Extended cervical approach for retrosternal multinodular goiter.

Objective: Partial or total sternotomy is required for 10% of retrosternal goiter. This study reviewed our experience with an extended cervicotomic approach as an alternative surgical solution for retrosternal goiter. Methods: A retrospective study was performed on patients who underwent partial or total thyroidectomy for retrosternal goiter between 2014 and 2019 at a tertiary medical centre. Data on clinical, radiologic, and pathologic factors were analysed. Peri- and postoperative outcomes were compared between extended and standard cervical approaches to predict the need for an extended cervical approach. Results: The cohort included 265 patients, of whom 245 (92.4%) were treated by standard thyroidectomy. In 17 (6.4%), the standard approach proved insufficient, and the horizontal incision was extended to a T-shape to improve access. The remaining 3 patients required a sternotomy. Use of the extended cervical approach was significantly associated with clinical features such as male gender, diabetes, high body mass index and postoperative hypocalcaemia. Conclusions: The extended cervicotomic approach is an alternative surgical solution for retrosternal goiter, with no increased risk of significant post-operative complications.

Case report of congenital goitre in a goat kid: Clinical and pathological findings.

Congenital goitre is a deadly thyroid metabolic disorder characterised by low thyroid hormone levels, subsequent secretion of excess Thyroid-Stimulating Hormone (TSH) from the pituitary gland, and compensatory thyroid gland hyperplasia. This study aimed to summarise the clinical and pathological features of congenital goitre in a goat kid. In April 2019, a dead female goat kid with a history of dystocia was referred to Ferdowsi University of Mashhad Veterinary Teaching Hospital, Mashhad, Iran, to examine the carcass and find the reason for death. The necropsy were performed, along with histopathology examination, and clinical signs were recorded. Examination of the foetus revealed the presence of an enlarged thyroid gland, and the skin was thick with myxedema, pale, and without hair. After cutting the skin, the swelling showed a significantly enlarged thyroid gland with two asymmetrical lobes, with the right lobe 3.9×7.1 cm and the left 3.7×7.5 cm in size. In the histopathological examination, a severe proliferation of follicular cells was observed, which caused the thyroid gland to be microscopically dense. In conclusion, this study highlights the importance of recognising and addressing congenital goitre in goat kids. To prevent such tragic outcomes, it is crucial to focus on early detection and intervention. Furthermore, the agents of goitre need to find out and be clear.

Graves' disease, myxedema, and papillary thyroid carcinoma / Doença de Graves, mixedema e carcinoma papilífero de tireoide

Graves' disease (GD) is the leading cause of hyperthyroidism and diffuse toxic goiter in iodine-sufficient geographi-cal areas. GD is associated with classical manifestations such as ophthalmopathy and thyroid dermopathy, in addi-tion to diffuse goiter, which may be the site of carcinomas, as a complication. Case report: A 52-year-old woman presented with goiter and symptoms compatible with hyperthyroidism, such as heat intolerance, weight loss, fati-gue, increased sweat, tachycardia, fine tremors, increased intestinal transit, anxiety, emotional lability, insomnia, exophthalmos, and pretibial myxedema. A complementary investigation confirmed the diagnosis of hyperthyroidism (high free T4 and total T3 levels and low thyroid-stimulating hormone - TSH levels). Ultrasound images showed dif-fuse enlargement of the thyroid lobes by approximately 10 times and the presence of three thyroid nodules, one of which was larger than 2 cm with heterogeneous echogenicity and vascularization throughout the nodule; ultrasoun-d-guided fine needle aspiration revealed cytology compatible with Bethesda IV; scintigraphy revealed a low uptake area (cold nodule) amid a diffuse high-uptake goiter. A thyroidectomy was performed, and the anatomical specimen diagnosis revealed papillary thyroid carcinoma in the right lobe, with adjacent parenchyma compatible with GD. Histopathological examination of the skin showed the presence of myxedema compatible with Graves' dermopathy. The patient evolved with the normalization of TSH levels and a reduction of cutaneous manifestations. Conclusion:GD abnormalities may not be restricted to the classic clinical manifestations, and a careful investigation may reveal the coexistence of carcinomas. (AU)

A doença de Graves (DG) é a principal causa de hipertireoidismo e bócio difuso tóxico em áreas geográficas com iodo suficiente. DG está associada a manifestações clínicas clássicas como oftalmopatia e dermopatia da tireoide, além do bócio difuso, que pode ser sítio de carcinomas, como uma complicação. Relato de caso: Mulher de 52 anos apresentou bócio e sintomas compatíveis com hipertireoidismo como intolerância ao calor, emagrecimento, fadiga, sudorese aumentada, taquicardia, tremores finos, trânsito intestinal aumentado, ansiedade, labilidade emocional, insônia, exoftalmia e mixedema pré-tibial. A investigação complementar confirmou o diagnóstico de hipertireoidis-mo (níveis elevados de T4 livre e T3 total; níveis baixos de hormônio estimulante da tireoide - TSH). As imagens ultrassonográficas mostraram aumento difuso dos lobos tireoidianos em aproximadamente 10 vezes e a presença de três nódulos tireoidianos, um dos quais, maior que 2 cm, com ecogenicidade e vascularização heterogêneas em todo o nódulo, cuja punção aspirativa por agulha fina guiada por ultrassom revelou citologia compatível com Bethesda IV; e a cintilografia evidenciou uma área de baixa captação (nódulo frio) em meio a um bócio difuso de alta captação. Foi realizada tireoidectomia e o diagnóstico da peça anatômica revelou carcinoma papilífero de tir-eoide em lobo direito, com parênquima adjacente compatível com DG. O exame histopatológico da pele mostrou a presença de mixedema compatível com dermopatia de Graves. A paciente evoluiu com normalização dos níveis de TSH e redução das manifestações cutâneas. Conclusão: As anormalidades da DG podem não estar restritas às manifestações clínicas clássicas, e uma investigação criteriosa pode revelar a coexistência de carcinomas, (AU)

A Specific Predicting Model for Screening Skip Metastasis From Patients With Negative Central Lymph Nodes Metastasis in Papillary Thyroid Cancer.

Skip metastasis is a specific type of papillary thyroid cancer lymph node metastasis (LNM). The present study aimed to clarify the typical clinical characteristics of skip metastasis and optimize the prediction model, so as to provide a more individual treatment mode for skip metastasis. We retrospectively analyzed 1075 PTC patients with different lymph node metastasis statuses from two clinical centers. Comparisons have been made between patients with skip metastasis and other types of LNM. Univariate and multivariate analyses were performed to detect the risk factors for skip metastasis with negative LNM, and a nomogram for predicting skip metastasis was established. The rate of skip metastasis was 3.4% (37/1075). Compared with other types of LNM, significant differences showed in tumor size, upper portion location, thyroid capsular invasion, and ipsilateral nodular goiter with the central lymph node metastasis (CLNM) group, and in age and gender with the lateral lymph node metastasis (LLNM) group. Four variables were found to be significantly associated with skip metastasis and were used to construct the model: thyroid capsular invasion, multifocality, tumor size > 1 cm, and upper portion. The nomogram had good discrimination with a concordance index of 0.886 (95% confidence interval [CI], 0.823 to 0.948). In conclusion, the significant differences between skip metastasis and other types of LNM indicated that the lymph node drainage pathway of skip metastasis is different from either CLNM or LLNM. Furthermore, we established a nomogram for predicting risk of skip metastasis, which was able to effectively predict the potential risk of skip metastasis in patients without preoperative LNM clue.

Excessive Prenatal Supplementation of Iodine and Fetal Goiter: Report of Two Cases Using Three-dimensional Ultrasound and Magnetic Resonance Imaging.

Fetal thyroid complications in pregnancy are uncommon, and are commonly related to the passage of substances through the placenta. The excessive iodine intake during the pregnancy is a well-known mechanism of fetal thyroid enlargement or goiter, and invasive procedures have been proposed for the treatment of fetal thyroid pathologies. In the present report, we demonstrate two cases from different centers of prenatal diagnosis of fetal thyroid enlargement and/or goiter in three fetuses (one pair of twins, wherein both fetuses were affected, and one singleton pregnancy). The anamnesis revealed the ingestion of iodine by the patients, prescribed from inadequate vitamin supplementation. In both cases, the cessation of iodine supplement intake resulted in a marked reduction of the volume of the fetal thyroid glands, demonstrating that conservative treatment may be an option in those cases. Also, clinicians must be aware that patients may be exposed to harmful dosages or substances during pregnancy.

As complicações fetais da tireoide na gravidez são incomuns e são comumente relacionadas à passagem de substâncias pela placenta. A ingestão excessiva de iodo durante a gravidez é um mecanismo bem conhecido de aumento da tireoide ou bócio fetal, e procedimentos invasivos foram propostos para o tratamento de patologias da tireoide fetal. No presente relato de caso, demonstramos dois casos de diferentes centros de diagnóstico pré-natal de aumento da tireoide fetal e/ou bócio em três fetos (um par de gêmeos, em que ambos os fetos foram afetados, e uma gravidez única). A anamnese revelou a ingestão de iodo pelos pacientes prescrita por suplementação inadequada de vitaminas. Nos dois casos, a interrupção da ingestão de suplemento de iodo resultou em uma redução acentuada do volume das glândulas tireoides fetais, demonstrando que o tratamento conservador pode ser uma opção nestes casos. Além disso, os médicos devem estar cientes de que as pacientes podem ser expostas a doses ou substâncias nocivas durante a gravidez.

Compressive optic neuropathy (CON) in Graves' disease caused by hypertrophy of levator and superior rectus muscles: A case report.

RATIONALE: Enlargemento of the medial rectus is the most predominant factor of compressive optic neuropathy (CON) in Graves' disease. This case report indicates that CON could develop only from the hypertrophic superior levator and superior rectus (SL/SR) muscle in a patient with poorly controlled Graves' disease, and described the possible risk of FT3-thyrotoxicosis with a prominent goiter to develop the current rare case with a review of the literature. PATIENT CONCERNS: A 66-year-old woman undergoing endocrine management of hyperthyroidism with prominent goiter visited the Department of Ophthalmology due to right-eye upper-eyelid retraction. DIAGNOSES: At initial presentation, the right and left margin reflex distance-1 (MRD-1) was 3.2 mm and 2.1 mm, respectively, and no proptosis or visual dysfunction was observed. Despite insufficient hormonal regulation, she refused to undergo goiter removal. The upper eyelid retraction gradually worsened to 7.7 mm of MRD-1, followed by the onset of 20 prism diopters (PD) of the right hypertropia, resulting in right-eye CON after 6 months. Her free thyroxin level was 3.88 ng/dl and free triiodothyronine was 24.90 pg/ml. Computed tomography and magnetic resonance imaging showed only SL/SR enlargement in the right orbit. INTERVENTIONS: Intravenous steroid and radiation therapy resulted in visual improvement; however, a prominent upper eyelid retraction and 35PD of hypertropia remained in her right eye. Orbital decompression, upper retraction repair, and superior rectus recession were performed to prevent the recurrence of CON and correct any disfigurement. OUTCOMES: The combination of conventional intravenous steroid pulse therapy, radiotherapy, and orbital decompression was effective, and no recurrence was observed for more than 1.5-years postoperatively. LESSONS: Enlargement of the SL/SR muscle complex may independently induce the CON. We believe that strict attention should be paid to patients with triiodothyronine thyrotoxicosis with progressive eyelid retraction and hypertropia.

Excessive prenatal supplementation of iodine and fetal goiter: report of two cases using three-dimensional ultrasound and magnetic resonance imaging / Suplementação pré-natal excessiva de iodo e bócio fetal: Relato de dois casos utilizando ultrassonografia tridimensional e ressonância magnética

Abstract Fetal thyroid complications in pregnancy are uncommon, and are commonly related to the passage of substances through the placenta. The excessive iodine intake during the pregnancy is a well-known mechanism of fetal thyroid enlargement or goiter, and invasive procedures have been proposed for the treatment of fetal thyroid pathologies. In the present report, we demonstrate two cases from different centers of prenatal diagnosis of fetal thyroid enlargement and/or goiter in three fetuses (one pair of twins, wherein both fetuses were affected, and one singleton pregnancy). The anamnesis revealed the ingestion of iodine by the patients, prescribed from inadequate vitamin supplementation. In both cases, the cessation of iodine supplement intake resulted in a marked reduction of the volume of the fetal thyroid glands, demonstrating that conservative treatmentmay be an option in those cases. Also, clinicians must be aware that patients may be exposed to harmful dosages or substances during pregnancy.

Resumo As complicações fetais da tireoide na gravidez são incomuns e são comumente relacionadas à passagem de substâncias pela placenta. A ingestão excessiva de iodo durante a gravidez é um mecanismo bem conhecido de aumento da tireoide ou bócio fetal, e procedimentos invasivos foram propostos para o tratamento de patologias da tireoide fetal. No presente relato de caso, demonstramos dois casos de diferentes centros de diagnóstico pré-natal de aumento da tireoide fetal e/ou bócio em três fetos (um par de gêmeos, em que ambos os fetos foram afetados, e uma gravidez única). A anamnese revelou a ingestão de iodo pelos pacientes prescrita por suplementação inadequada de vitaminas. Nos dois casos, a interrupção da ingestão de suplemento de iodo resultou em uma redução acentuada do volume das glândulas tireoides fetais, demonstrando que o tratamento conservador pode ser uma opção nestes casos. Além disso, os médicos devem estar cientes de que as pacientes podem ser expostas a doses ou substâncias nocivas durante a gravidez.

Plant constituents and thyroid: A revision of the main phytochemicals that interfere with thyroid function.

In the past few decades, there has been a lot of interest in plant constituents for their antioxidant, anti-inflammatory, anti-microbial and anti-proliferative properties. However, concerns have been raised on their potential toxic effects particularly when consumed at high dose. The anti-thyroid effects of some plant constituents have been known for some time. Indeed, epidemiological observations have shown the causal association between staple food based on brassicaceae or soybeans and the development of goiter and/or hypothyroidism. Herein, we review the main plant constituents that interfere with normal thyroid function such as cyanogenic glucosides, polyphenols, phenolic acids, and alkaloids. In detail, we summarize the in vitro and in vivo studies present in the literature, focusing on the compounds that are more abundant in foods or that are available as dietary supplements. We highlight the mechanism of action of these compounds on thyroid cells by giving a particular emphasis to the experimental studies that can be significant for human health. Furthermore, we reveal that the anti-thyroid effects of these plant constituents are clinically evident only when they are consumed in very large amounts or when their ingestion is associated with other conditions that impair thyroid function.

Factores clínicos y bioquímicos asociados con la tirotropina en embarazadas aparentemente sanas / Clinical and biochemical factors associated with thyrotropin in seemingly healthy pregnant women

Introducción: Los valores de tirotropina (TSH) pueden modificarse marcadamente durante el embarazo, en relación con diversos factores clínicos y bioquímicos. Objetivo: Identificar los factores clínicos y bioquímicos asociados con la tirotropina en embarazadas aparentemente sanas. Métodos: Estudio descriptivo, transversal, con 247 gestantes aparentemente sanas del municipio Plaza de la Revolución., en el periodo comprendido de septiembre de 2015 a enero de 2019. Variables analizadas: edad materna y gestacional, trimestre del embarazo, color de la piel, paridad, hábito de fumar, antecedentes familiares de enfermedad tiroidea (APF), consumo de suplementos con yodo, índice de masa corporal (IMC), presencia de bocio al examen físico, TSH, tiroxina total (T4t) y libre (T4l), triyodotironina total (T3t) y libre (T3l), gonadotropina coriónica (hCG), anticuerpos contra la peroxidasa tiroidea (AcTPO) y la tiroglobulina (AcTg) y yoduria. Resultados: La TSH (1,66 ± 0,91mUI/L) tuvo una asociación negativa con la edad materna (r = -0,17; p = 0,008), la paridad (nulíparas 1,80 ± 0,90 mUI/L, multíparas 1,45 ± 0,89 mUI/L; p = 0,003), los APF (positivos 1,56 ± 0,91 mUI/L, negativos 1,81 ± 0,89 mUI/L; p = 0,03), la T4t (r = -0,15; p = 0,02), la T4l (r = -0,23; p = 0,000) y la hCG (r = -0,52; p = 0,001). Mostraron una relación directa la edad gestacional (r = 0,25; p = 0,000) y el uso de suplementos yodados (consumo 1,96 ± 0,72mUI/L, no consumo 1,62 ± 0,93 mUI/L; p = 0,03). Conclusiones: La tirotropina presenta una relación inversa con la edad materna, la paridad, los antecedentes familiares de enfermedad tiroidea, la T4 total y libre, y la gonadotropina coriónica, y una relación directa con la edad gestacional y el consumo de suplementos con yodo(AU)

Introduction: Thyrotropin (TSH) values can be sharply modified during pregnancy, in relation to various clinical and biochemical factors. Objective: Identify clinical and biochemical factors associated with thyrotropin in seemingly healthy pregnant women. Methods: Descriptive, cross-sectional study with 247 seemingly healthy pregnant women from Plaza de la Revolution municipality in the period from September 2015 to January 2019. Variables analyzed: maternal and gestational age, trimester of pregnancy, skin color, pregnancies, smoking habit, family history of thyroid disease (APF), consumption of iodine supplements, body mass index (BMI), presence of goiter to physical examination, TSH, total and free (T4l) thyroxine (T4t), total (T3t) and free (T3l) triiodothyronine, chorionic gonadotropin (hCG), antibodies against thyroid peroxidase (AcTPO) and thyroglobulin (AcTg) and urinary iodine. Results: TSH (1.66 ± 0.91mUI/L) had a negative association with maternal age (r = -0.17; p x 0.008), pregnancy (nulliparas 1.80 ± 0.90 mUI/L, 1.45 ± 0.89 mUI/L; p x 0.003), APF (positive 1.56 ± 0.91 mUI/L, negative 1.81 ± 0.89 mUI/L; p x 0.03), the T4t (r = -0.15; p s 0.02), the T4l (r = -0.23; p x 0.000) and the hCG (r = -0.52; p x 0.001). They showed a direct relationship with gestational age (r x 0.25; p x 0.000) and the use of iodine supplements (consumption 1.96 ± 0.72mUI/L, not consumption 1.62 ± 0.93 mUI/L; p x 0.03). Conclusions: Thyrotropin has an inverse relationship with maternal age, pregnancies, family history of thyroid disease, total and free T4, and chorionic gonadotropin, and a direct relationship with gestational age and consumption of iodine supplements(AU)

Energy vessel sealant devices are associated with decreased risk of neck hematoma after thyroid surgery.

Postoperative neck hematomas following thyroidectomy occur in up to 6.5% of cases. It is unclear whether the use of energy vessel sealant devices effects the rate of PNH. We hypothesized use of an EVSD to be associated with decreased risk of PNH in patients undergoing thyroidectomy. The 2016-2017 American College of Surgeons Thyroidectomy database was queried for patients undergoing thyroidectomy with and without EVSDs. A multivariable logistic regression analysis was performed to evaluate for risk of PNH. From 11,355 patients undergoing thyroidectomy, an EVSD was used for 7460 (65.7%) patients. Age distribution was similar between the two groups (52 vs. 53-years old, p = 0.467). Compared to patients without EVSD used, patients with EVSD used had higher rates of comorbid hypertension (40.6% vs. 34.8%, p < 0.001) and diabetes (14.2% vs. 11.5%, p < 0.001); however, a lower rate of PNH (1.4% vs. 2.4%, p < 0.001). After adjusting for known risk factors for PNH including age, prior neck surgery, and comorbidities, EVSD use was associated with a decreased risk of PNH (OR 0.453, 95% CI 0.330-0.620, p < 0.001). The strongest associated risk factors for PNH were hypertension (OR 1.823, 95% CI 1.283-2.591, p = 0.001) and toxic goiter (OR 1.837, 95% CI 1.144-2.949, p = 0.012). When compared to standard vessel ligation, EVSD use was associated with a lower risk of PNH in patients undergoing thyroidectomy. The strongest associated risk factor for PNH was toxic goiter. Future prospective research is needed to confirm these findings and if corroborated, then increased use of an EVSD should be employed.

Stable Iodine Nutrition During Two Decades of Continuous Universal Salt Iodisation in Sri Lanka.

Universal salt iodisation (USI) was introduced in Sri Lanka in 1995. Since then, four national iodine surveys have assessed the iodine nutrition status of the population. We retrospectively reviewed median urine iodine concentration (mUIC) and goitre prevalence in 16,910 schoolchildren (6-12 years) in all nine provinces of Sri Lanka, the mUIC of pregnant women, drinking-water iodine level, and the percentage of households consuming adequately (15 mg/kg) iodised salt (household salt iodine, HHIS). The mUIC of schoolchildren increased from 145.3 µg/L (interquartile range (IQR) = 84.6-240.4) in 2000 to 232.5 µg/L (IQR = 159.3-315.8) in 2016, but stayed within recommended levels. Some regional variability in mUIC was observed (178.8 and 297.3 µg/L in 2016). There was positive association between mUIC in schoolchildren and water iodine concentration. Goitre prevalence to palpation was a significantly reduced from 18.6% to 2.1% (p < 0.05). In pregnant women, median UIC increased in each trimester (102.3 (61.7-147.1); 217.5 (115.6-313.0); 273.1 (228.9-337.6) µg/L (p = 0.000)). We conclude that the introduction and maintenance of a continuous and consistent USI programme has been a success in Sri Lanka. In order to sustain the programme, it is important to retain monitoring of iodine status while tracking salt-consumption patterns to adjust the recommended iodine content of edible salt.

Graves' disease complicated by fetal goitrous hypothyroidism treated with intra-amniotic administration of levothyroxine.

Fetal goitrous hypothyroidism is a rare entity and is caused mainly by maternal treatment of Graves' disease (GD). We report a case of a 22-year-old woman referred at 12 weeks of gestation due to hyperthyroidism subsequent to recently diagnosed GD. She started treatment with propylthiouracil and, at 21 weeks of gestation, fetal goitre was detected. A cordocentesis confirmed the diagnosis of fetal goitrous hypothyroidism, and intra-amniotic administration of levothyroxine (LT4) was performed and repeated through the pregnancy due to maintenance of fetal goitre. The pregnancy proceeded without further complications and a healthy female infant was born at 37 weeks of gestation, with visible goitre and thyroid function within the normal range at birth. Although there is no consensus on the optimal dose, the number of injections and the interval between them, intra-amniotic LT4 administration is recommended once fetal goitrous hypothyroidism is suspected, in order to prevent long-term complications of fetal hypothyroidism.

Indicators of immunological and hormonal research in patients with non-hospital pneumonia-liquidators of the Chernobyl accident after treatment.

AIM: The aim of the study is to study the state of the immunological and hormonal background in patients with non-hospital pneumonia (NP) - liquidators of the accident at the Chernobyl nuclear power plant (ChNPP) after treatment. MATERIALS AND METHODS: Patients with NP were divided into 2 groups of liquidators of the Chernobyl accident (main group), patients with NP who did not participate in liquidation of the Chernobyl accident (control group), which determined immunological parameters [CD3+, CD4+, CD8+, CD16+, CD20+ expressing cells, immunoglobulin concentrations (Ig) A, M, G] and hormonal indicators (antibodies to thyroglobulin, thyroglobulin, triiodothyronine, thyroxin, cortisol, insulin, testosterone, estradiol, estriol). The main group - liquidators of the Chernobyl accident in an immunological study of 32 NP patients, hormonal - 20; control group - respectively 37 and 38. RESULTS: Combined therapy contributed to an increase in T-lymphocytes in the main and control groups, as well as T-suppressors (Tc) and T-helper cells (Tx), respectively (p<0.05). Also increased the content of B-lymphocytes, IgA, IgM, complement and phagocytic activity in the main and control groups. The ratio Tx/Tc decreased, also decreased IgG, load index, zero cells in the main and control groups.The study of hormonal background in patients with NP showed that the content of thyroglobulin after complex therapy in the main group increased, in the control group their content did not change. The content of triiodothyronine and thyroxine increased after treatment in the main group. In patients with NP of the control group, on the contrary, there was a decrease in thyroid function in terms of thyroglobulin. The study of sex hormones showed that the content of testosterone, estradiol, estriol in patients with NP of the main group increased after treatment, whereas in the control group there was a decrease in estradiol confidence, and testosterone level remained unchanged. The content of estriol increased (p<0.001) in the control group. The increased amount of insulin decreased (p<0.01) in the main group, whereas in the control group these indicators almost did not change. CONCLUSION: After complex therapy, immunological parameters in NP patients in both the main and control groups are normalized, however, recovery in the main group is slower, which requires continued immunological correction in the outpatient setting. Hormonal background approaching the norm more in patients with NP of the control group than the main one.

Systematic thyroid screening in myotonic dystrophy: link between thyroid volume and insulin resistance.

BACKGROUND: Myotonic dystrophy (DM1), a neuromuscular disease related to DMPK gene mutations, is associated to endocrine disorders and cancer. A routine endocrine work-up, including thyroid ultrasound (US), was conducted in 115 genetically-proven DM1 patients in a neuromuscular reference center. The aim of this study was to determine the prevalence and the causes of US thyroid abnormalities in DM1. RESULTS: In the whole population (age 45.1 ± 12.2 years, 61.7% female), palpable nodules or goiters were present in 29.2%. The percentage of US goiter (thyroid volume > 18 mL) and US nodules were, respectively, 38.3 and 60.9%. Sixteen of the 115 patients had a thyroidectomy, after 22 fine-needle aspiration cytology guided by thyroid imaging reporting and data system (TIRADS) classification. Six micro- (1/6 pT3) and 3 macro-papillary thyroid carcinoma (PTCs) (2/3 intermediate risk) were diagnosed (7.9% of 115). Thyroid US led to the diagnosis of 4 multifocal and 2 unifocal (including 1 macro-PTC) non-palpable PTCs. Ultrasound thyroid volume was positively correlated to body mass index (BMI) (p = 0.015) and parity (p = 0.036), and was inversely correlated to TSH (p < 0.001) and vitamin D levels (p = 0.023). The BMI, the frequencies of glucose intolerance and PTC were significantly higher in UsGoiter versus non-UsGoiter groups. CONCLUSION: In this systematically screened DM1 cohort, the frequency of UsGoiter, mainly associated to BMI, was about 40%, US nodules 60%, thyroidectomies 13-14%, and PTCs 8%, two-thirds of them being micro-PTCs with good prognosis. Therefore, a systematic screening remains debatable. A targeted US screening in case of clinical abnormality or high BMI seems more appropriate.

Relación deltre hipotiroidismo subclínico y bocio con el origen del agua consumida por una población del conurbano bonaerense / Relationship of subclinical hypothyroidism and goiter with the origin of water consumed by a population of the Buenos Aires suburbs

El hipotiroidismo subclínico (HS), elevación de tirotrofina con hormonas tiroideas normales, junto al bocio, aumentó la frecuencia en las últimas décadas. Con el objetivo de relacionar la prevalencia de bocio y HS con el consumo de agua subterránea como factor de riesgo etiológico poblacional, se analizaron 879 historias clínicas de un centro médico de Glew, en el conurbano bonaerense Sur. Se estudió la población según edad (20-60 y 12-19 años) y tipo de agua consumida (potabilizada o napa subterránea). El agua subterránea fue consumida por el 70.5% del grupo de 20 a 60 años (n = 559, 79.9% mujeres) y por el 66.3% del grupo de 12 a 19 años (n = 57, 81.4% mujeres). En el grupo de 20 a 60 años la prevalencia de HS en consumidores de agua potabilizada y subterránea fue del 1% y 57.8% (p < 0.0001) y la de bocio de 3.8% y 38.9% (p < 0.0001), respectivamente; con un riesgo atribuible al agua subterránea de 57% para HS y 35% para bocio. En el grupo de 12 a 19 años, la prevalencia de HS fue 6.9% y 52.6% (p < 0.0001) y de bocio 13.8% y 77.2% para los grupos de agua potabilizada y subterránea, (p < 0.0001) respectivamente; con un riesgo atribuible al agua subterránea de 46% para HS y 61% para bocio. El análisis fisicoquímico mostró presencia de nitratos (entre 24 y 83 mg/l) en aguas de pozos y ausencia en agua potable. La prevalencia aumentada de HS y bocio podrían deberse a la acción disruptora tiroidea de los nitratos.

Subclinical hypothyroidism (SH), elevation of the level of thyrotrophin with normal thyroid hormones, along with goiter (glandular size > 25g), increased in recent decades. In order to relate the prevalence of goiter and SH with the consumption of groundwater, as a population etiological risk factor, we analyzed 879 clinical histories from a medical center in the city of Glew in the South Buenos Aires suburbs. The population was studied according to age (20 to 60 and 12 to 19 years) and type of water consumed (potable water or groundwater). Groundwater was consumed by 70.5% of the group from 20 to 60 years old (n = 559, 79.9% women) and by 66.3% of the group from 12 to 19 years old (n = 57, 81.4% women In the group of 20 to 60 years, the prevalence of SH in potable water and groundwater users was 1% and 57.8% (p < 0.0001) and the goiter rate of 3.8% and 38.9% (p < 0.0001) respectively; with an attributable risk to groundwater of 57% for HS, and 35% for goiter In the group of 12 to 19 years, the prevalence of SH was 6.9% and 52.6% (p < 0.0001) and goiter 13.8% and 77.2% for the water and groundwater groups (p>0.0001) respectively, with an attributable risk of 46% for HS y 61% for goiter. The physicochemical analysis showed the presence of nitrates in the range of 24 to 83 mg/l in groundwater and absence in potable water. The increased prevalence of HS and goiter could be due to the thyroid disrupting action of nitrates.

[Relationship of subclinical hypothyroidism and goiter with the origin of water consumed by a population of the Buenos Aires suburbs]. / Relación del hipotiroidismo subclínico y bocio con el origen del agua consumida por una población del conurbano bonaerense.

Subclinical hypothyroidism (SH), elevation of the level of thyrotrophin with normal thyroid hormones, along with goiter (glandular size > 25g), increased in recent decades. In order to relate the prevalence of goiter and SH with the consumption of groundwater, as a population etiological risk factor, we analyzed 879 clinical histories from a medical center in the city of Glew in the South Buenos Aires suburbs. The population was studied according to age (20 to 60 and 12 to 19 years) and type of water consumed (potable water or groundwater). Groundwater was consumed by 70.5% of the group from 20 to 60 years old (n = 559, 79.9% women) and by 66.3% of the group from 12 to 19 years old (n = 57, 81.4% women In the group of 20 to 60 years, the prevalence of SH in potable water and groundwater users was 1% and 57.8% (p < 0.0001) and the goiter rate of 3.8% and 38.9% (p < 0.0001) respectively; with an attributable risk to groundwater of 57% for HS, and 35% for goiter In the group of 12 to 19 years, the prevalence of SH was 6.9% and 52.6% (p < 0.0001) and goiter 13.8% and 77.2% for the water and groundwater groups (p > 0.0001) respectively, with an attributable risk of 46% for HS y 61% for goiter. The physicochemical analysis showed the presence of nitrates in the range of 24 to 83 mg/l in groundwater and absence in potable water. The increased prevalence of HS and goiter could be due to the thyroid disrupting action of nitrates.

[Comparisons of clinical characteristics and prognosis between patients with primary and secondary thyroid lymphoma].

Objective: To compare clinical characteristics and prognosis between patients with primary (PTL) and secondary thyroid lymphoma (STL) . Methods: A retrospective analysis was performed on 46 patients with thyroid lymphoma (PTL 19, STL 27) from January 2002 to October 2018. Results: ①PTL group included 4 males and 15 females, with a median age of 57 years. The STL group included 10 males and 17 females, with a median age of 61 years. Diffuse large B-cell lymphoma (DLBCL) was the main pathological subtype in both PTL and STL groups, with 14 cases (73.7%) and 20 cases (74.1%) respectively. In terms of clinical manifestations, goiter was the most common symptom in PTL patients 100.0% (19/19) , while 29.6% (8/27) STL had goiter (P<0.001) . The incidences of increased thyroglobulin antibody (TRAb) /thyroid peroxidase antibody (TPO) were 81.3% (13/16) in PTL group and 43.8% (7/16) in STL group (P=0.028) respectively. Concerning the clinical features of patients, only two PTL patients (10.5%) with advanced Ann Arbor stage (Ⅲ/Ⅳ) , while 21 (77.8%) STL experienced advanced Ann Arbor stage (P<0.001) . Elevated serum ß(2)-MG were appeared in 1 (7.1%) PTL and 9 (47.4%) STL patients (P=0.013) , and advanced IPI score (3-5) was more common in STL than PTL (59.3% vs 5.3%, P<0.001) . ②Among the 17 PTL patients who received treatments, 15 (88.2%) achieved remission; as for STL patients received treatments, 23/25 (92.0%) were in remission. The 5-year overall survival (OS) rates of PTL (n=17) and STL groups (n=25) were (87.4±8.4) % and (70.0±13.1) % (P=0.433) respectively. ③The 5-year OS rate in 41 patients with B-cell thyroid lymphoma was (81.1±7.5) %. Univariate analysis showed that IPI score of 3-5 (P=0.040) and high level of serum IL-8 (P=0.022) were significantly associated with poor outcome. Conclusion: DLBCL was the most common subtype in both PTL and STL, and goiter was the major symptom in PTL. IPI score of 3-5 and high level of serum IL-8 were unfavorable prognostic factors for patients with B-cell thyroid lymphoma.

Evidence of an ancient (2000 years ago) goiter attributed to iodine deficiency in North America.

The Adena pipe figurine was found in the 2000 year-old Adena burial mound in Ross County, Ohio, USA by William C. Mills in 1901. The pipe reportedly represents an achondroplastic dwarf male Native American. However, the clinical aspect (swelling of the neck), the environmental/cultural characteristics in this area (iodine-poor soils, absence of seafood and milk consumption, tobacco smoking), and the marked prevalence of goiter among Native American populations favor the diagnosis of a goiter associated to iodine deficiency. Similar indigenous art representations found in South America and Mesoamerica strengthen this hypothesis. To our knowledge the Adena pipe is the first example of goiter depicted in Native North American art and one of the oldest from the continent.

Management of thyrotoxicosis in children and adolescents: 35 years' experience in 304 patients.

BACKGROUND: Diffuse toxic goiter accounts for about 15% of all childhood thyroid diseases. There is great controversy over the management of Graves' disease in children and adolescents. This article reports our experience in 304 children and juvenile patients with Graves' disease. METHODS: Between 1981 and 2015, 304 patients aged 5-19 years with diffuse toxic goiter were studied, of whom 296 patients were treated with antithyroid drugs (ATD) for 18 months. Patients with persistent or relapsed hyperthyroidism who refused ablative therapy with surgery or radioiodine were managed with continuous methimazole (MMI) treatment. RESULTS: In 304 patients (245 females and 59 males), the mean age was 15.6±2.6 years. After 18 months of ATD therapy, 37 remained in remission and of the 128 who relapsed, two, 29 and 97 patients chose surgery, continuous ATD and radioiodine therapy, respectively. Of the 136 patients who received radioiodine, 66.2% became hypothyroid. Twenty-nine patients received continuous ATD therapy for 5.7±2.4 years. The mean MMI dose was 4.6±12 mg daily, no serious complications occurred and all of them remained euthyroid during the follow-up. Less abnormal thyroid-stimulating hormone (TSH) values were observed in these patients, as compared to patients who were on a maintenance dose of levothyroxine after radioiodine induced hypothyroidism. CONCLUSIONS: Original treatment with ATD and subsequent radioiodine therapy remain the mainstay of treatment for juvenile hyperthyroidism. Continuous ATD administration may be considered as another treatment modality for hyperthyroidism.