[Thyroid functional activity and hemodynamic parameters in upper-class schoolchildren presenting with endemic goiter].

We studied the relationship between iodine deficiency, blood cortisol levels, andhemodynamicparameters in 536schoolchildren of Vladikavkaz aged 13-17 years. Urine iodine was measured using cerium arsenite reaction, thyroid function was evaluated from thyrotropin, T3, and free T4 levels, blood cortisol was determined by the immonoenzyme assay using Alcor Bio kits. The study group included 24 subjects with endemic goiter, control group was comprised of 14 healthy adolescents. Hemodynamic parameters were studied using a Vivid 7 Dimension scanner.

[Brain bioelectric activity forming in adolescents living in different endemic goiter area of European North].

UNLABELLED: Northern European regions are goiter endemic and iodine-deficient areas, and also differ in the degree of extreme weather conditions in the Polar and Subpolar latitudes. The age formation of the nervous system in adolescents depends on these discomfort climatic factors. AIM: The study of functional brain activity depending on the thyroid profile in adolescents living in the European North. PATIENTS AND METHODS: 211 adolescents (male and female) aged 15-16 years living in the Subpolar (64 degrees 30' N) and Polar (67 degrees 40' N) Russian regions were observed. An electroencephalogram in a state of quiet wakefulness with eyes closed monopolar 16 standard leads was recorded. Electroencephalogram characteristic were performed by the values: of the wave amplitudes, index and absolute spectral power in each frequency band: 4-7 Hz, 8-12 Hz and 13-24 Hz. In serum samples by immune-enzyme assay thyrotropin, triiodothyronine and thyroxine levels were determined. All the described changes were statistically significant at p < 0.05-0.001. RESULTS: A higher activity of diencephalic subcortical brain structures, expressed in the form of increased -activity and photic driver reactions were determined in adolescents living in Polar region. Background thyroid status determines the age formation of brain activity. In adolescents living in the Polar region a high concentration of thyrotropin in the blood and the availability of significant relations with thyroid hormones levels with a brain theta-activity were detected. In adolescents living in Subpolar region is more intense age optimization of neural processes, as well as the greatest number of neuro-endocrine relationships.

Iconography of goiter: four refined examples in the Sacred Mountain of Varese, Italy.

BACKGROUND: Four goiter representations observed by the authors in the sculptures of the Sacred Mountain of Varese, Italy, are described here. SUMMARY: They should be regarded as a typical and proper example of the iconography of "real goiter," where the artists had the definite intention to depict persons with goiter. CONCLUSIONS: Studies of representations of individuals with goiter are not that rare, even though most of the observations reported in the literature deal with images that should be considered occasional swelling of the anterior neck, "thick neck," or "pseudogoiter" because the artists probably did not have any intention to illustrate the pathological condition.

[Peculiarities of formation, clinical presentations and therapy of diffuse nontoxic goiter of children].

The paper deals with the peculiarities of formation, clinical presentations and therapy of diffuse nontoxic goiter of children. The paper highlights the connection of the disease with the genetic predisposition, the impact of natural and anthropogenic strumagenes, immune processes. The clinical presentations of the diffuse nontoxic goiter are diffuse enlargement of thyroid gland, normal or high level of thyrotropichypophysis hormone when the content of thyroxin and triiodothyronine is normal, which is treated as the subclinic hypothyroidism syndrome. The variety of the disease pathogenesis theories leads to testing of different therapeutic methods, the principal ones among them are the use of iodine preparation and replacement therapy.

Evidence of endemic goiter and iodine deficiency in a mountainous area of Haiti.

OBJECTIVE: To investigate reports of iodine-deficiency disorder in a specific area of Haiti. METHODS: In March 2008, this cross-sectional study was performed in an area 15 miles northeast of Jacmel, Haiti, within the Chaîne de la Selle Mountains. Before arrival of the study team, an announcement was made throughout local villages soliciting volunteers to meet at a central location. Of those who arrived, participants were selected in an attempt to sample individuals from all age groups, regardless of goiter status. After providing verbal informed consent, each participant was photographed and assigned a number to be used to protect privacy. An examiner performed palpation of the thyroid gland on each participant in accordance with World Health Organization criteria. Results of palpation were classified into 3 grades: grade 0, the thyroid gland was not palpable; grade 1, the thyroid gland was palpable but not visible; and grade 2, the thyroid gland was palpable and visible while the patient was in a normal position. Casual urine samples were collected from each participant and analyzed spectrophotometrically for urinary iodine concentration. RESULTS: Eighty-eight individuals aged 2 to 72 years participated in the study. Median urinary iodine concentration was 39 microg/L. Of the 88 participants, 82 (93%) were iodine deficient (18 [20%] were severely deficient), and 45 (51%) had goiter on physical examination, including 27 with grade 1 goiters and 18 with grade 2 goiters. CONCLUSIONS: We have documented iodine deficiency with associated endemic goiter in this previously uninvestigated Haitian population, for which world health agencies currently lack definitive data. These data have potential implications for both the local area and the country as a whole where further evaluation and treatment are needed for persons at high risk for iodine-deficiency disorder.

[Neuroendocrine, neorophysiological and neuropsychological changes in children form the iodine deficient population with endemic goiter].

The study was performed in Chokhatauri region, on students of age 13-14 in village Meria in 36 schools. There is discovered mild iodine deficiency with median variation from 78 to 96 %. After clinical and ultrasound studies, it was identified endemic goiter (83.33%). There was performed multi-profile clinical studies on young people by neurologists, neurophysicians, endocrinologists, pediatricians. Electroencephalographic study was performed by digital equipment by visual and computer analysis of the results. There were identified brain functional changes of diffuse character in EG writings. It was identified multineurological complains, especially in children with endemic goiter. With neurophysiologist's tests was estimated neurocognistic functional studies, as in people with endemic goiter also with healthy ones. According to test scores, was estimated perception of visual-space construction, speed of intellectual task performing, quality of functional recognition. According to the results, was estimated visual space memory. The scores in children with endemic goiter was lower then in healthy children. The results are giving possibility to estimate in children with endemic goiter mild neuro-endocrinology, neuro-physiology and neuro-physiology changes coursed by iodine deficiency, before infringement in their clinical appearance. In time prevention of this infringement will give us possibility to avoid future pretended infringement in intellect development.

The adaptation of TSH secretion to autonomy in non-toxic goiter may be based-on active regulation of set-point and sensitivity of central TSH-receptors, perhaps by the microRNA (MIR) gene.

The hypothalamic-pituitary-thyroid (HPT) feedback system is one of the most complex regulatory systems and it has intrigued researchers for more than 50 years. One of the unsolved problems of this regulation in humans is the hypothalamic and pituitary adaption to autonomous function of the thyroid gland in non-toxic goiter (NTG). A new hypothesis, that TSH secretion is actively regulated in NTG in response to changes in thyroid autonomy in order to keep the patient euthyroid, was discussed in the present study on basis of previous experimental data in NTG patients with different degree of autonomous function. The patients were submaximally suppressed for one month with a fixed daily dose of T3. Group data suggested an inverse correlation between TSH suppression and suppression of thyroid function. Group data also suggested that TSH suppression was significantly correlated to basal TSH. This means that a NTG patient with a low normal TSH in blood before suppression (basal TSH) and a high degree of autonomous function may exhibit a relatively high TSH suppression. This ensures a minimal stimulation of the thyroid gland thereby protecting the gland from developing hyperthyroidism. A patient with a high normal TSH in blood before suppression (basal TSH) and a low degree of autonomous function, may exhibit a relatively low TSH suppression, indicating a high stimulation of the thyroid gland thereby protecting the patient from developing hypothyroidism. It is hypothesized that this adaption of TSH secretion to autonomy in NTG patients may be based on active regulation of both the set- point of the central TSH-receptors and the sensitivity of these receptors as well. Such an active regulation of the HPT axis may be controlled by one of the newly found post-transcriptional genes called MIR (microRNA).

[Current views on the etiopathogenesis of goiter in children]. / Wspólczesne poglady na etiopatogeneze wola u dzieci.

The most frequent cause of goiter in children is a deficit of iodine, leading to endemia of goiter in the regions with insufficient supplementation of this element. Goiter occurs also in the course of autoimmunological diseases of the thyroid gland (Hashimoto disease, Graves' disease), genetically-related disorders of thyroid hormones, biosynthesis/impaired biosynthesis of thyroid hormones. According to the theory of goiter pathogenesis, excessive enlargement of the thyroid gland is due to adaptation of follicle cells of the gland aiming at neutralizing the impaired synthesis of the thyroid hormones caused by various intrathyroid, environmental and genetic factors/agents. The mechanisms stimulating thyrocytes to hyperplasia or hypertrophy are very complex and still unknown in spite of having identified many physiological and pathogenetic factors connected with goiter.

Development of a dried whole-blood spot thyroglobulin assay and its evaluation as an indicator of thyroid status in goitrous children receiving iodized salt.

BACKGROUND: Serum thyroglobulin appears to be a sensitive marker of thyroid dysfunction in endemic goiter. However, its value as an indicator of thyroid status in children after the introduction of iodized salt has not been tested. OBJECTIVE: The objective was to optimize and validate a thyroglobulin assay on dried whole blood spots and to evaluate thyroglobulin as an indicator of thyroid response to iodized salt. DESIGN: A standardized, commercially available, sandwich fluoroimmunometric serum thyroglobulin assay was adapted for use on blood spots and validated in Swiss children. In a 1-y prospective study in 377 goitrous Moroccan children aged 6-15 y, the assay was used to measure thyroglobulin before and after the introduction of iodized salt. Urinary iodine, thyroid volume, thyrotropin, and thyroxine were measured, and regression was done with thyroglobulin as the dependent variable. RESULTS: Correlation between the blood spot and serum assays was excellent (r = 0.98). The SD of the difference between the blood spot and serum assays was 3.8 micro g/L; the median CVs for the blood spot assay in controls and samples were 6.3% and 14.4%, respectively. Median thyroglobulin was 24.5 (range: 0-328.8) micro g/L at baseline and fell significantly after the introduction of iodized salt to 6.2 (0-83.1) and 4.4 (0-47.1) micro g/L at 5 and 12 mo, respectively (P < 0.0001). Regression of urinary iodine and thyroid volume on thyroglobulin was highly significant at baseline and at 5 mo (P < 0.001). CONCLUSION: Thyroglobulin, measured in dried whole blood spots, may be a valuable indicator of improving thyroid function in children after supplementation with iodized salt.

Endothelin-1 levels in patients with disorders of the thyroid gland.

The endothelium derived peptide endothelin-1 (ET-1) is the major isoform of the endothelin peptide family, which is produced and secreted in the endothelial cell system. We measured plasma levels in patients with thyroid diseases and investigated associations between laboratory and clinical markers of thyroid metabolism and ET-1 plasma levels. ET-1 plasma levels were determined in patients with Graves' disease (n = 54), endemic goiter (n = 26), patients with Hashimoto's thyroiditis (n = 21) and compared to healthy controls (n = 60). ET-1 plasma levels were significantly elevated in patients with Hashimoto's thyroiditis (p < 0.0001) and in patients with Graves' disease (p = 0.003), when compared to healthy controls. In patients with endemic goiter, no significant differences were found compared to healthy controls (p = 0.298) and when compared to patients with Graves' disease (p = 0.16). We did not observe an association between ET-1 plasma levels and parameters of thyroid disease (e.g. thyroidea-stimulating hormone, thyroxine, volume of the thyroid). Furthermore, patients with and without endocrine thyroid disease showed no significantly different ET-1 plasma levels (p = 0.78). These data suggest that the autoimmunologically induced inflammatory response of the thyroid gland in Hashimoto's thyroiditis and Graves' disease is responsible for increased ET-1 plasma levels. Furthermore, our data do not support a role for ET-1 as a valid quantitative indicator for stage or progression in endemic goiter, Graves' disease or Hashimoto's thyroiditis.

Clinically evident thyroid gland disorders in Lublin Region.

The authors tried to assess the prevalence of thyroid gland pathology in Lublin and the Lublin Region population over 35 years old. The study was performed a few years after introduction of iodine prophylaxis in Poland. In our study we still found high prevalence of goitre--about 12% in town and rural population. A very low rate of diagnosed and treated patients with clinically evident thyroid gland pathology was observed in countryside area. Our data confirm the known phenomenon of considerably higher prevalence of thyroid gland diseases in females. Decrease of prevalence of hyperthyroidism in recent years but still low prevalence of overt hypothyroidism are characteristic of a temporary period from moderate iodine deficiency to sufficient iodine intake.

[Autonomic system disorders in endemic goiter]. / Vegetativye narusheniia pri éndemicheskom zobe.

Vegetative tonicity, reactivity and provision were studied in 88 patients with endemic goiter (EG) aged 18 to 40 years. Vegetative dystonia syndrome (VDS) in EG develops as parasympathicotonia. Subjective symptoms of vegetative dysregulation are more pronounced in high reactive and personality anxiety, in neurotism, they do not depend on extra- or introversion. VDS in EG deteriorates mental and physical performance, attention. Vegetative reactivity in EG becomes hypersympathicotonic. Vegetative dystonia affects reaction to the disease. Prolapse of heart valves often seen in EG patients results rather from hypothyroid edema of the myocardium than from VDS. Therefore, treatment of such patients with beta-adrenoblockers is not grounded. Vegetative dysregulation gradually attenuates in response to replacement hormone therapy with thyroxine.

[Natural deficiency of trace elements and ways of its prevention]. / Prirodnyi defitsit mikroélementov i puti ego preodoleniia.

Eighty female adolescents living in the area where goiter is endemic were examined. The rates of increases in height and weight under 10 years were found to lag behind and, on the contrary, to excel their standard values in adolescence. The accelerated increases in height and weight in girls aged 11 to 15 years were attended by rises in morbidity rates. The number of children with normal sexual development in the area of goiter endemics was reduced to 28.8% and the prevalence of menstrual dysfunction increased up to 54.8%. Impaired menstrual function was most frequently recorded in girls with changed levels of follicle-stimulating and interstitial cell-stimulating hormones.

Assessment of goiter in an area of endemic iodine deficiency.

Urinary iodone (UI) excretion and sonographically measured thyroid volume were investigated in 195 subjects living in 6 separate villages in the Casamance region of southeastern Senegal, West Africa. A comparison of goiter prevalence using thyroid palpation and volume measurement and of iodine excretion expressed as micrograms per gram (microg/g) creatinine or micrograms per deciliter (microg/dl) urine was undertaken, and possible pathogenetic factors were investigated. Ultrasound measured thyroid volumes were above the recommended upper limit of the reference range for an area replete in iodine in 83.1% or females, 52.3% of males, and 80.0% of children aged 13 years or younger. Overall sensitivity and specificity for palpation compared to sonographically demonstrated thyroid enlargement was 51.7% and 91.5%, respectively. Thyroid enlargement was not associated with ethnic origin, thiocyanate ingestion, HLA DR/DQ phenotype frequency, or thyroid growth-stimulating immunoglobulin (TGI) positivity. Median UI was 32 microg/g creatinine with 65.0% having values consistent with iodine deficiency (< 50 microg/g). When results were expressed as micrograms per deciliter, the percentage having values consistent with iodine deficiency (< 5.0 microg/dl) increased to 95.7%. The findings suggest a primary role for iodine deficiency in goitrogenesis in the study population. They demonstrate that classification of the severity of the endemia in this or other study populations in areas of iodine deficiency is dependent on the methods used to determine goiter prevalence (palpation or ultrasound measured thyroid enlargement), or dietary iodine status (iodine excretion expressed as micrograms per gram creatinine or micrograms per deciliter urine).

[Surgery of the goiter]. / Chirurgie der Struma.

Surgery of the goiter has been greatly influenced by Theodor Kocher all over the world. Dedicated to his understanding of goiterogenesis he is considered the father of the prevention and elimination of the wide spread iodine deficiency goiter disease in Switzerland by introducing the iodinesation of salt. Therefore Switzerland is the only country in Europe, which is no longer an iodine deficiency region but remains an endemic goiter region. The traditional conservative Kocher type of surgical resection of the multinodular goiter showed to harbour the problem of a high recurrence rate. The analysis of our Bernese data (3193 thyroid operations with 4395 nerves at risk) brought us to the point to question this traditional surgical strategy. In order to lower the recurrence rate and in addition to lower surgical morbidity we started from 1990 to resect much more thyroid tissue in order to resect all pathologic thyroid tissue. This meant as a minimal surgical procedure, a thyroidectomy on one side followed by a subtotal resection on the contralateral side in case of bilateral disease. The surgical concept in parallel was supported by the novel molecular biological concept of goiterogenesis presented by our Bernese research team, which could demonstrate that the potential for goiterogenesis and clonal growth of functional and morphological independent cluster is distributed all over the whole thyroid gland. Therefore a more radical resection at the first operation will resect much more potential clones at risk to become recurrent goiters than the 'old' conservative resection type. With the more radical initial resection combined with a routine demonstration of the recurrent laryngeal nerve and the parathyroid glands we could reduce the recurrent laryngeal nerve palsy from 2.7% (nerves at risk) in the early period (1972-1990) to 0.7% with the more radical resection (1991-1996, p < 0.05). In parallel the postoperative hypoparathyroidism of the early period of 3.6% could be lowered to 1% in the actual series (p < 0.05). Theodor Kocher's conservative thyroid gland surgical concept has now one century later found a correction by a Bernese team again, which could significantly reduce the morbidity of thyroid gland surgery and as well, will greatly reduce the incidence of recurrent goiter disease after initial surgery in our endemic region.

Autonomy in endemic goiter.

The occurrence of hyperthyroidism in many individuals after introduction of iodine prophylaxis in endemic goiter areas can have dramatic consequences for the affected individuals. It indicates that in such individuals the increase of serum thyroid hormone level in response to iodine supplementation does not exert its normal negative feedback on thyroid activity, ie, that in such individuals some thyroid tissue has become autonomous. In this short review we summarize what is known about the possible mechanisms, cause, diagnosis, and consequences of thyroid autonomy.