A contemporary analysis of goiters undergoing surgery in the United States.

INTRODUCTION: We identified disparities and at-risk populations among patients with goiters undergoing thyroidectomy. MATERIALS AND METHODS: The National Inpatient Sample (NIS) database was queried for patients with goiter who underwent thyroidectomy between 2009 and 2013. Multivariable logistic regression was used to determine factors associated with goiters undergoing thyroidectomy. RESULTS: The study consisted of 103,678 patients with thyroidectomy and a goiter diagnosis, which included: simple goiter (n = 7,692, 7.42%), nodular goiter (n = 73,524, 70.92%), thyrotoxicosis (n = 14,043, 13.54%), thyroiditis (n = 1,248, 1.20%), and thyroid cancer (n = 7,169, 6.92%). Factors associated with operation for simple goiter included age >65 years (AOR 1.43 [1.15-1.79]), black race (AOR 1.35 [1.14-1.58]), and being uninsured (AOR 2.13 [1.52-2.98]). Patients with cancerous goiters undergoing thyroidectomy were less likely to be Black (AOR 0.38 [0.31-0.48]) or uninsured (AOR 0.25 [0.07-0.89]). DISCUSSION: Understanding disparities within populations undergoing thyroidectomy for goiter may allow for targeted efforts to more effectively treat goiters nationwide.

Prevalence and determinants of micronutrient deficiencies among rural children of eight states in India.

BACKGROUND/AIMS: Micronutrient deficiencies continue to be a major public health problem in India. The aim of this study was to assess the prevalence and determinants of micronutrient deficiencies among rural children. METHODS: A community-based cross-sectional study was carried out by adopting a multistage stratified random sampling procedure. A total of 71,591 preschool children were included for ocular signs, 3,291 preschool children and 6,616 adolescents for hemoglobin, and 28,437 school-age children for iodine deficiency disorders. RESULTS: The prevalence of Bitot's spots was 0.8% (CI = 0.6-0.9) and anemia among preschool children and adolescents was 67% (CI = 64.4-69.5) and 69% (CI = 67.0-71.4), respectively. The prevalence of total goiter was 3.9% (CI = 3.4-4.6). The risk of Bitot's spots was 2.4 times higher among preschool children of Scheduled Caste (SC) or Scheduled Tribes (ST) than others and risk of anemia was twice as high (CI = 1.5-2.6) among adolescents of SC and ST. The micronutrient deficiencies were significantly lower in children who used sanitary latrines. CONCLUSIONS: Micronutrient malnutrition is a public health problem among rural children, and it was higher among children of SC/ST, illiterate parents and those not possessing a sanitary latrine. Thus, there is a need to improve environmental sanitation; fortification of foods could also help in mitigating the problem.

Autoimmune thyroid disease in patients with vitiligo: prevalence study in India.

OBJECTIVE: To identify the prevalence of autoimmune thyroid disease (AITD) in Asian Indian patients with vitiligo and to compare the clinical profile between thyroid peroxidase (TPO) antibody-positive and TPO antibody-negative groups. METHODS: In this cross-sectional, case-controlled study, 50 patients with vitiligo (29 women and 21 men) were included. Patients with previous disorders, irradiation, or surgical procedures involving the thyroid were excluded from the study. All participants underwent a complete physical examination, and a single fasting blood sample was analyzed for thyroid function (triiodothyronine, thyroxine, thyroid-stimulating hormone, and TPO and thyroglobulin antibodies), inflammatory and immunologic markers (erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor), and serum calcium, phosphorus, and alkaline phosphatase concentrations. All patients underwent thyroid ultrasonography, and the data were analyzed by appropriate statistical methods. RESULTS: The mean age of the study participants was 42.7 ± 17 years, and 14 of 50 patients (28%) had TPO antibody positivity. A goiter was present in 11 of 50 patients, and the thyroid volume by ultrasonography was similar between the 2 groups. Subclinical hypothyroidism was found in 14 of 50 patients (28%) but more frequently in the TPO antibody-positive group (8 of 14 or 57%) than in the TPO antibody-negative group (6 of 36 or 17%). The prevalence of AITD was 20 of 50 patients (40%) when the TPO antibody-positive group and those with subclinical hypothyroidism were considered collectively. None of the patients had overt hypothyroidism or hyperthyroidism. All other clinical, biochemical, and inflammatory variables did not differ significantly between the TPO antibody-positive and antibody-negative groups. CONCLUSION: Our data showed a 40% prevalence of thyroid disease in patients with vitiligo in India. The risk is exacerbated in patients with thyroid autoimmunity; thus, regular screening of patients with vitiligo for AITD is needed.

Incidence of thyroid malignancy among goitrous thyroid lesions from the Sarawak General Hospital 2000-2004.

INTRODUCTION: Thyroid cancer is the most common among all endocrine malignancies. The worldwide prevalence of goitre in the general population is estimated at 4-7 percent and the incidence of malignancy in goitrous thyroid is about ten percent. It is postulated that goitrous thyroid is a precursor lesion to the development of malignant thyroid diseases. As Sarawak is a state well known for endemic goitre, this study focused on establishing the incidence of thyroid malignancy among goitrous thyroid swellings. METHODS: This study was a hospital-based retrospective study on the archived collection of the surgically-removed thyroid specimens from the Sarawak General Hospital, Malaysia. Cases were grouped into cancer and non-cancer groups. The cancer group included papillary thyroid carcinoma (PTC), PTC follicular variant, follicular carcinoma and anaplastic carcinoma (ANA). RESULTS: A total of 820 thyroid cases which underwent surgical removal in years 2000 to 2004 were collected. Of these, 143 (17.4 percent) were male and 677 (82.6 percent) female. It was observed that the highest prevalence of thyroid swelling cases occurred in the age group 41-60 years while the lowest prevalence occurred in the age group under 21 years, 371 (45.2 percent) vs. 31 (3.8 percent). By ethnicity, the Ibans and Malays were found to have a higher prevalence at 275 (33.5 percent) and 196 (23.9 percent), respectively, while the lowest prevalence was observed in Indians, 11 (1.3 percent). 55 cases (6.7 percent) were found to be cancerous and the rest (93.3 percent) were non-cancerous thyroid swellings. Histologically, the highest incidence of carcinoma was PTC (4.0 percent) and the lowest was ANA (0.2 percent). CONCLUSION: Based on our observations, although goitrous thyroid swelling is quite a common problem in Sarawak, thyroid malignancy is not a major issue. Among thyroid malignancies, PTC is the most common histological type of malignancy.

Thyroid volume, selenium levels and nutritional habits in a rural region in Albania.

OBJECTIVE: Environmental factors are involved in goiter development. An increased number of goitrous patients were identified among outpatients in Gyrocaster, a mountainous region in Southwestern Albania. We examined possible associations of thyroid enlargement with nutritional factors. DESIGN: 112 consecutive patients, 104 females, aged 52.8 +/-12.1 (mean+/-SD), who either were taking thyroxine (n=27) or were suspected to have thyroid disease were examined. Thyroid parameters and nutritional habits were recorded and serum selenium and urine iodine levels were determined; thyroid ultrasound was performed. RESULTS: The median thyroid volume (TV) was 20.4 ml (range 4.4-97.6). All consumed food was home-produced. TV correlated negatively with the frequency of lamb-goat meat and vegetables consumption (p=0.05 and p=0.03, respectively). Mean TV was significantly lower in those eating lamb-goat >1 times/week (21.4+/-13.3 vs 31.9+/-23 ml, p<0.01). The association of TV with lamb meat consumption was independent of sex, education or occupation (p < 0.009). Selenium levels ranged from 30.6-138 microg/L (reference range 43-190). There was no association between selenium levels and TV. 43% of the subjects had TSH < 0.3 mU/L (those on thyroxine were excluded). Log TSH correlated negatively with TV and fT4 levels (p < 0.007), indicating the presence of autonomy (TSHRab positive in two subjects). Mean urinary iodine excretion was 99.8+/-35.3 microg/gr creatinine (normal >100). CONCLUSIONS: Nutritional factors may be involved in the development of goiter in Southwestern Albania. No role of selenium was found. The higher consumption of lamb-goat meat and vegetables, all non-industrialized, appeared to be protective. This finding may reflect better socioeconomic status, although this was not identified. Unrecognized subclinical hyperthyroidism, probably due to thyroid autonomy, was quite common.

Two common and three novel PDS mutations in Thai patients with Pendred syndrome.

Pendred syndrome is an autosomal recessive disorder characterized by congenital sensorineural deafness, goiter, and impaired iodide organification. It is caused by mutations in the PDS gene. Most published mutation studies of Pendred syndrome have dealt with Western populations. In this study, we examined clinical and molecular characteristics of 16 affected individuals in 6 unrelated Thai families. Of all the affected, 100% (16/16) had bilateral deafness, 68.8% (11/16) goiters, and 25% (4/16) hypothyroidism. Follicular thyroid carcinoma and Hürthle cell adenoma were found in affected members of a family, raising the possibility of an increased risk of thyroid carcinoma in Pendred syndrome patients. Sequence analysis of the entire coding region of the PDS gene successfully identified all 12 mutant alleles in these 6 families. The 12 identified mutant alleles constituted 6 distinct mutations including 3 splice site mutations (IVS4-1G>A, IVS7-2A>G, IVS9- 1G>A), one frame shift mutation (1548insC) and 2 missense mutations (T67S, H723R). Eight mutations out of 12 were constituted by IVS7- 2A>G and 1548insC, each one being present in 4 distinct alleles in our studied group. The identification of these two frequent PDS mutations will facilitate the molecular diagnosis of Pendred syndrome in Thai populations. In addition, three newly identified mutations, T67S, IVS4-1G>A, and IVS9-1G>A, were not observed in 50 unrelated healthy Thai controls.

[Neuromyelopathy in the population of Noir-marron of Saint-Laurent du Maroni in French Guiana]. / Neuromyélopathies dans la population de Noirs marrons de Saint-Laurent du Maroni en Guyane française.

The neurological observations have been reported at André Bouron Hospital of Saint-Laurent du Maroni and at General Hospital of Cayenne during a period of 5 years. All patients belonged to the "Noir Marron" ethnic group and lived in the area of Saint-Laurent. There were six women and four men, aged 15-35 years. Neurological symptoms were isolated or associated to other organ failure. Neurological manifestations included retrobulbar optic neuropathy, spastic paraparesis, sensitive ataxia and cerebellar ataxia, psychiatric symptoms were observed. Other organs affected were cardiovascular, digestive, cutaneous or endocrinologic (thyroid). Diet consist mainly in cassava. Thiamin deficiency has been observed several times. Improvement of neurological deficits following thiamin administration points towards Thiamin as an etiological factor. Ethnological specificity of Saint-Laurent area may explain that such neurological manifestation have not been observed in the rest of the department.

The prevalence of goitre in remote inland versus coastal areas.

The study was conducted to compare the prevalence of goitre among Malays and Aborigines in remote inland rural areas to those in coastal areas. All subjects were examined thoroughly by an experienced endocrinologist for the presence of goitre. The overall goitre prevalence in coastal areas was 6.3%; 6.0% (4/67) of Aborigines and 6.7% (4/60) of Malays were affected. However, in remote inland areas, the prevalence of goitre was almost 5 times higher compared to coastal areas. The prevalence of goitre was 30.7% in Baling; 30.2% (19/63) Aborigines and 30.8% (92/299) Malays were affected. Iodine deficiency is the most likely cause for the high prevalence of goitre in the remote inland areas.

Thyroid function and pubertal development in malnutrition.

Thyroid function and pubertal development of aborigines (Orang Asli) and Malays at different socioeconomic strata were assessed among 1136 subjects aged 7 years and above. Anthropometric measurements, goitre and pubertal staging were done. Serum thyroxine (T4), triiodothyronine (T3) and growth hormone were measured using radioimmunoassays (RIA) and serum thyroid stimulating hormone (TSH) by immunoradiometric assays (IRMA). It was found that serum T3 in children was significantly higher in Malays from rural areas, girls and children aged less than 13 years. However, in adults, T3 was significantly associated with anthropometric indices. On the contrary, serum T4 levels were higher among children from urban areas. In adults, serum T4 levels were significantly related to nutritional status and they increased according to the levels of social development, being lowest in remote areas and highest in urban areas. However, serum TSH levels were significantly higher in Orang Asli at all ages and among malnourished children. By using multiple regression, apart from age, gender and ethnicity, nutritional status was a significant predictor for T3 levels in children and adults. Presence of goitre was an important factor which determined the T4 levels in children and adults after controlling for other factors. It was also a predictor for TSH levels in children but not in adults. Fasting serum growth hormone (GH) levels were significantly higher among less privileged groups and decreased according to social development. Serum growth hormone was negatively correlated with anthropometric indices and had a significant association with malnutrition.(ABSTRACT TRUNCATED AT 250 WORDS)

Goitre prevalence in indigenous population of Evenkia.

Representatives of indigenous northern peoples (the Evenks and the Kets) living in a large Siberian territory named Evenkia were studied. There were children 6-14 years of age and adults aged 18-45 years. Thyroid volumes were determined by ultrasound. Iodine excretion was estimated. Normal thyroid volumes were found in 27.5% of the children. A high prevalence of goitre was detected in the adults. 55.4% of the women and 29.1% of the men had thyroid volumes above normal upper limits. Nodular goitres were found in 10.8% of the adults. 58.8% of the subjects had urinary iodine excretion below 10 micrograms/dl. Data show that the territory of Evenkia, settled by northern aborigines, is iodine deficient. The usage of the iodinated salt is ineffective. The preservation of the iodine content in salt remains the main problem in this area. In addition, some other goitrogenic agents may contribute to the high goitre prevalence in the indigenous population in Evenkia.

Strong association between HLA DRw9 and Hashimoto's thyroiditis in southern Chinese.

The distribution of HLA-A, -B, and -DR antigens in 53 Southern Chinese patients with Hashimoto's thyroiditis including 33 with goitre and 20 without goitre was compared with the distribution in 100 Southern Chinese controls. There was a significantly increased prevalence of HLA Bw46 in the nongoiterous patients and of HLA DRw9 in both groups of patients, but only for HLA DRw9 in the goiterous group was the increase significant after adjustment for the number of antigens studied. Based on these findings and those in other autoimmune diseases it is considered that the haplotype Bw46, DRw9 in Chinese takes the place of B8, DR3 in Caucasians in carrying genes which predispose to the development of auto-immune disease.