Detecting Amyloid Goiter With 99mTc-PYP SPECT/CT in the Setting of Ankylosing Spondylitis: An Uncommon Involvement of AA Amyloidosis.

ABSTRACT: We present a case with systemic amyloidosis secondary to ankylosing spondylitis (AA amyloidosis), whose 99mTc PYP scintigraphy revealed amyloid deposition in the thyroid gland (amyloid goiter). Amyloidosis is characterized by extracellular accumulation of amyloid fibril proteins leading to organ malfunction. Even though AA amyloidosis can be observed in patients with systemic inflammatory diseases, it is a very rare complication in ankylosing spondylitis. SPECT/CT images showed diffuse tracer uptake in enlarged thyroid gland containing fat density areas.

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.

Thyroid volume in Turkish school-age children living in an iodine-sufficient region.

OBJECTIVES: We aimed to obtain local normative data on thyroid volume evaluated by ultrasonography and iodine status by measuring urine iodine levels in school-age children living in Aydin province. METHODS: In this cross-sectional study, a sample comprising 1,553 cases was meticulously selected from a total cohort of 170,461 children aged 6-17, drawn from 21 distinct educational institutions located within the Aydin region, as participants in the investigation. Those with a known chronic disease or thyroid disease were excluded from the study. The children underwent physical examinations and ultrasonography imaging of the thyroid gland, and urine samples were collected to measure urinary iodine concentration (UIC). RESULTS: The median UIC was 189.5 (IQR=134.4) µg/L, which was optimal according to WHO criteria. Thyroid volume was found to be 4.6 (IQR=3.5) mL in girls and 4.2 (IQR=4.0) mL in boys (p=0.883). The thyroid volumes in our study were found to be smaller when compared to the WHO. According to WHO age and body surface area criteria, thyroid volume was over 97 % in 0.9 % (n=15) of cases. Thyroid volume was found to have a positive correlation with age, height, weight, body mass index (BMI), and body surface area (BSA) in both genders (p<0.001). However, there was no significant correlation between thyroid volume and UIC. CONCLUSIONS: This cross-sectional study provides normative data on thyroid volume and iodine status in school-age children in iodine-sufficient population, revealing a low prevalence of goiter and correlations between thyroid volume and anthropometric measures.

Effects of iodine status on thyroid volume and goiter in children living in an iodine-replete area.

Objective: Adequate iodine intake is essential for growing children, and thyroid volume (Tvol) is considered as an indicator of iodine status. We investigated Tvol and goiter using ultrasonography (US) and their association with iodine status in 228 6-year-old children living in Korea. Methods: Iodine status was assessed using urine iodine concentration (UIC) and categorized as deficient (<100 µg/L), adequate (100-299 µg/L), mild excess (300-499 µg/L), moderate excess (500-999 µg/L), and severe excess (≥1000 µg/L). Tvol was measured using US, and a goiter on the US (goiter-US) was defined as Tvol greater than 97th percentile value by age- and body surface area (BSA)-specific international references. Results: The median Tvol was 2.4 mL, larger than the international reference value (1.6 mL). The age- and BSA-specific goiter-US rates were 25.9% (n = 59) and 34.6% (n = 79), respectively. The prevalence of excess iodine was 73.7% (n = 168). As iodine status increased from adequate to severe excess, the goiter-US rate significantly increased (P for trend <0.05). The moderate and severe iodine excess groups showed higher risk of goiter-US (adjusted odds ratio (aOR) = 3.1 (95% CI: 1.1-9.2) and aOR = 3.1 (95% CI: 1.2-8.3), respectively; age-specific criteria) than the iodine-adequate group. Conclusions: Excess iodine was prevalent in Korean children, and their Tvol was higher than the international reference values. Goiter rate was associated with iodine excess, which significantly increased in the moderate and severe iodine excess groups. Further studies are warranted to define optimal iodine intake in children.

Influencing Factors and New Reference Intervals of Adult Thyroid Volume in Iodine-Sufficient Areas of China.

The diagnosis of goiter is based on the thyroid volume measured by ultrasound in which iodine plays an important role. The purpose of this study was to evaluate the factors that affect thyroid volume and update the reference range of thyroid volume to provide a new basis for the diagnosis and treatment of goiter. A study population from mainland China was evaluated in the Thyroid disorders, Iodine status and Diabetes Epidemiological (TIDE) study. Thyroid size was measured by ultrasound, and thyroid volume was calculated. A quantile regression model was used to analyze the influence of related factors on the thyroid volume at each percentile. The median urinary iodine concentration (UIC) was 185.54 µg/l. The quantile regression model suggested that body surface area (BSA) and thyroid-stimulating hormone (TSH) were positive and negative factors for thyroid volume, respectively (p < 0.01). Excess iodine reduces the median and lower limits of thyroid volume. In iodine-sufficient areas, smoking is no longer a risk factor. The reference value range of thyroid volume stratified by sex was 3.92-19.06 ml for males and 3.1-16.17 ml for females. The maximum reference ranges for stratification by sex and BSA were 4.25-20.98 ml for men and 3.44-18.31 ml for women. The iodine nutrition level of the population in mainland China is sufficient. Iodine has the potential to alter the effect of certain factors on thyroid volume and effect is not regional. The new reference interval of adult thyroid volume based on sex and BSA has been updated, which can be used as a reliable reference for updating the diagnostic criteria of endemic goiter.

Evaluation of thoracic inlet view plain radiograph in the management of patients with goitre.

Background: Thoracic inlet view radiograph is an investigation for assessing patients with goitre in many centres in the sub-Saharan-region. However, there is paucity of information on its usefulness in the diagnosis of retrosternal goitre (RSG) and in planning for thyroidectomy. Method: A review of patients with goitre managed in the Division of Endocrine Surgery, University College Hospital, Ibadan, Nigeria, between 2002 and 2014 was done. Data were obtained from Operating Theatre Log and electronic data archive of the Division. Clinical RSG (CRSG) was taken as a gland that the examining fingers could not get below its lower margin and Radiological RSG (RRSG) on thoracic inlet view was any extension of the thyroid gland beyond the thoracic inlet. Intra-operatively, if any part of the gland extends beyond the thoracic inlet it was considered as an RSG. Results: 221 (96.5%) of the 229 patients who had thoracic inlet plain radiograph were included in this study. The Male to Female ratio was 1:5.5. WHO grade III goitre was seen in 56.1% of the patients and 43.9% had grade II goitre. The CRSG, RRSG and Intra-operative RSG were seen in 7.7%, 16.7% and 17.6% respectively. The specificity and sensitivity of clinical examination in determining RSG was 88.7% and 94.1% and that of Thoracic inlet radiograph was 97.8% and 94.6% respectively. Conclusion: It is a useful study for screening patients with goitre for retrosternal extension, however it could not be used to determine the need for extra-cervical surgical access during thyroidectomy.

Prevalence of thyroid nodules and characteristics of thyroid ultrasound in children with goiter: a single center experience.

BACKGROUND: Goiter is a common presenting sign of various thyroid diseases in children. Thyroid nodules are clinically and/or radiologically significant findings due to their high malignancy rate. The ultrasound (US) characteristics of pediatric patients with goiter are rarely reported in literature; thus, the purpose of this study is to assess the characteristics of thyroid US and the prevalence of thyroid nodules in pediatric patients with goiter. METHODS: A retrospective review of children and adolescents under the age of 18 (2015-2020) referred for neck ultrasound due to goiter in clinical examination. RESULTS: A total of 262 patients were included with a mean age of 13.77 ± 3.7 years. Thyroid antibodies were positive in 119/262 (45.4%) patients. Thyroid US reported to be abnormal in 210/262 (80%) patients. Thyroid nodule were found in 33.6% (n = 88/262) of patients with goiter and in 41.9% (n = 88/210) of patients with abnormal thyroid US result. Patients with positive antibodies had more of heterogeneity and hypervascularity of the gland on thyroid US (P < 0.001). On the other hand, thyroid nodules were more likely to be presented in patients with negative thyroid antibodies (P = 0.025). The heterogeneity within the thyroid positive group was significantly correlated with increasing TPOAb (P < 0.001) and TSH levels (P < 0.028). Heterogeneity on US had a positive predictive value (P = 0.041), while hypervascularity had low prediction for thyroid nodules (P = 0.022). Age, gender, family history of thyroid diseases, antibodies status and echogenicity in US did not show any significant associations with thyroid nodules. Papillary thyroid carcinoma was diagnosed in six patients and one of these patients was positive for thyroid antibodies. CONCLUSION: Thyroid nodules are quite common in our population. Thyroid nodules were significantly associated with heterogeneity in US. Although, no clinical or biochemical factors could predict the presence of thyroid nodules on thyroid US in our cohort, the absence of thyroid antibodies should lower the threshold for performing thyroid US.

Children and adolescent patients with goiter and normal thyroid function: US findings related to underlying autoimmune thyroid diseases.

This study was conducted to investigate and compare thyroid ultrasonography (US) findings in children and adolescents with goiter and normal thyroid function with positive or negative thyroid autoimmunity. From 2000 to 2020, we reviewed initial thyroid US images in 33 autoimmune thyroid diseases (AITDs) patients and 52 nonAITD patients. Our review of the images focused on thyroid parenchymal hypoechogenicity and heterogeneous echopattern subdivided into 2 groups according to severity: hypoechogenicity 1 and 2 (HO1 and HO2) and heterogeneity 1 and 2 (HE1 and HE2). HO1 and HE1 were observed more frequently in the nonAITD group (86.5% and 42.3%, respectively), while HO2 and HE2 were observed more frequently in the AITDs group (36.4% and 81.8%, respectively). More patients in the AITDs group showed change of both US groups and thyroid function state within the follow-up periods than in nonAITD group (33.3% and 5.77%, respectively). Children and adolescent AITDs patients showed more severe parenchyma hypoechogenicity and heterogeneous echopattern compared with nonAITD patients with goiter and normal thyroid function.

Case Report: Functional Analysis and Neuropsychological Evaluation of Dyshormonogenetic Fetal Goiter in Siblings Caused by Novel Compound Hyterozygous TPO Gene Mutations.

Introduction: It is rare for a euthyroid mother to carry a child with a fetal goiter. However, cases of congenital hypothyroidism (CH) caused by thyroid dyshormonogenesis have been reported. Even though gene mutations associated with fetal goiter have been reported in a few studies, the effects on intellectual development have not been investigated. This study aimed to characterize and investigate the underlying genetic mechanism of CH and neuropsychological development and growth of two siblings with CH-induced fetal goiters. Case report: Two male siblings from a non-consanguineous marriage with CH and fetal goiter were diagnosed by ultrasonography at 32- and 26-weeks of gestation. This condition was confirmed by cordocentesis in the first pregnancy (TSH: 135 µIU/ml). The mother was euthyroid, and no intra-amniotic levothyroxine treatment was performed. Peripheral blood DNA was screened for TPO mutations. The new deletion p.Cys296Alafs*21 and the p.Arg665Trp mutation, inherited from heterozygous parents, were identified in both patients. Functional analysis showed both mutations reduced the TPO enzyme activity and impaired the membrane localization. The p.Cys296Alafs*21 mutation produces a protein product with a drastically reduced molecular weight. Additionally, a complete clinical and neuropsychological evaluation was also performed. The WISC IV test was employed to provide an overall measure of the siblings' cognitive and intellectual abilities. No growth retardation was detected in either child. In general, both children showed normal neuropsychological development; however, they exhibited slight reduction of Processing Speed Index scores, which are sensitive to neurological and attentional factors and motor maturation activity. Notably, the younger sibling obtained significantly low scores in the Operational Memory Index, a measure of attention capacity and psychoneurological immaturity. Conclusion: We described a new TPO compound heterozygosity that severely impaired the TPO activity and membrane localization leading to severe CH and fetal goiter. This is the first report showing the neuropsychological evaluation in patients with dyshormonogenetic fetal goiter. More studies are needed to understand the neurodevelopmental outcomes of neonates with CH-induced fetal goiters.

Ectopic Pulmonary Goiter Simulating Malignant Tumor Detected on SPECT/CT.

ABSTRACT: A 46-year-old asymptomatic woman with a newly detected large pulmonary mass was admitted to our hospital. An ultrasonography-guided needle biopsy was performed based on a suspicion of malignancy, and an ectopic goiter was confirmed pathologically. Laboratory findings were unremarkable, except that thyroid function tests suggested subclinical hyperthyroidism. A 131I whole-body scintigraphy and SPECT/CT were further performed and revealed intense radioiodine uptake in the pulmonary mass, the mediastinal nodule, and thyroid gland. A diagnosis of ectopic pulmonary goiter with normally located thyroid was finally made.

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.

Fetal Goitrous Hyperthyroidism in a Pregnant Woman with Triiodothyronine-Predominant Graves' Disease.

Triiodothyronine (T3)-predominant Graves' disease is characterized by increased serum free T3 (FT3) levels after free thyroxine (FT4) levels become normal or even low during antithyroid drug treatment. We encountered a 34-year-old pregnant woman, gravida 5 para 4, who was complicated by T3-predominant Graves' disease. She was diagnosed with Graves' disease at 20 years old, and had received methimazole. Methimazole was changed to potassium iodide to reduce the risk of congenital anomalies during the first trimester. The dose of antithyroid drugs was adjusted based on maternal FT4 levels, so that maternal Graves' disease deteriorated and fetal goitrous hyperthyroidism appeared during the second trimester. Since the fetus presented goiter and tachycardia at 27-28 gestational weeks, doses of methimazole and potassium iodide were increased. A male newborn weighing 2604 g was delivered by a cesarean section at 35 gestational weeks. The newborn was diagnosed with neonatal hyperthyroidism, and received methimazole for six months. He developed normally with normal thyroid function at 1 year old. In pregnancies complicated by T3-predominant Graves' disease, the kinds and doses of antithyroid drugs have to be carefully selected to maintain maternal levels of FT4 as well as FT3 within the normal range, considering trimesters of pregnancy, teratogenicity of medication, and maternal levels of thyroid-stimulating hormone receptor antibody.