hot nodules clearly presented a higher vascularization compared to the remaining parenchyma. The vascularization was more evident in the peripheral area of the nodule even if few signs of flow were present inside the nodule. During a 24 months followup, 10 patients showed an important reduction and sometimes even the extinction of the intranodular flow signs followed by a clear reduction of the nodule's volume.