Prevalence of thyroid diffuse goiter and its association with body mass index and the presence of cysts and nodules in children and adolescents: the Fukushima Health Management Survey.

The main cause of diffuse thyroid goiter is autoimmune chronic thyroiditis, otherwise known as Hashimoto's thyroiditis. Thyroid hormones play pivotal roles in growth and development during childhood. However, the prevalence of diffuse goiter and the relationships between diffuse goiter, thyroid volume, cysts and nodules, and anthropometric measurements in children are not well known. Among 789,459 participants who participated in thyroid ultrasound examinations, 320,206 participants (male: 161,728; female: 158,478) aged 1-23 years were analyzed. Logistic regression analyses were conducted to calculate the odds ratios of the standard deviation score of body mass index (BMI-SDS), the SDS of bilateral width multiplied thickness area (BWTAR-SDS) as a provisional determination of thyroid volume, and the presence of nodules or cysts for positive diffuse goiter compared with negative diffuse goiter after correction for sex and age. The prevalence of diffuse goiter increased in a female-dominant manner with aging. Compared with the absence of diffuse goiter, the age- and sex-adjusted odds ratios (95% confidence intervals) for BMI-SDS (1 SD), BWTAR-SDS (1 SD), cysts, and nodules were 1.24 (1.21-1.27), 3.21 (3.13-3.29), 0.53 (0.50-0.58), and 1.38 (1.17-1.64), respectively. The odds ratios of nodules for positive diffuse goiter were 4.18 (1.08-16.08), 1.76 (1.01-3.07), 1.80 (1.32-2.45), and 1.34 (1.08-1.67) in the age groups 1-7, 8-11, 12-15, and 16-23 years, respectively. The age-dependent increase in the prevalence of diffuse goiter was independently associated with increased BMI and positive prevalence of nodules in young individuals.

Perinatal airway management in neonatal goiter: A healthcare cost and utilization project (HCUP) kids' inpatient database analysis.

INTRODUCTION: Fetal goiter is a rare congenital disorder that can present with life-threatening neonatal airway obstruction. Lifesaving and function-preserving airway management strategies are available, but routine delivery affords a limited window for intervention. Accordingly, fetal goiter is reported among the most common indications for ex-utero intrapartum treatment (EXIT). While EXIT prolongs the window for airway intervention to benefit the neonate, it elevates the risk to the pregnant person and requires extensive resources; therefore, data to guide ideal treatment selection are essential. This study aims to compare perinatal airway interventions between individuals with a birth hospitalization discharge diagnosis (BHDD) of goiter and the general population. MATERIALS AND METHODS: Individuals with and without BHDD of goiter were identified in the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database from 2000 to 2019. The frequency of airway interventions on day of life (DOL) 0 or 1 were compared using the Rao-Scott chi-square test. Additionally, gestational age, type of intervention, complications, mortality, birth weight, and length of stay were examined for the goiter cohort. RESULTS: Two-hundred eighty-seven weighted cases of goiter were identified in the study period. The population was 61 % male, 55 % White, and median birthweight was 3.3 kg. The median length of stay was 4.3 days, and average total charges were $42,332. Airway intervention on DOL 0 or 1 was performed in 16.9 % of individuals with goiter compared to 1.6 % in neonates without goiter (p < 0.001). Interventions in the goiter cohort included endotracheal intubation in 16 % of cases, laryngoscopy/bronchoscopy in 1-5% of cases, and tracheostomy in <1 % of cases. Fewer than 1 % of individuals undergoing intubation additionally had mass decompression/resection on DOL 0 or 1. No neonates received extracorporeal membrane oxygenation cannulation or cardiopulmonary resuscitation. Hypoxic encephalopathy occurred in <1 % of cases, among which endotracheal intubation was the only airway intervention performed. There were no mortalities among neonates with goiter. CONCLUSION: Individuals with BHDD of goiter receive significantly higher rates of perinatal airway intervention. In most cases, endoscopic interventions alone were sufficient to avoid hypoxic neurological complications. These findings contribute to data to aid in clinical counseling and empower patients to make informed decisions according to their values and treatment goals.

[The problem of iodine deficiency in the Chechen republic: assessment of the current state and ways of solution].

Iodine deficiency disorders (IDD) are prevalent and highly morbidity, have hidden progression, severe disabling somatic complications, including cognitive disorders, reproductive losses, and oncopathology. This presents a serious challenge to the healthcare system of the Russian Federation, as it affects over 3 million people. The lack of relevant data on the severity of IDD and the current prevention programs at the regional level necessitates the need for appropriate research and measures in individual subjects of the Russian Federation. AIM: To conduct a comprehensive study to assess the current iodine security of the population of the Chechen Republic, to analyze the prevalence of thyroid pathology and compare it with official statistics, to formulate conclusions about the necessary preventive measures. MATERIALS AND METHODS: In the Chechen Republic, a total of 1239 people were examined, of which 921 were schoolchildren of pre-pubertal age (8-10 years) and 318 were adults. The survey of the adult population was carried out at medical organizations in four districts of the republic (Nadterechny, Shalinsky, Vedensky, Grozny) and included a questionnaire survey, a clinical examination by an endocrinologist with palpation of the thyroid gland, thyroid ultrasound, and a study by a qualitative method of samples of table salt used in households for the presence of iodine.Children's examinations were carried out by the cluster method on the basis of secondary schools in 9 out of 15 districts of the republic and included an examination by an endocrinologist and measurement of anthropometric parameters (height, weight), thyroid ultrasound to evaluate volume, determination of iodine concentration in single portions of urine and qualitative analysis of samples of table salt used in children's nutrition in families for the presence of iodine.The incidence and prevalence of thyroid disease among the population of the Chechen Republic were analyzed using data from official state statistics - form No. 12 «Information on the number of diseases registered in patients living in the area served by the medical institution¼ (ROSSTAT data as of 01.01.2021). RESULTS: According to the results of a survey of 921 pre-pubertal children, the median urinary iodine concentration was 71.3 µg/L (frequency of values below 50µg/L - 17,7%) and varies from 48.9 to 179.2 µg/L in the surveyed areas. According to thyroid ultrasound data, diffuse goiter was detected in 16.4% of the examined children, with goiter frequency ranging from 11.3% to 23.5%. The proportion of iodized salt consumed in schoolchildren's families was 4.2% in all study areas (range of values from 1.3% to 8%), which indicates an extremely low level of using iodized salt by household.According to the results of the examination of the adult population (n=318), structural changes in thyroid tissue were detected in 79.9% (n=254), while the proportion of nodular thyroid pathology being 83% (n=205), with a range of values across different districts of 52.5-80%. CONCLUSION: Based on the obtained data, according to WHO criteria, it can be stated that, overall, the degree of severity of iodine deficiency disorders in the Chechen Republic corresponds to mild severity with a tendency towards moderate severity in several districts of the foothills. The results of the examination of the adult population indicate a high prevalence of thyroid pathology, predominantly nodular, in the Chechen Republic. The data obtained in the course of large-scale research made it possible to initiate the development of necessary medical and organizational measures in the region - a program for the prevention of IDD.

Multinodular goitre surgery complications and directly observed surgeons' skills: A prospective double-blind observational cohort study.

OBJECTIVE: To study multinodular goitre patients' surgery by direct observation of surgical technique, and to compare complications with surgeons' skills and experience, for improved training of future thyroid surgeons. METHODS: Based on positivist epistemology and analytical observational design, this prospective double-blind study of a cohort of multinodular goitre patients operated upon by variedly experienced surgeons, was conducted at Bahawal Victoria Hospital Bahawalpur and Nishtar Medical University Hospital Multan, Pakistan, from December 2016 to April 2019. Patients were admitted through outpatient department and operated upon in routine operation lists. The surgeons were specialists/senior registrars, assistant professors, associate professors and professors. The patients were divided into two virtual groups: the one operated upon by surgeons with >3 years of post-fellowship experience and the other operated upon by surgeons with <3 years of post-fellowship experience. Surgeries were directly observed and differences in surgical technique and complications were recorded for respective groups. Data was analysed using SPSS 20. RESULTS: Of the 134 patients, there were 73(54.5%) in group 1 and 61(45.5%) in group 2. Overall, there were 119(88.8%) females and 15(11.2%) males. The overall mean age was 37.17±13.41 years (range: 14-80 years). Of the 25 surgeons, 13(52%) were in group 1 and 12(48%) in group 2. Group 1 had fewer complications compared to group 2, which on certain parameters was statistically significant (p<0.05). CONCLUSIONS: Surgeons' experience and technique were found to have significant relationship with the rate of complications. Direct observation of surgeries is significant for real life evaluation and training of junior surgeons.

Assessment of iodine nutrition of schoolchildren in Gonda, India, indicates improvement and effectivity of salt iodisation.

OBJECTIVE: To study the total goitre rate (TGR), urinary iodine concentration (UIC) and salt iodine content among schoolchildren in a previously endemic area for severe iodine deficiency disorder (IDD). DESIGN: Cross-sectional epidemiological study. SETTING: The study was carried out in the Gonda district (sub-Himalayan region) of North India. PARTICIPANTS: Nine hundred and seventy-seven schoolchildren (6-12 years) were studied for parameters such as height, weight, UIC and salt iodine content. Thyroid volume (TV) was measured by ultrasonography to estimate TGR. RESULTS: The overall TGR in the study population was 2·8 % (95 % CI 1·8, 3·8). No significant difference in TGR was observed between boys and girls (3·5 % v. 1·9 %, P = 0·2). There was a non-significant trend of increasing TGR with age (P = 0·05). Median UIC was 157·1 µg/l (interquartile range: 94·5-244·9). At the time of the study, 97 % of salt sample were iodised and nearly 86 % of salt samples had iodine content higher than or equal to 15 part per million. Overall, TGR was significantly lower (2·8 % v. 31·0 %, P < 0·001), and median UIC was significantly higher (157·1 v. 100·0 µg/l, P < 0·05) than that reported in the same area in 2009. CONCLUSIONS: A marked improvement was seen in overall iodine nutrition in the Gonda district after three and a half decades of Universal Salt Iodisation (USI). To sustainably control IDD, USI and other programmes, such as health education, must be continuously implemented along with putting mechanisms to monitor the programme at regular intervals in place.

[Dynamics of epidemiological indicators of thyroid pathology in the population of the Russian Federation: analytical report for the period 2009-2018].

BACKGROUND: The level of iodine consumption by the population largery determines the spectrum of thyroid pathology. To date, in the Russian Federation, iodine-deficiency disorders (IDD) occupy a leading position in the structure of all thyroid diseases. Chronic ID leads to adverse health consequences and significant economic costs for their elimination on a national scale. However, the spectrum of thyroid pathology is not limited to the problem of ID, and the study of other thyroid diseases is also of interest. AIMS: to assess the dynamics of prevalence and incidence of IDD and other thyroid diseases in the entire population of the RF for the period 2009-2018, using official state statistics. MATERIALS AND METHODS: the main epidemiological indicators (incidence and prevalence) of thyroid diseases in the entire population of the RF were analyzed using official state statistics. The analyzed period is 2009-2018. There was no medical intervention. To assess the dynamics of prevalence and incidence, a linear regression models were constructed, the slope of the trend line was calculated. RESULTS: the data were analyzed in accordance with the structure of diseases presented in the statistical reporting: goiter, thyroiditis, hypothyroidism, thyrotoxicosis, congenital iodine deficiency syndrome. For the ten-year period 2009-2018 there is a statistically significant increase in the prevalence of various forms of goiter, thyrotoxicosis, congenital iodine deficiency syndrome in the entire population of the Russian Federation. During the observation period, an increase in the incidence of thyrotoxicosis was revealed. With regard to the incidence of congenital iodine deficiency syndrome, only an upward trend was revealed. Despite the fact that during the observation period the number of new cases of various forms of goiter decreased, the prevalence of goiter among the population of the Russian Federation remains high: 1.2% of the population by January 1, 2019. with the growth of autoimmune pathology, improvement of the level of diagnosis, and also, in some cases, with overdiagnosis (for example, when diagnosing autoimmune thyroiditis in individuals with asymptomatic carriage of antithyroid antibodies). The current approaches to iodine prophylaxis are not effective enough. CONCLUSIONS: the results of the analysis indicate mainly an increase in the high prevalence of thyroid pathology among the population of the RF against the background of regional events. The problem of ID remains unresolved, which dictates the need to introduce universal mandatory salt iodization in the territory of the RF.

Point of Care Thyroid Ultrasound (POCUS) in Endocrine Outpatients: A Pilot Study.

BACKGROUND: Thyroid ultrasound is used for the assessment and characterisation of thyroid nodules/goitres and to guide diagnostic biopsy, it is normally performed by radiologists. Point of care ultrasound (POCUS) by trained non-radiologists, has the potential to reduce cost, expedite diagnosis and enhance patient satisfaction if embedded in an outpatient clinic setting. AIM: To perform a pilot of the use of point of care thyroid ultrasound in an endocrine outpatient setting for the assessment of thyroid nodules and goitres. METHODS: Thyroid ultrasound was undertaken with consultant radiologist supervision, over a period of 16 months between January 2017 to April 2018. Using a GE Logic e7 portable thyroid ultrasound machine with 12 MHz linear probe. All scans were performed on patients attending for assessment of thyroid disorders at the Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast. RESULTS: Thyroid ultrasound was performed on 40 patients (M:10,F30), mean age 52 years, range 23-77 years, median follow up 14 months, range 6-18 months. Twenty scans were performed to assess thyroid nodules, 13 for investigation of a goitre and the remaining 7 were for patient preference. 39 patients had benign thyroid disease, 1 patient had a confirmed newly diagnosed papillary thyroid carcinoma (PTC). The ultrasound 'U' classification was U1 and U2 (n=37), U3 and above (n=3). Fine needle biopsy (FNA) was performed on 9 patients with one confirmed as a thyroid carcinoma (Thy1;n=2, Thy2;n=6 and Thy 5;n=1). Thyroid ultrasound reporting was broadly similar between radiologist and non-radiologist (p< 0.01). Time to scan was reduced during the pilot from the existing model (n=40) of a mean of 52 days (range 7-95 days) to 1 day (p<0.01). CONCLUSION: With appropriate training and radiology supervision, point of care thyroid ultrasound can be performed accurately and safely in outpatients by an endocrinologist. There are potential benefits in terms of cost savings, time to scan, reduction in clinic visits, and in expediting diagnosis.

The Results of 16 Years of Iodization: Assessment of Iodine Deficiency Among School-age Children in Antalya, Turkey

Objective: Iodine deficiency (ID) continues to be a problem around the world. This study investigated the prevalence of ID and goiter among school-age children in the city center of Antalya, Turkey. The aim was to investigate the effect of an iodization program, which had been running for sixteen years, on nutritional iodine status in this population. Methods: A total of 1,594 school children, aged 6-14 years, were included in this cross-sectional study. ID was evaluated based on median [interquartile range (IQR)] urine iodine/creatine (UI/Cr) (µg/g) ratio and median (IQR) UI concentrations (UIC) (µg/L). UICs were measured using the Sandell-Kolthoff method. Goiter was determined by palpation and staged according to World Health Organization classification. Results: Median (IQR) UIC was found to be 174.69 (119.17-242.83) µg/L, and UIC was found to be lower than 50 µg/L in 6.5% of the population. The median UI/Cr ratio increased from 62.3 to 163.3 µg/g and goiter rates had decreased from 34% to 0.3% over the 16 years of the program. However, 19% were still classified as ID (mild, moderate or severe) and, furthermore, 11.5% were classified as excessive iodine intake. Conclusion: Comparison of two cross-sectional studies, carried out 16-years apart, showed that Antalya is no longer an ID region. However, surveillance should be continued and the percentage of ID and iodine excess individuals in the population should be monitored to avoid emerging problems.

Socioeconomic status of the population - a prime determinant in evaluating iodine nutritional status even in a post salt iodization scenario.

Background To compare the state of iodine nutrition among school age children (SAC) in high- (HSGs) and low-socioeconomic groups (LSGs) during a post iodation scenario in Kolkata. Methods Clinical examinations of the goiter, median urinary iodine (MUI), mean urinary thiocyanate (MUSCN) in SAC (6-12 years) from both sexes in the different socioeconomic groups were carried out and the iodine content of edible salt was measured. Results A total of 5315 SAC, of which 2875 SAC were from a HSG and another 2440 SAC from an LSG were clinically examined for goiter. In the HSGs the total goiter prevalence (TGP) was 3.2% and in the LSGs the TGP was 9.1% and the difference was statistically significant (p<0.001). The MUI of the HSGs was 242 µg/L as compared to 155 µg/L in the LSGs (p<0.001). MUSCN of the HSGs was 0.77±0.45 mg/dL while in the LSGs it was 0.94±0.44 mg/dL and the difference was statistically significant (p<0.01). In the HSGs 19.4% salt samples had 15-30 ppm iodine and 80.6% salt samples were above 30 ppm as compared to 26.3% salt samples which were below 15 ppm, 37.1% salt samples which were between 15 and 30 ppm and 36.6% salt samples which were above 30 ppm in the LSGs. Conclusions The population of the LSGs was clinically mildly iodine deficient having no biochemical iodine deficiency while in the HSGs it was more than the adequate requirement and the HSG children are possibly at risk of excess iodine induced thyroid diseases. Existing goiter prevalence in the LSGs was from their relatively high consumption of dietary goitrogens. Therefore, socioeconomic status plays a pivotal role in the management of iodine nutrition even in a post salt iodation scenario.

Valoración del bocio congénito y permeabilidad de la vía aérea mediante resonancia magnética fetal / Congenital Goiter Evaluation and Airway Permeability by Fetal Magnetic Resonance Imaging

El bocio congénito es una patología infrecuente, que se genera por alteración de la función tiroidea fetal de causa endógena o exógena: disfunción tiroidea materna, déficit de aporte de yodo en la dieta o secundario a la toma de medicación. La repercusión en la maduración del feto, la compresión de estructuras adyacentes debido al aumento de tamaño, lo cual puede ser un factor de riesgo de obstrucción de la vía aérea y de lesiones hipóxico-isquémicas, hacen que el diagnóstico y tratamiento de esta patología sea de vital importancia. Habitualmente, se diagnostica por ecografía en el segundo o tercer trimestre de embarazo, pero la resonancia magnética (RM) se ha convertido en una técnica diagnóstica complementaria e importante ante un eventual tratamiento intraparto

Congenital goiter is an uncommon condition caused by altered fetal thyroid function of endogenous or exogenous cause (maternal thyroid dysfunction, iodine deficiency in the diet or secondary to taking medication). The impact on the mature development of the fetus, as well as the compression of adjacent structures due to increased size, which may be a risk factor for airway obstruction and hypoxic-ischemic lesions, make the diagnosis and treatment of this pathology of vital importance. It is usually diagnosed by ultrasound in the second or third trimester of pregnancy, but magnetic resonance imaging (MRI) has become a complementary and important diagnostic technique in the event of an intrapartum treatment procedure

ASSESSMENT OF ADEQUATE IODINE AVAILA-BILITY TO THE POPULATION OF WEST KAZAKHSTAN BASED ON THE DATA OF INORGANIC IODINE IN URINARY EXCRETION.

Aim of research - to study the iodine supply of the region according to the degree of urinary iodine excretion in the West region of the Republic of Kazakhstan. Of 6493 schoolchildren participating in the study of the frequency of goiter, random sampling was applied to select 884 children to determine UIC. To establish the excretion of inorganic iodine in a single portion of urine in the field, express diagnostics, the "Iodine test" kits (manufactured in Ukraine), was applied. The collection of urine for the determination of UIC was carried out in disposable cups, hermetically sealed with stoppers to prevent the entry of iodine vapors into the test samples. The test was carried out immediately after urine collection. The concentration of iodine in the urine was expressed in µg/l. The method is semiquantitative and makes it possible to distinguish urine samples with iodine content below 70, from 70 to 100, from 100 to 300 and above 300 µg/L. The obtained data on the study of UIC in schoolchildren in the West Kazakhstan showed that the proportion of children with optimal urinary excretion of iodine (100-300 µg/L) is 62.67% (95% CI: 59.48-65.86%). Indices ranging from 100 to 200 µg/L were detected in 27.15% (95% CI: 24.22-30.08%, more than 200 µg/L and up to 300 µg/L - in 35.52% (95% CI: 32.37-38.68%) of schoolchildren. UIC exceeds 300 µg/L - in 18.89% (95% CI: 16.31-21.47%) of schoolchildren. Concentration of iodine in the urine of more than 400 µg/L was determined in 1.81% (95% CI: 0.93-2.69%) of children. Low excretion rates of iodine, less than 70 µg/L, were detected in 2.83 % (95% CI: 1.74-3.92%) of schoolchildren, and from 70 µg/L to 100 µg/L - in 13.8 % (95% CI: 11.53-16.07%). Thus, in 62.67% (95% CI: 59.48-65.86%) there is an optimal allocation of iodine in the urine, it can be considered that iodine status of the population of West Kazakhstan is adequate. In West Kazakhstan, in the absence of iodine deficiency, a strained goiter endemia remains.The formation of goiter endemia in the region does not exclude the influence of other strumogenic factors, which need further study.

Hygienic assessment of the effects of pesticides application on adult population morbidity with thyroid gland diseases.

OBJECTIVE: Introduction: It is proved that some groups of fungicides and herbicides are capable of affecting the thyroid gland, provoking its growth, leading to a compensatory change in the activity of the hormones synthesis. Therefore, the presence of their residual amounts in plant may affect the level of thyroid gland pathology. The aim of the work was to analyze the influence of pesticide application on the Ukrainian adult population morbidity with thyroid diseases in the period from 2001 to 2014. PATIENTS AND METHODS: Materials and methods: The methods of empirical and theoretical research of scientific information, namely analysis, synthesis, induction, deduction and systematization, epidemiological, cartographic and statistical methods were used. RESULTS: Results: The maximum level of thyroid pathology was found in the northern, western and northwestern regions, where the diffuse goiter dominates in the morbidity and prevalence of thyroid diseases; minimal - in the southern, eastern and south-eastern regions. It was established that the highest volumes of application of chemical plant protection products in the period 2001-2013 took place in the southern and central regions of Ukraine, namely in Poltava, Vinnitsa, Kharkiv, Dnipropetrovsk, Khmelnytsky, Odesa and Mykolaiv regions. Sufficiently high levels of pesticide application were in the Kyiv, Kherson regions, Crimea, Zaporizhia, Kirovograd and Cherkasy regions. CONCLUSION: Conclusions: The probability of the active chemical plant protection products usage effect on the level of prevalence and incidence of thyroid cancer, various types of goiter, hypothyroidism, thyrotoxicosis and thyroiditis in the central and southern regions was determined. Are regions with well-developed agricultural production.

Thyroid Disease Around the World.

Thyroid disease is one of the most common pathologies in the world, with two of the most clinically important subgroups being iodine deficiency and thyroid goiter, and thyroid cancer. This review looks at the current state of thyroid disease in the world and evaluates the future direction in terms of thyroid disease treatment and prevention. Several of the most impactful epidemiologic studies are presented and analyzed, as well as a brief overview of the current socioeconomic burden of disease.

The Assessment of Risk Factors for Difficult Intubation in Thyroid Patients.

OBJECTIVES: We aimed to assess possible risk factors related to difficult intubation in patients undergoing thyroid surgery. METHODS: We prospectively collected data of 200 patients scheduled for thyroid surgery. Clinical risk factors were defined as: Mallampati score, interincisor gap, thyromental distance, sternomental distance, range of neck motion, body mass index, neck circumference, goiter, the presence of radiological findings suggesting compression and thyroid weight. All evaluations were performed with Macintosh assessed for Cormack and Lehane (CL) classification and modified intubation difficulty scale (MIDS). RESULTS: It was observed that the proportion of patients with a thyroid weight ≥40 g, goiter, a Macintosh CL score = 3-4 and the mean neck circumference were significantly higher in the group with a MIDS score >5 (p = 0.018, p = 0.011, p < 0.001, respectively). CONCLUSION: The presence of a palpable goiter, thyroid weight ≥40 g and thyromental distance <6.5 cm were risk factors associated with difficult intubation in the multivariate regression model.

Analyzing cost-effectiveness of neural-monitoring in recurrent laryngeal nerve recovery course in thyroid surgery.

PURPOSE: The increasing use of intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgery imposes an evaluation of cost-effectiveness. METHODS: The analysis estimated the cost versus utility of different alternatives that simulate nerve injury course and the consequences for the following cohorts of patients: (1) no RLN injury, or vocal fold palsy (VCP) recovery within 1 month (2), 2 months (3), 6 months (4), and after 12 months (5). In the model applied, the average simulated cohort consisted of a young female patient, 40 years old, employed, daily voice user, who underwent elective, conventional total thyroidectomy via cervical incision using a standardized intermittent IONM technique, for an operable benign, bilateral, diffuse, multinodular, non-toxic, non-retrosternal goiter. RESULTS: IONM was cost-ineffective when parameters such as the rates of transient vocal fold palsy (VCP) reached 38.5%. IONM was cost-effective if the rate of VCP was 33.6% at 1 month, 22.9% at 2 months, 9.8% at 6 months, and 3.8% at 12 months, independent of phono-surgery. The described scenario is cost-effective only in a high-volume setting. CONCLUSIONS: This study used simulation economic modeling to assess clinical and cost-effectiveness utility of IONM implementation. In light of the limitations of a simulation-based study, we conclusively assumed that IONM is cost-effective for permeant RLN injuries.

Poor dietary diversity, wealth status and use of un-iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia.

BACKGROUND: Globally, more than two billion people are at risk of iodine deficiency disorders, 32% of which are school children. Iodine deficiency has been recognized as a severe public health concern in Ethiopia, however little is known about the problem. Therefore, this study aimed to assess the prevalence of goiter and associated factors among school children (6 to 12 years) in Dabat District, northwest Ethiopia. METHODS: A school-based cross-sectional study was conducted from February 21 to March 31, 2016. A total of 735 school children were included in the study. A stratified multistage sampling followed by systematic sampling technique was employed to select the study participants. Thyroid physical examination was done and classified according to the World Health Organization recommendations as grade 0, grade 1, and grade 2. The level of salt iodine content was determined using the rapid field test kit. The value 0 parts per million (PPM), <15 PPM and ≥15 PPM with the corresponding color chart on the rapid test kit were used to classify the level of iodine in the sampled salt. A multivariable logistic regression analysis was employed to identify factors associated with goiter. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was calculated to show the strength of association. In multivariable analysis, variables with a P-value of <0.05 were considered statistically significant. RESULTS: In this community, the overall prevalence of goiter was 29.1% [95% CI: 25.9, 32.6], in which about 22.4 and 6.7% had goiter grade 1 and grade 2, respectively. The age of children (AOR = 1.13; 95% CI: 1.01, 1.26), being housewife mother (AOR = 1.49; 95% CI: 1.08, 2.15), use of unprotected well water source for drinking (AOR = 6.25; 95% CI: 2.50, 15.66), medium household wealth status (AOR = 1.78; 95% CI: 1.18, 2.92), use of inadequately iodized salt (AOR = 2.79; 95% CI: 1.86, 4.19), poor dietary diversity score of the child (AOR = 1.92;95% CI: 1.06, 3.48) and medium maternal knowledge (AOR = 0.65; 95% CI: 0.42, 0.94) were significantly associated with goiter. CONCLUSIONS: The prevalence of goiter is higher in Dabat District, which confirmed a moderate public health problem. Therefore, regular monitoring of household salt iodine content, improving access to safe water, promoting the importance of diversified food for children is recommended to address the higher burden of iodine deficiency.

[ASSESSMENT OF THE IODINE STATUS IN THE POPULATION IN WESTERN KAZAKHSTAN ACCORDING TO DATA OF URINARY IODINE CONCENTRATIONS].

AIM: To evaluate iodine status in the population of Western Kazakhstan on the example oftheAktobe region according to data of urinary iodine concentrations. There were examined 2257 children aged from 7 to 12 years. Urinary iodine was carried out in 10% of schoolchildren by semiquantitative method under field conditions. According to the 30-cluster survey the prevalence of goiter in the region amounted to 42.71 ± 1.04%. The proportion of children with optimal urinary iodine concentrations is only 12.8%, more than 300 mcg/l--57.82% of the children, more than 400 mcg/l was determined in 25.12% of the children. The high prevalence of goiter against the background of high rates of urinary iodine suggests the impact of other goitrogenic factors in the region.

Demographics, disparities, and outcomes in substernal goiters in the United States.

BACKGROUND: Disparities distinguishing patients with substernal goiters from nonsubsternal goiters have not been thoroughly described. METHODS: The National Inpatient Sample database was used to compare patients who underwent substernal thyroidectomy years 2000 to 2010 with those who underwent thyroidectomy for nonsubsternal goiter. RESULTS: A total of 110,889 patients underwent thyroidectomy for goiter (5,525 substernal and 105,364 nonsubsternal). Substernal thyroidectomy patients were older, more likely to be Black or Hispanic and to have Medicare insurance. They had a higher comorbidity index, were more likely to be admitted emergently and to have postoperative complications such as hemorrhage/hematoma, pneumothorax, pulmonary embolism, and hypocalcemia/hypoparathyroidism. Furthermore, substernal thyroidectomy patients had 73% increased odds of death during admission than nonsubsternal thyroidectomy patients. CONCLUSIONS: Substernal goiters present a distinct type of goiter with identifiable patient-level characteristics and an increased risk of postoperative complications and death. Earlier identification and treatment of goiters may allow earlier interventions at a stage when risks are reduced.

Effects of short term mild L-Thyroxine suppression therapy on myocardial functions, and its assessment with tissue Doppler imaging.

BACKGROUND: While adverse effects of overt hyperthyroidism on the cardiovascular system are well-known, the effects of subclinical hyperthyroidism are not clear. The aim of the study was to investigate the effects of short term mild L-thyroxine (LT4) suppression therapy on myocardial functions in a group of premenopausal women with goiter, by using echocardiographic methods and tissue Doppler imaging (TDI). METHODS: Sixteen participants with goiter received LT4 suppression therapy to keep TSH levels between 0.1-0.4 µIU/mL. After baseline and 1st month assessment, 6-weeks follow-up were scheduled until 6th month assessment to adjust the medication dose during study period. All TSH levels decreased below 0.4 µIU/mL by the end of first month and stayed below this level throughout study period. At the beginning of the study and at month 6, the thyroid ultrasonography, Holter monitorization test, stress test, electrocardiograms and echocardiograms of participants were assessed. This was followed by a comparison of baseline and 6th month data. RESULTS: Baseline and 6th month 2-D echocardiography measurements of participants revealed that mean left ventricle diameter in diastole (4.1±0.3 vs 3.8±0.2 mm) and posterior wall thickness in diastole (0.9±0.1 vs. 0.8±0.1 mm) decreased (P<0.05); while stroke volume (41.9±9.9 vs. 48±8.2), stroke volume index (25.6±5.4 vs. 29.4±4.7), cardiac output (3.5±1.4 vs. 3.9±0.9) and cardiac index (2.2±0.8 vs. 2.4±0.5) increased (P<0.05). Other 2D echocardiography parameters did not change significantly. The pulse wave Doppler examination, stress test and Holter monitorization of participants did not reveal any difference between baseline and 6th month measurements. No statistically significant difference was observed in measurements of TDI except decreased septum S velocity. CONCLUSIONS: Short term mild LT4 suppression treatment did not cause systolic or diastolic dysfunction, or conduction defect in the heart; therefore may be safe in premenopausal females with not known cardiac disease.