The Effect of Conventional Open Thyroidectomy on Clinical Results and Respiratory Function Tests in Multinodular Goitre.

AIM: The primary aim of our study was to measure the effect of conventional open thyroidectomy performed for patients with multinodular goiter (MNG) on pulmonary volumes measured with respiratory function tests independent from surgical indications. A secondary aim was to determine whether there was a significant improvement in the complaints due to obstructive symptoms after MNG surgeries. METHODS: This study was conducted between October 2020 and June 2022. Patients who were hospitalized to undergo surgery for giant multinodular goiter were prospectively included in the study. Patients were questioned about complaints of pressure, hoarseness, dyspnea, sleep apnea, snoring, and dysphagia before the surgery and during the follow-up 6 months after surgery. In addition, pulmonary function tests were performed preoperatively, 48 hours after surgery and 6 months after surgery. Forced expiratory volume in 0.5 seconds forced expiratory volume in 1 second and forced vital capacity values in pulmonary function test (PFT) measurements were recorded. RESULTS: A total of 55 patients, 42 females and 13 males, mean age 49.54 ± 13.6 years, were included in the study. Although there was a significant decrease in clinical symptoms caused by the thyroid volume within 6 months in patients who were operated for giant MNG there was no significant change in pulmonary function tests. There was a positive correlation between the thyroid volume and nodule weight in patients with MNG. CONCLUSIONS: Our results suggest that it is not necessary to follow up with patients without obstructive findings in preoperative pulmonary function tests with pulmonary function tests in the postoperative period.

Thyroid gland changes in patients with acromegaly

ABSTRACT Objective Acromegaly is characterized by high neoplastic morbidity as a side effect of growth hormone (GH) hypersecretion. Increased incidence of goiter, thyroid carcinoma, and thyroid dysfunction is also reported. The aim of the present study was to find the prevalence of thyroid dysfunction and goiter in patients with acromegaly and determine its relationship to disease activity, disease duration, and the presence of secondary hypothyroidism. Subjects and methods In a cross-sectional study of the period 2008-2012 were included 146 patients with acromegaly (56 men, 90 women) of mean age 50.3 ± 12.4 years. Acromegaly disease activity and thyroid function were evaluated in all patients. Thyroid ultrasonography was performed to calculate thyroid volume and detect the presence of nodular goiter. Results Ninety-one patients were determined to have an active disease, and 55, a controlled disease. The mean thyroid volume in patients without previous thyroid surgery was 37.6 ± 38.8 mL. According to disease activity, thyroid volume was significantly higher in patients with active disease (38.5 ± 45.4 mL vs. 27.2 ± 18.4 mL, p = 0.036). A weak positive correlation was found between thyroid volume and insulin-like growth factor 1 (IGF-1) in the whole group and in females (R = 0.218; p = 0.013, and R = 0.238; p = 0.037, respectively). There was no significant correlation of thyroid volume with disease duration and GH level in the whole group and in both sexes. The patients with secondary hypothyroidism had twofold smaller thyroid volume, relative to the rest of the group. The prevalence of thyroid dysfunction was 39%, with a female to male percentage ratio of 1.73. Goiter was diagnosed in 87% of patients, including diffuse goiter (17.1%) and nodular (69.9%), with no significant difference between patients with active and controlled disease or the presence of secondary hypothyroidism. Conclusions Thyroid volume in patients with acromegaly depends on disease activity and the presence of secondary hypothyroidism as a complication. The increased prevalence of nodular goiter determines the need of regular ultrasound thyroid evaluation in the follow-up of patients with acromegaly. Arch Endocrinol Metab. 2020;64(3):269-75

Efecto combinado de la interacción genética sobre el desarrollo del bocio nodular con tiroiditis autoinmune y adenoma tiroideo en los habitantes de Bucovina del Norte / Combined effect of gene-gene interaction on the development of nodular goiter with autoimmune thyroiditis and thyroid adenoma in the inhabitants of Northern Bukovyna

ABSTRAC This article presents the results of a comprehensive analysis of the combined influence of genetic polymorphisms associated with various links of apoptosis regulation (BCL-2, CTLA-4 and APO-1/Fas) on the development of nodular goiter with autoimmune thyroiditis and thyroid adenoma in the studied population. The analysis was performed using the Multifactor Dimensionality Reduction (MDR) method by calculating the prediction potential. Graphic models of gene-gene interaction with the highest cross-validation consistency created by the MDR method showed complex "synergistic or independent" impact of polymorphic loci of the CTLA-4 (+49G/A), Fas (-1377G/A) and BCL-2 (63291411 A>G) genes on the onset of thyroid pathology in general, or its individual types (nodular goiter with autoimmune thyroiditis and thyroid adenoma) in the population of Northern Bukovyna.

RESUMEN Este artículo presenta los resultados de un análisis exhaustivo de la influencia combinada de polimorfismos genéticos asociados a diversos enlaces en la regulación de la apoptosis (BCL-2, CTLA-4 y APO-1/FAS) sobre el desarrollo de bocio nodular con tiroiditis autoinmune y adenoma tiroideo en la población estudiada. Para ello, se utilizó el método de reducción de dimensionalidad multifactorial (MDR) mediante el cálculo de los potenciales de predicción. Los modelos gráficos de interacción gen-gen con la mayor consistencia de validación cruzada creada por el método MDR mostraron un complejo impacto «sinérgico o independiente¼ de los loci polimórficos de los genes CTLA-4 (+49G/A), FAS (-1377G/A) y BCL-2 (63291411A>G) en el inicio de la patología tiroidea en general, o sus tipos individuales (bocio nodular con tiroiditis autoinmune y adenoma tiroideo) en la población de Bucovina septentrional.

Vitamin D status in Egyptian euthyroid multinodular non-toxic goiter patients and its correlation with TSH levels / Estado de vitamina D en pacientes egipcios con BMN eutiroideo y su correlación con las concentraciones de TSH

Background and aim: Although the prevalence of MNG is widespread throughout the world, its pathogenesis is poorly understood, and the complex interactions of both genetic predisposition and the individuals’ environment are likely. However, to the best of our knowledge, it remains unknown whether there is a relationship between vitamin D status and prevalence or pathogenesis of euthyroid MNG. Therefore, the goal of the present study was determination of vitamin D status in euthyroid MNG as well as exploration of the correlation between vitamin D status & TSH levels. Methods: A total of 77 patients diagnosed with euthyroid MNG and 50 subjects without goiter were matched according to age, weight and BMI as control group in this case control study. Results: We found that patients with euthyroid MNG had statistically significant lower mean of [25(OH)D] (24.21±8.68ng/mL) in comparison with its mean in control subjects (28.37±10.91ng/mL, P value=0.019). The 28 sufficient vitamin D MNG patients had statistically significant lower level of TSH than 49 insufficient vitamin D MNG patients. Vitamin D and TSH levels correlate with vitamin D levels in MNG patients in Pearson correlation. Also 25 OH vitamin D was a significant independent predictor for TSH levels among euthyroid MNG patients in regression analysis. Conclusions: Patients with euthyroid MNG have lower levels of vitamin D and TSH levels correlate with vitamin D levels in euthyroid MNG patients. In addition, 25 OH vitamin D was a significant independent predictor for TSH levels among euthyroid MNG patients. We recommend hypovitaminosis D evaluation and correction in patients with MNG (AU)

Antecedentes y objetivo: A pesar de su amplia prevalencia en todo el mundo, se sabe poco de la patogénesis del BMN. Es probable que existan interacciones complejas de la predisposición genética y el entorno de los sujetos. No obstante, sigue sin saberse si existe una relación entre el estado de vitamina D y la prevalencia o la patogénesis del BMN eutiroideo. Por ello, el objetivo de este estudio era determinar el estado de vitamina D en el BMN eutiroideo, y explorar la correlación entre las concentraciones de vitamina D y TSH. Métodos: En este estudio de casos y controles se emparejó por edad, peso e IMC a 77 pacientes diagnosticados BMN eutiroideo y a 50 sujetos sin bocio como grupo de control. Resultados: Los pacientes con BMN eutiroideo tenían una concentración media de (25[OH]D) (24,21±8,68ng/ml) significativamente inferior a la hallada en los sujetos de control (28,37±10,91ng/ml, valor de p=0,019). Los 28 pacientes con BMN y vitamina D suficiente tenían valores de TSH estadísticamente inferiores a los 49 pacientes con BMN y vitamina D insuficiente. Las concentraciones de vitamina D y de TSH se correlacionan con los valores de vitamina D en los pacientes con BMN en la correlación de Pearson, y la 25 OH vitamina D era un factor predictivo independiente de los valores de TSH en los pacientes con BMN eutiroideo en un análisis de regresión. Conclusiones: Los pacientes con BMN eutiroideo tienen concentraciones más bajas de vitamina D y los valores de TSH se correlacionan con los de vitamina D en esos pacientes. Además, la 25 OH vitamina D era un factor predictivo independiente importante de la concentración de TSH en los pacientes con BMN eutiroideo. Se recomienda la evaluación de la hipovitaminosis D y su corrección en los pacientes con BMN (AU)

Tireóide e gravidez / Thyroid and pregnancy

A gravidez está associada com a necessidade aumentada de secreção hormonal pela tireóide desde as primeiras semanas após a concepção. Para que esta maior demanda ocorra, a gestação induz uma série de alterações fisiológicas que afetam a função tireoidiana e, portanto, os testes de avaliação da função glandular. Para as mulheres grávidas normais que vivem em áreas suficientes em iodo, este desafio em ajustar a liberação de hormônios tireoidianos para o novo estado de equilíbrio e manter até o término da gestação, geralmente, ocorre sem dificuldades. Entretanto, em mulheres com a capacidade funcional da tireóide prejudicada por alguma doença tireoidiana ou naquelas que residem em áreas de insuficiência iódica, isso não ocorre. O manejo de disfunções tireoidianas durante a gestação requer considerações especiais, pois tanto o hipotireoidismo quanto o hipertireoidismo podem levar a complicações maternas e fetais. Além disso, nódulos tireoidianos são detectados, com certa freqüência, em gestantes, o que pode gerar a necessidade do diagnóstico diferencial entre benignos e malignos ainda durante a gestação.

Pregnancy is associated with an increased requirement of hormone secretion by the thyroid, within the first weeks after conception. To this greater demand to occurs, pregnancy induces a series of physiological changes that affect thyroid function and, consequently, the tests of glandular function. For normal pregnant women living in areas with a sufficient supply of iodine, this challenge regarding the adjustment of thyroid hormone releases to this new state of equilibrium and its maintenance until the end of pregnancy it meets no difficulties. However, among women with impaired thyroid function due to some thyroid disease or among women residing in areas with an insufficient iodine supply, this does not occur. The management of thyroid dysfunction during gestation requires special considerations, since both hypothyroidism and hyperthyroidism can lead to maternal and fetal complications. In addition, thyroid nodules are detected at reasonable frequency among pregnant women, a fact that requires a differential diagnosis between benign and malignant growths during the pregnancy itself.

Resultados a corto plazo del tratamiento con 131I en pacientes con bocio multinodular: influencia del grado de hipertiroidismo asociado y otras variables / Short-term results of treatment with 131I in patients with multinodular goiter: effect of the associated degree of hyperthyroidism and other variables

Objetivo. Evaluar la efectividad del tratamiento con radioyodo y la incidencia de hipotiroidismo posterior en pacientes con hipertiroidismo subclínico o hipertiroidismo clínico asociado a bocio multinodular (BMN). Métodos. Estudio retrospectivo de 69 pacientes consecutivos con BMN tratados con 131I, con una dosis fija ponderada de 16 mCi (592 MBq), durante el año 2008 y seguidos durante seis meses. Se clasificaron en dos grupos: hipertiroidismo subclínico e hipertiroidismo clínico. Comparamos la tasa de éxito y la incidencia de hipotiroidismo. Resultados. En el 82,09% de los pacientes se corrigió la disfunción tiroidea; entre los pacientes con hipertiroidismo clínico la proporción fue del 100% y con hipertiroidismo subclínico del 78,13% (p=0,105). La incidencia global de hipotiroidismo fue de 16,42%; 25,00% entre los que presentaban hipertiroidismo clínico y 14,55% entre los hipertiroidismos subclínicos (p=0,400). No se encontraron diferencias estadísticamente significativas al analizar los resultados según el grado de descenso de TSH en los pacientes con hipertiroidismo subclínico. Siete individuos presentaron anticuerpos antiperoxidasa tiroidea (anti-TPO) antes del tratamiento; la incidencia de hipotiroidismo fue superior en ellos (57,14% vs 11,67%; p=0,011). La prevalencia de arritmias cardiacas fue cuatro veces mayor en el grupo de hipertiroidismo clínico. El tratamiento previo con tiamazol afectó de manera positiva a los resultados. Conclusiones. Una dosis fija ponderada de 131I es altamente efectiva y segura para el control del hipertiroidismo clínico y subclínico asociado al BMN. Los pacientes con anticuerpos anti-TPO positivos parecen tener un elevado riesgo de desarrollar hipotiroidismo postyodo(AU)

Objective. To assess the effectiveness of radioactive iodine (RAI) therapy and the incidence of hypothyroidism post RAI in patients with subclinical hyperthyroidism or clinical hyperthyroidism with Multinodular Goiter (MNG). Methods. A retrospective study of 69 consecutive patients treated with 131I for MNG during the year 2008 observed for six months. All patients received a single fixed dose of 16 mCi (592 MBq) weighted by the gland size. They were categorized into two groups: subclinical hyperthyroidism or clinical hyperthyroidism. We compared the success rate and the incidence of hypothyroidism. Results. The thyroid dysfunction was corrected in 82.09% of the patients. Success rate was 100% in the clinical hyperthyroidism group and 78.13% in the subclinical hyperthyroidism group (P=0.105). The overall incidence of hypothyroidism was 16.42%; 25.00% of patients with clinical hyperthyroidism and 14.55% with subclinical hyperthyroidism developed this secondary effect (P=0.400). No statistically significant differences were found in the success rate in the incidence of hypothyroidism when the results were analyzed according to the thyrotropin decrease in patients with subclinical hyperthyroidism. Seven patients had positive anti-thyroid peroxidase antibodies (anti-TPO) before therapy. The incidence of hypothyroidism was significantly higher in them (57.14% vs 11.67%; P=0.011). Cardiac arrhythmias were four times more frequent in patients with clinical hyperthyroidism. Previous treatment with thiamazol positively affected the outcome. Conclusions. A single fixed weighted dose of 131I is highly effective and safe for the control of clinical and subclinical hyperthyroidism due to MNG. Patients with anti-TPO antibodies may have a high risk of developing post-iodine hypothyroidism(AU)

Bocio multinodular gigante por defecto de síntesis de tiroglobulina / Giant multinodular goiter due to thyroglobulin synthesis defect

Los defectos de la síntesis de tiroglobulina son una causa poco frecuente de hipotiroidismo congénito. El diagnóstico neonatal de esta entidad puede escapar a los programas de screening por la existencia de niveles normales de hormonas tiroideas y discretamente elevados de TSH. Se presenta el caso clínico de una niña que consulta a los 14 años por bocio muy voluminoso (grado 3) y disfagia a sólidos. El estudio de la función tiroidea mostró concentraciones muy bajas de tiroglobulina y de T4, valores normales de T3 y elevación moderada de los niveles de TSH, hipercaptación tiroidea y respuesta negativa al test de descarga de perclorato. El screening neonatal para hipotiroidismo congénito fue negativo. Se diagnostica a los 3 años de hipotiroidismo por bocio difuso (grado lb). No recibió tratamiento sustitutivo con hormona tiroidea por decisión familiar, Siguiendo tratamiento naturalista con aminoácido 1-tirosina, zinc y Suplementos vitamínicos. El desarrollo pondoestatural y psicomotor fue normal. En resumen, el desarrollo precoz de bocio en niños con screening neonatal normal y en estado de eutiroidismo debe hacernos sospechar la existencia de una dishormonogenesis, y entre ellas la producida por defecto de la síntesis y secreción de tiroglobulina (AU)

Cisto de paratireoide: relato de caso / Parathyroid cyst: case report

Os cistos de paratireoide säo lesöes muito raras, com cerca de 200 casos descritos na literatura. Seu principal diagnóstico diferencial e com nódulo tireodiano, podendo causar sintomalogia de compressäo cervical e hiperparatireoidismo. Descrevemos um caso em que o diagnóstico foi realizado somente no exame de congelaçäo intra-operatório e discutimos aspectos relevantes na conduta nesses tumores infrequentes

Bócio multinodular atóxico: avaliaçäo da taxa de recidiva e funçäo após tiroidectomia parcial: análise retrospectiva de 39 casos / Nontoxic multinodular goiter: evaluation of recurrence rate and function after thyroidectomy partial: retrospective analysis of 39 cases

Realizou-se um estudo retrospectivo sobre a taxa de recidiva e funçäo hipofíseo-tiróidea em 39 pacientes com bócio multinodular atóxico, submetidos a tiroidectomia parcial, no período de 1970 a 1983, visando avaliar possíveis correlaçöes entre alteraçöes da funçäo tiróidea, extensäo da cirurgia e recidiva do bócio. A incidência da recidiva do bócio foi de aproximadamente 15%, sendo a maioria identificada dez ou mais anos após a cirurgia. Operaçöes mais radicais diminuíram a taxa de recidiva, às custas de um aumento do risco de hipotiroidismo subclínico. Näo foram encontradas diferenças estatisticamente significativas nos níveis plasmáticos de T3, T4, T4 livre e TSH (basal e após TRH) entre os pacientes com ou sem recidiva. Em uma paciente o tratamento pós-operatório com tiroxina näo evitou o aparecimento do bócio recidivante. Isto sugere que o aumento do TSH näo parece ser necessário para a manutençäo do bócio atóxico recidivante. Uma vez que a maioria dos pacientes submetidos a tiroidectomia permanece eutiróidea e apenas uma pequena proporçäo desenvolve recidiva, parece-nos questionável o uso pós-operaçäo rotineiro de hormônios tiróideos visando à profilaxia da recidiva do bócio multinodular