RESUMO
PURPOSE: The occurrence and histopathological features of incidental thyroid carcinoma (ITC) vary considerably among populations from different geographical regions. The aim of this study is to assess the prevalence and histopathological characteristics of ITC in patients who underwent thyroid surgery for apparently benign thyroid diseases in an endemic goiter area in Italy. METHODS: A total of 649 consecutive patients (531 females and 118 males; mean age, 52.9 ± 11.0 years), who underwent thyroid surgery at the Endocrine Surgery Unit of the tertiary care "Renato Dulbecco" University Hospital (Catanzaro, Italy) in the period between years 2017 and 2022, were included in this retrospective study. A comprehensive histopathological examination was performed on surgically excised thyroid tissue. Logistic regression analysis was employed to identify potential predictors of ITC. RESULTS: The histopathological examination revealed the presence of ITC in 81 patients, accounting for 12.5% of the total study population. The female to male ratio was found to be 6.4 to 1. Among the patients with ITC, 72 had papillary carcinoma (PTC), with 53 of these tumors being microcarcinomas (microPTC). Additionally, 5 patients had follicular thyroid carcinoma, 2 patients had low-risk follicular cell-derived thyroid neoplasms, 1 patient had an oncocytic carcinoma, and 1 patient had a medullary thyroid carcinoma. Logistic regression analysis demonstrated a significant association between female sex and incidental microPTC. CONCLUSIONS: These findings provide further evidence of the common occurrence of ITC, typically in the form of microPTC, among individuals who undergo thyroid surgery for apparently benign thyroid diseases.
Assuntos
Bócio Endêmico , Achados Incidentais , Neoplasias da Glândula Tireoide , Humanos , Feminino , Masculino , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Pessoa de Meia-Idade , Itália/epidemiologia , Adulto , Estudos Retrospectivos , Idoso , Bócio Endêmico/epidemiologia , Bócio Endêmico/patologia , Prevalência , Tireoidectomia , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/epidemiologia , Adenocarcinoma Folicular/cirurgiaRESUMO
BACKGROUND: There has recently been an increase in the incidental histological diagnosis of papillary thyroid microcarcinoma (I-PTMC), that varies from 3.5% in autopsies studies, to 5.2% in thyroid specimens from thyroid surgery, up to 9.4% in patients from areas of endemic goiter. AIM: To evaluate the incidence and the histological characteristics of I-PTMC in patients undergoing thyroidectomy for benign thyroid diseases, and to evaluate sex, age, toxic and non-toxic goiter, Hashimoto's thyroiditis as potential risk factors. MATERIALS AND METHODS: Prospective observational study on 124 patients, median age 56.3±13.25sd range 24-80 years, 93(75%)F, 31(25%)M, with surgical indications for toxic and non-toxic uni/multinodular goiters, in pharmacological euthyroidism. An accurate histological examination (HE) of entirely embedding thyroid samples was performed to identify microscopic foci of I-PTCM. Logistic regression analysis of the abovementioned parameters was performed to identify the risk factors. RESULTS: Total incidence of I-PTMC was 15.3%(19/124), with F/M ratio 2:1. All I-PTMCs were intraparenchymal with an intact thyroid capsule; 68.5% were bilateral-multifocal, 21% unilateral-unifocal, 10.5% unilateral-multifocal; maximum diameter was <5mm in 57.9% and ≥5mm in 42.1%; 63.1% were follicular variant, 36.9% classical variant; intra-thyroid lymphatic invasion and lymph node infiltration of the central compartment and para-tracheal was found in the only patient with "tall-cell" classical variant. No risk factors was found. CONCLUSIONS: The incidence higher than that reported in the literature, is probably due to the accurate HE of entirely embedding thyroid samples, which is the most important tool to identify microscopic foci of I-PTCM. The highest reported rate of bilateral multifocality of the neoplasm recommend the total thyroidectomy as surgical treatment of choice, also in patients undergoing thyroid surgery for "presumptive" benign diseases. KEY WORDS: Benign Thyroid Disease, Incidental Papillary Thyroid Microcarcinoma, I-PTCM, Thyroid Surgery.
Assuntos
Carcinoma Papilar , Bócio Endêmico , Bócio , Doenças da Glândula Tireoide , Neoplasias da Glândula Tireoide , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Carcinoma Papilar/diagnóstico , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia , Bócio/cirurgiaRESUMO
Iodine is an essential component of the hormones produced by the thyroid gland and is, therefore, essential for mammalian life. A landmark trial in the early 20th century definitively demonstrated that iodine supplementation could prevent what was then known as "endemic goiter." Subsequent studies over the next decades demonstrated that iodine deficiency causes a spectrum of disease, including not just goiter, but also cretinism, intellectual impairment, and adverse obstetric outcomes. Salt iodization, first used in Switzerland and the United States in the1920s, has become the mainstay of iodine deficiency prevention efforts. The dramatic reduction in the global prevalence of iodine deficiency disorders (IDD) over the past 30 years represents an outstanding and under-recognized public health achievement. This narrative review provides an overview of critical scientific discoveries and advances in public health nutrition related to the prevention of IDD in the United States and worldwide. This review was written to commemorate the centennial of the founding of the American Thyroid Association.
Assuntos
Hipotireoidismo Congênito , Bócio Endêmico , Bócio , Iodo , Desnutrição , Feminino , Gravidez , Humanos , Bócio/epidemiologia , Bócio Endêmico/complicações , Bócio Endêmico/epidemiologia , Bócio Endêmico/prevenção & controle , Iodo/uso terapêutico , Hipotireoidismo Congênito/complicações , Cloreto de Sódio na DietaRESUMO
OBJECTIVES: Iodine deficiency goiter can develop in children on a restrictive diet and most have normal thyroid function. We report a 6-year-old girl with iodine deficiency goiter with thyroid function studies mimicking thyroid hormone resistance alpha. Thyroid hormones mediate its effects through thyroid hormone receptors alpha and beta. Biochemical picture of low/low-normal T4 and high/high-normal T3 levels, variably reduced reverse T3 and normal TSH is characteristic of thyroid hormone resistance alpha. CASE PRESENTATION: A 6-year-old girl, born out of non-consanguineous marriage presented with goiter of 1.5 years duration. She was without symptoms of thyroid dysfunction. The patient was evaluated at one year of age for macrocephaly with cranial ultrasound which was normal. She had normal growth and development. Patient was vegan and was not on any medications or supplements. Laboratory work up showed TSH 5.03 uIU/mL (0.34-5.5), FT4 0.3 ng/dL (0.58-1.2), FT3 5.3 pg/mL (2.5-3.9), total T3 258 ng/dL (94-241), reverse T3 <5.0 ng/dL (8.3-22.9) and negative thyroglobulin antibody and thyroid peroxidase antibody. Thyroglobulin level was 1,098.8 ng/mL (<13 ug/L), and urine iodine 15.8 ug/L (<100 ug/L) confirming a diagnosis of iodine deficiency goiter. Patient was started on iodine supplements, 150 ug daily and repeat work up 3 months later were TSH: 2.717 uIU/mL, T3, total 182 ng/dL, T4, total 9.3 ug/dL, FT 4 2.1 ng/dL. CONCLUSIONS: Iodine deficiency goiter may present with low FT 4, elevated T3 and normal TSH mimicking thyroid hormone resistance alpha and should be considered in children on restrictive diet.
Assuntos
Bócio Endêmico , Bócio , Hipotireoidismo , Iodo , Desnutrição , Síndrome da Resistência aos Hormônios Tireóideos , Criança , Feminino , Humanos , Testes de Função Tireóidea , Tireoglobulina , Tireotropina , Tiroxina , Tri-IodotironinaRESUMO
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Assuntos
Bócio Endêmico , Iodo , Bócio Endêmico/prevenção & controle , Humanos , Iodo/uso terapêuticoRESUMO
BACKGROUND: Nowadays, the Republic of Belarus belongs to the countries with sufficient iodine supply, which made it possible to reduce the incidence of non-toxic goiter and congenital hypothyroidism. However, even a slight change in iodine consumption influences the pattern of thyroid diseases. In addition to iodine deficiency, other environmental conditions, as well as genetic factors, play a significant role in the etiology of thyroid diseases. AIM: To analyze the dynamics of the main epidemiological indicators of benign thyroid diseases from 2009 to 2019 in the adult population of the Republic of Belarus, using the data of official state statistics. MATERIALS AND METHODS: The indicators of the incidence and prevalence of benign thyroid diseases were studied on the basis of state statistics for 2009-2019. To analyze the dynamics of the studied indicators, regression analysis was used with the construction of linear and polynomial models. RESULTS: A decrease in the incidence and prevalence of diffuse euthyroid goiter and an increase in the incidence and prevalence of nodular euthyroid goiter, thyroiditis, acquired hypothyroidism, Graves' disease, as well as the incidence of nodular toxic goiter were revealed. CONCLUSION: Obtained data indicate, that there is an increase in the prevalence of most of the studied thyroid diseases, despite the adequate iodine supply. The above justifies the need for further study of the causes of the identified trends, as well as the necessity of developing new methods of diagnosis and treatment of thyroid diseases.
Assuntos
Bócio Endêmico , Bócio Nodular , Doença de Graves , Iodo , Neoplasias da Glândula Tireoide , Tireoidite , Bócio Endêmico/complicações , Bócio Endêmico/epidemiologia , Bócio Nodular/complicações , Bócio Nodular/epidemiologia , Doença de Graves/complicações , Humanos , República de Belarus/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/etiologia , Tireoidite/complicaçõesRESUMO
The impairment of adaptive mechanisms of functional systems of the body plays an important role in the occurrence of gastrointestinal diseases. This impairment is caused by unfavorable ecological and radiation conditions, external stress factors, food containing carcinogens, macro - and microelements deficiency. Technogenic environmental pollution contributes to decrease in the level of iodine in the body and more severe course of thyroid pathology. Diseases of the digestive and endocrine systems and their combination will occupy one of the leading places among the existing pathologies according to the forecasts of WHO experts in the XXI century. Adaptation of the body to various environmental influences is the most important factor in the quality of life. The relevance of the study was determined by the high incidence of psychological disadaptation, borderline personality disorders and, as a consequence, decrease in the quality of life in patients with gastrointestinal pathology and hypothyroidism. The article presents the results of comparative analysis of the quality of life indications of patients with gastric ulcer and / or gastroesophageal reflux disease in combination with hypothyroidism. The Russian-language analogue of the international questionnaire SF36 was used to analyze the indicatoions of patients' quality of life. The results of the study will allow to formulate the diagnosis exactly and organize adequate, comprehensive multidisciplinary treatment.
Assuntos
Bócio Endêmico , Hipotireoidismo , Iodo , Humanos , Hipotireoidismo/epidemiologia , Incidência , Qualidade de VidaRESUMO
In 1800, American physician and naturalist Benjamin Smith Barton (1766-1815) published A Memoir Concerning the Disease of Goitre as it Prevails in Different Parts of North-America. The text documented the nature of the disease in the United States and highlighted how it differed from the ailment's presentation in European patients. While medical topographies were common during this period, Barton's goiter research and the steady stream of American goiter research that followed are worth special attention. This body of literature demonstrates how American physicians understood their relationship to transnational medical discussions and the unique perspective they brought to them. Goiter literature was common in European medical and travel writing during this period and intensely focused on the appearance of the disease in the mountains of Switzerland and Northern Italy. American goiter by its very appearance in non-mountainous regions of the United States contradicted nearly all of the received wisdom about the ailment's cause and potential cure. For two decades, American writers leveraged their own observations and local knowledge to challenge larger narratives in their field.
Assuntos
Doenças Endêmicas/história , Bócio Endêmico/história , Doenças Endêmicas/estatística & dados numéricos , Bócio Endêmico/induzido quimicamente , História do Século XIX , Humanos , Estados UnidosAssuntos
Bócio Endêmico , Medicina na Literatura , Pessoas Famosas , História Medieval , Humanos , ItáliaAssuntos
Bócio Endêmico , Medicina nas Artes/história , Pinturas , História do Século XVI , Humanos , ItáliaRESUMO
PURPOSE: Salt iodization in Manipur of north-east India failed to prevent endemic goiter, therefore an in depth study carried out to evaluate thyroid functions of goitrous subjects in a randomly selected region. METHODS: Goiter survey conducted in children and women of reproductive ages by palpation followed by measurement of urinary iodine, thiocyanate and house-hold salt iodine to evaluate iodine nutritional status and consumption pattern of bamboo-shoots (BS). In all grade-2 goitrous subjects, free thyroxine, triiodothyronine, TSH, TPO and Tg antibodies, thyroid volume and echogenecity by ultrasonography and cytomorphology of thyroid by FNAC studied. RESULTS: Study population was 2486 children and 1506 women, goiter prevalence was 12.59% and 16.27% respectively; median urinary iodine and mean thiocyanate were 166 µg/l and 0.729 ± 0.408 mg/dl while salt iodine was ≥30 ppm. Serum thyroid hormones and TSH profiles of all grade-2 goitrous subjects showed 16.21% were subclinically hypothyroid, 2.16% overt hypothyroid, 4.86% subclinically hyperthyroid and 6.48% overt hyperthyroid, serum TPO- and Tg-antibodies found positive in 41.62%. Ultrasonographic results showed 24% had enlarged thyroid and 86.4% hypoechoic. Cytomorphological studies showed prevalence of colloid goiter (41.08%), lymphocytic thyroiditis (37.83%), Hashimoto's thyroiditis (8.10%), autoimmune thyroiditis (4.32%), sub-acute thyroiditis (2.16%) and 1.62% each papillary, medullary carcinoma, simple diffused hyperplasia and adenomoid nodular goiter. CONCLUSIONS: Grade-2 goitrous individuals in this mild goiter endemic region were affected by hypo- and hyperthyroidism with hypoechoic thyroid and thyroiditis. Thiocyanate that originates from BS even in presence of adequate iodine developed goiter and led goitrous population towards such diseases.
Assuntos
Exposição Dietética/efeitos adversos , Bócio Endêmico/induzido quimicamente , Iodo/administração & dosagem , Cloreto de Sódio na Dieta/administração & dosagem , Tiocianatos/efeitos adversos , Adulto , Autoanticorpos/sangue , Bambusa/efeitos adversos , Bambusa/química , Criança , Exposição Dietética/estatística & dados numéricos , Feminino , Bócio Endêmico/diagnóstico , Bócio Endêmico/epidemiologia , Bócio Endêmico/imunologia , Humanos , Índia/epidemiologia , Iodo/urina , Masculino , Prevalência , Saúde da População Rural/estatística & dados numéricos , Tiocianatos/urina , Glândula Tireoide/patologia , Glândula Tireoide/fisiopatologia , Hormônios Tireóideos/sangue , Tireotropina/sangueAssuntos
Cristianismo , Bócio Endêmico/patologia , Medicina nas Artes , Aleitamento Materno , Pré-Escolar , Cristianismo/história , Pessoas Famosas , Feminino , Bócio Endêmico/epidemiologia , Bócio Endêmico/história , História Medieval , Humanos , Masculino , Medicina nas Artes/história , Estado Nutricional , Pinturas/história , Sicília/epidemiologiaRESUMO
Familial aggregation of endemic congenital hypothyroidism (CH) in an iodine-deficient population from northern Congo (Democratic Republic (DR)) was analysed on data collected four decades ago (1979-1980). During a systematic survey of 62 families, 46 endemic CH subjects (44 myxedematous and 2 neurological) were identified based on clinical evidence within a village cohort of 468 subjects. A distribution analysis showed that two families presented significant excess of cases versus a random background distribution. Both families were characterised by two healthy parents having all of their five offspring affected by some form of endemic CH. Goitre prevalence in endemic CH was lower than that in the general population, while goitre prevalence in the unaffected part of the cohort (parents and siblings) was similar to that of the general population. Some unidentified genetic/epigenetic factor(s) could contribute to the evolution of some iodine-deficient hypothyroid neonates through irreversible and progressive loss of thyroid functional capacity during early childhood (<5 years old). Besides severe iodine deficiency, environmental exposure to thiocyanate overload and selenium deficiency, factors not randomly distributed within families and population, intervened in the full expression of endemic CH. Further exploration in the field will remain open, as iodine deficiency in Congo (DR) was eliminated in the 1990s.
Assuntos
Hipotireoidismo Congênito/epidemiologia , Bócio Endêmico/epidemiologia , Iodo/deficiência , Selênio/deficiência , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Hipotireoidismo Congênito/genética , República Democrática do Congo/epidemiologia , Exposição Ambiental/efeitos adversos , Feminino , Bócio Endêmico/genética , Humanos , Lactente , Recém-Nascido , Masculino , Linhagem , Fenótipo , Prevalência , Tiocianatos/toxicidade , Adulto JovemRESUMO
BACKGROUND: Various factors can affect incidence of thyroid disorders and disease profiles may show abrupt changes in endemic goitrous areas. In this study, it was aimed to analyze the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in terms of risk of malignancy and general recommendations in an endemic goiter region (EGR). METHODS: In this retrospective study, a total of 500 patients who had thyroidectomy following thyroid fine needle aspiration biopsy were enrolled. For the assessment of thyroid cytology, BSRTC was used and for the evaluation of ultrasound features of thyroid nodules, ACR TIRADS lexicon was adopted. For the assessment of thyroid cytology, Bethesda classification was used and for the evaluation of ultrasound features of thyroid nodules, ACR TIRADS lexicon was adopted. RESULTS: In the EGR setting, benign category of BSRTC had a cancer risk of 6.2% which was two times more than the 2017 BSRTC revision reported. Nodules 10-14.9 mm in diameter had nearly 4 times higher malignancy risk than nodules >15 mm. In this group of patients, the risk of malignancy for TIRADS level 1, 2, 3, 4 and 5 was 1.16%, 2.94%, 7%, 45.64% and 94.44%, respectively. The malignancy rates for Bethesda system category I, II, III, IV, V and VI were as follows: 14.43%, 6.2%, 19.05%, 36.73%, 75.68% and 100%. CONCLUSIONS: There are slight differences between the common set of standards and this study results regarding risk of malignancy. This brings up the question whether there is need for revision for the use of categories and the appropriate management in endemic goiter regions.