Epidemiologic examinations of goiter in the population of the Sejny community]

The study was aimed at the evaluation of incidence of goiter in the population of the community of Sejny. The survey comprising 1520 subjects revealed the presence of thyroid enlargement in 31.8% of the subjects studied, indicating the occurrence of a mild endemy. The facts speaking for this type of endemy are: predominance of cases with goiter of OB or I degree (83%), higher incidence of goiter in women than in men (3.3 times), occurrence of nodular goiter in 12% of cases with goiter, and sporadic appearance of hypothyroidism. Goiter endemy in the population of this area can be attributed to such goitrogenic factors as low level of iodine and high content of calcium in the water, tobacco smoking, and a habit of drinking tap water.     

Behavior of thyroid autoantibodies in persons inhabiting an endemic goiter area]

The study was aimed at investigating the occurrence of thyroid autoantibodies (ATMA and TGA) in persons inhabiting the area of goiter endemy of mild degree. The survey comprised 1508 persons of age ranging from 3 to 68 years. The subjects studied have been divided into the groups taking into account age, sex, degree of thyroid enlargement (according to WHO, 1974), and the characteristics of the goiter. The occurrence of ATMA or TGA antibodies was demonstrated in 17% of the subjects. An increase in the incidence and titer of thyroid autoantibodies with age was observed. The occurrence of thyroid autoantibodies was observed more frequently in the subjects with parenchymatous goiter. No correlation was found between the incidence of the antibodies and goiter size. Thyroid autoantibodies have also been found in 10% of subjects without goiter. The results obtained do not indicate convincingly the role of the thyroid autoantibodies in the pathogenesis of endemic goiter.     

Effectiveness of iodine prophylaxis and frequency of thyroid enlargement (thyroid goiter) and clinical diagnosis of thyroid diseases in inhabitants of the Szczecin region after the Czernobyl accident]

The study, supported by program MZ-XVII, was carried on 4567 inhabitants of the area of Szczecin (2350 females and 2217 males). The population was chosen randomly, according to a simple drawing scheme. All subjects were clinically examined using standardised questionnaires. In 3468 persons (including 1807 girls and women, 1661 boys and men) apart form clinical examination, the assessment of thyrotropin, thyroxine and triiodothyronine in serum and frequency of antithyroglobulin antibodies and antithyroid membrane antibodies were evaluated. The data indicate that 94% of children in Szczecin's region received the prophylactic dose of iodine, mostly between the 1st and the 5th of May 1986. Only 17% of the adults received iodine. The most common preparation was Lugol solution given in a single dose. Among all persons who received iodine, only in 5% of subjects the side effects were noted (mostly in children), including symptoms of gastrointestinal tract (vomiting, abdomen pain) and occasionally intrathyroid side effects (thyroid pains). In examined population the high frequency of thyroid enlargement, mainly in women (up to 43-44% at the age group 30-50 years) was found. The frequency of clinical diagnosis of thyroid disease was higher in women than in man (most often the diffuse goiter, rarely the nodular goiter). The frequency of thyroid enlargement and clinical diagnosis of thyroid disease was not dependent on prophylactic iodine intake. The iodine prophylaxis did not influence on thyroid hormones and TSH serum levels and on frequency of antithyroid antibodies.     

Physiological and Morphological Specific Features of the Formation of the Thyroid Status in the Aboriginal and Migrant Populations of Magadan Oblast

Ultrasonographic determinations of the thyroid gland volumes and measurement of the blood plasma content of thyroxin and triiodothyronine were carried out in 1176 apparently healthy residents of the Magadan oblast, all those examined being divided by sex, age, and the adaptation time in the North. Special attention was given to the thyroid system parameters of the aborigines 17 to 40 years old living in the urban area and not involved in the traditional life style. The indigenous population of the Extreme North and migrants were shown to have marked functional adaptive hyperplasia of the thyroid gland and diffuse goiter in 15% of cases. The size of the thyroid gland and the level of the thyroid hormones in the aboriginal population are within the average European range. Diffuse goiter manifestations in males virtually do not occur; in women, the incidence does not exceed 5%. The assumption is advanced as to the formation in aborigines of the northern hypothyroid phenotype providing for the sustained optimal level of the thyroid system functioning without an increase in the thyroid volume.     

Primary thyroid angiosarcoma: an unusual localization

ABSTRACT: The finding of thyroid nodules is a very common occurrence in routine clinical practice. Approximately 5% to 7% of the entire population have thyroid nodules. Vascular lesions are one of the most controversial issues in thyroid pathology. These include benign lesions such as hemangiomas and, rarely, malignant tumors such as angiosarcomas or undifferentiated angiosarcomatoid carcinomas. In particular, angiosarcoma of the thyroid gland is a rare, highly aggressive malignant vascular tumor and in Italy the greatest geographical incidence of this lesion is witnessed near the Alps. Here, a case of thyroid angiosarcoma in a 71-year-old man with a history of goiter for about 20 years is described. The unusual localization of this lesion, the difficulties in reaching a definitive diagnosis for this particular histological type of primary tumor and a history of long-standing multinodular goiter in thyroid of an older man from outside the Alpine region prompted us to report this case of thyroid angiosarcoma mainly to discuss surgical, histopathological and immunohistochemical features.     

Results of epidemiologic studies performed after the disaster in Czernobyl among the adult part of the population in the region of Krakow]

Epidemiologic studies following the Czernobyl accident were performed in region Kraków, including Kraków, Nowy Sacz and Kielce district. 1426 males and 2495 females were selected according to the random sample on the whole population of Kraków and Nowy Sacz, as well as in some selected areas in Swietokrzyski Mountains, and in Kielcecity. The aim of the study was to assess the results of the prophylaxis with Kalium iodine after the radiation and the incidence of the goiter in the population. It was stated, that 19.2% of the population in Kraków district, 16.9% in Nowy Sacz and 20% in Kielce received the prophylactic dosis of K.J. 80% took mainly the Lugol solution, between May, the 1st and 5th, 1986. Among 18 of person showing side effects like gastrointestinal disturbances, 16 were of female sex. Goiter incidence according to WHO classification was 50.7%, 67.3% and 49.9% in Kraków, Nowy Sacz and Kielce respectively. The difference between the incidence of goiter in males and females was 1:3. In women it was rather Ist and IInd degree of goiter, in men OB and Ist. Nodules of thyroid gland in the rural region of Kraków, Nowy Sacz and Kielce were seen in women in 10.8%, 1.7%, add 12.3% consecutively. Hormonal studies i.e T3, T4, TSH serum concentration showed normal results in all groups studied. TSH concentration was the highest in the group OB. The microsomal and antithyroglobulin antibodies level was the same independently on the prophylactic dosis of Lugol solution. The high incidence of thyroid diseases not related to the accident was observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Thyroid cancer in patients with hyperthyroidism

OBJECTIVE: The coexistence of hyperthyroidism and thyroid cancer is considered a rare event. With the aim of assessing the clinical relevance of this association, we have retrospectively analyzed the incidence of thyroid cancer in 425 hyperthyroid patients seen and treated by surgery in our institutions. METHODS: Among these hyperthyroid patients, we observed 241 (56.7%) cases of multinodular toxic goiter, 120 (28.3%) of uninodular toxic goiter and 64 (15%) cases of Graves' disease. RESULTS: Thyroid cancer was diagnosed in 7 (1.65%) hyperthyroid patients. Histological examination revealed the presence of papillary carcinoma in 5 cases and follicular carcinoma in 2 cases. Neoplasia was detected in 4 patients with nodular toxic goiter and in 3 with uninodular toxic goiter. None of the patients with Graves' disease had thyroid cancer. During the follow-up of 74 months (range 4-154), there were no deaths or any recurrences. CONCLUSION: Although the occurrence of thyroid cancer in hyperthyroid patients is a rare event, the presence of a 'cold' nodule in a hyperfunctioning thyroid should be carefully evaluated to exclude the presence of concurrent malignancy.     

Epidemiologic studies after the disaster in Czernobyl in the population of children in the Krakow region]

In 1989-1990 the epidemiologic studies about the impact of of Czarnobyl events on the health of children in Kraków and Nowy Sacz region were performed. The morphologic and functional changes of thyroid gland in children were estimated. Almost 90% of children in both districts received the iodine preparations for prophylactic reason. The mean time of intake was between 5-10 days following the Czarnobyl explosion. There were no relationship between the dose of iodine absorbed during prophylactic action and incidence of goiter. The prevalence of goiter amounted to 34.8-47.6% in boys and girls consecutively in Kraków district and 53.8-70.5% in Nowy Sacz. No hormonal changes in T3, T4 and TSH serum concentration were found in children with goiter and those without goiter. The complications after iodine intake were transient and seen only in a small number of children.     

Increased incidence of euthyroid and hyperthyroid goiters independently of thyrotropin in patients with acromegaly

The incidence of palpable goiters, the thyroid functional state and thyroid radioisotope uptake was analyzed retrospectively in 80 patients with acromegaly and 80 patients with prolactinomas. 71% of all patients with acromegaly had an enlargement of the thyroid (goiter); 49% of them had diffuse and 39% nodular goiters. The incidence of goiters in patients with prolactinomas from the same iodine deficient geographic region was only 35% (82% diffuse and 18% nodular). 17.5% of acromegalic patients underwent thyroid surgery before diagnosis of growth hormone excess. 17.5% of acromegalic patients with goiters had autonomous areas in their thyroids and 5% were clearly hyperthyroid. Goiters developed slightly more often in females (74%) than in males (67%). The mean preoperative growth hormone level was higher in acromegalic patients with goiter. The incidence of goiters was positively correlated with the documented time of elevated growth hormone concentration in serum. Two patients with exaggerated response of thyrotropin (TSH) (delta TSH greater than 20 mU/l) to the application of thyrotropin-releasing hormone (TRH) had no goiters. On the other hand most patients (61%) with goiters had a low TSH-response to TRH (delta TSH less than 10 mU/l) representing in part occult autonomy of thyroid function. No patient with prolactinoma has had previous thyroid surgery nor thyroid autonomy. One patient with prolactinoma suffered from Graves' disease and none of the acromegalic patients had this disease. We finally conclude that the elevation of growth hormone leads to increased incidence of euthyroid and hyperthyroid (autonomous) goiters independently of the influence of TSH.     

Physical growth and development, neurological maturation, and behavioral functioning in two Ecuadorian Andean communities in which goiter is endemic. II. PTC taste sensitivity and neurological maturation

PTC (phenylthiocarbamide) taste sensitivity was correlated with a measure of visual-motor maturation in children six to 15 years of age in two Ecuadorian Andean communities in which goiter (enlargement of the thyroid gland) and cretinism are endemic. The children in one population received injections of iodine in oil IM in 1966 while the children in the other population did not. The correlations between PTC taste sensitivity and visual-motor maturation were significant in both sex groups in the non-iodized population, but not in the iodized population. There was also a significant increase in taste sensitivity with age in the non-iodized, but not the iodized, population. The data support the hypothesis that the sensitive “tasters” of PTC limit their ingestion of naturally occurring goitrogens and are at an adaptive advantage with respect to the less sensitive “tasters” and “non-tasters” in this area in which iodine intake is low and the consumption of food crops containing naturally occurring goitrogens is high.     

Influence of radioactive contamination and iodine prophylaxis after the Czernobyl disaster on thyroid morphology and function of the Poznan region]

The radioactive contamination of Poznań Region was recognized after Chernobyl accident as average. The predicted values of minimal (inhalation) and maximal (inhalation and ingestion) committed dose equivalent to the thyroid varied from 2.5 (min) to 24.7 (max) mSv in different groups of adults and children. To follow up the results of iodine prophylaxis and some aspects of possible thyroid gland morphological and functional changes 11086 persons were carefully investigated clinically and biochemically. Among these 11086 persons were 42.6% males and 57.4% females both adults from 17 till 40 year and children up do 16 years. The following parameters were reviewed: pregnancy, time of residence in the region, thyroid abnormalities, family history concerning thyroid diseases, iodine intake in April and May 1986 with possible side effects, changes in the thyroid size observed before and after 1986, degree and kind of thyroid enlargement, serum concentration of T3, T4, TSH, ATMA and ATG titre and finally the effectiveness of thyroid blockade at 24, 48 and 72 h after ingestion of Lugol's solution. Side effects of the ingestion of potassium iodide from 30-70 mg were observed in 153 cases, 36 of them consulted medical doctors but in no case the side effects (dominated by vomiting) threatened the life. In the investigated group were 144 pregnant women. Majority, because 88% of them delivered the baby on or after time and 6.9% before time, 4.9% of natural abortions were noted but non artificial. In the group of children thyroid gland abnormalities before 1986 were reported in 3 cases in 23 after 1986 it is after Chernobyl accident. This information is interesting but needs more precise analysis of different dependencies occurring. The data obtained indicated the existence in Poznań. Region the goiter endemy because 27.5% of investigated children and adults had goiter classified as grades O-B, I, II and III. The elevation or diminution of T3 values were noted in 1164 cases, for T4 in 418 cases and for TSH in 1412 cases. The presence of antimembrane and antithyroglobulin antibodies were observed in 303 cases. All persons with changes observed in thyroid morphology and function are periodically controlled and the results will be published separately. The investigations performed and results presented concern the early aspects of radioactive contamination and effects of iodine prophylaxis. The answer regarding late effects including thyroid cancer needs further multi year studies for which the clinical material investigated in different parts of Poland and well documented should be used as model group for further periodical studies.     

Calcitonin- and somatostatin-positive cells in thyroid gland of pigs at different ages

Immunohistochemical studies were carried out on calcitonin-, somatostatin- and serotonin-reactive cells in newborn pigs and pigs at 3 weeks and 7 months old. The aim of these studies was to examine if the expression of various bioactive substances by parafollicular cells in the pig thyroid varied during development. The volume density of the follicular epithelium was nearly the same in newborn and 3-week-old piglets and significantly lower in 7-month-old animals. The volume density of calciton-in-positive cells, expressed as a percentage of the follicular epithelium density, was similar in young animals, being 12.10% and 13.03% in newborn and 3-week-old piglets, respectively. A small but significant increase to 14.40% was seen in 7-month-old pigs. Somatostatin-positive cells formed a much smaller population at all time points, but these also showed a significant increase with age (0.13%, 0.17% and 0.52% of follicular epithelium density in newborn, 3-week- and 7-month-old pigs, respectively). However the changes in the volume density of somatostatin-positive cells correlated inversely with thyroid activity, the density being highest when the activation index was lowest, suggesting that thyroid activity may be regulated by an increase in the synthesis of this inhibitory peptide. Serotonin-positive cells were extremely rare at all time points and their volume density was not calculated.     

Results of studies on the effect of radiologic contamination after the Czernobyl catastrophe and prophylactic iodine on thyroid morphology and function of inhabitants of North-East Poland]

The results of the investigations of radioactive contamination after the Chernobyl catastrophe and subsequent iodine prophylaxis on the thyroid gland function and morphology in Northeast Poland. The aim of the study was to determine whether kalium iodine in one dose during radioactive contamination in Poland limited the radioactive dose in the thyroid gland and if significant disadvantageous side-effects in the intrathyroid and extrathyroid occurred. Additionally during the studies we tried to determine if radioactive iodine contamination which occurred in the region of the Medical Academy in Bia?ystok caused an increase in thyroid disease. It is interesting to note the different results obtained after radioactive contamination with the results from the investigations in this same territory in 1983-1985. In 1983-1985, before the Chernobyl catastrophe, 6,921 persons in Northeast Poland were investigated. In 1986-1988, immediately after the disaster 4,010 persons were investigated. The main study according to grant No MZ-XVII was carried out in three provinces: Bia?ystok, Suwa?ki and Olsztyn. In this investigation 10,011 persons born before April 26, 1986 and after January 1, 1936 participated, 5,789 townspeople and 4,222 villagers, 3,987 children up to 16 years of age it the time of the disaster 1,973 boys and 2,009 girls; 6,024 adults 2,509 men and 3,516 women were drawn from a register. Committed doses to the thyroid in the investigated region were one of the highest in Poland and depended on age group and were depended on time of prophylaxis non proportional. Iodine prophylaxis was provided mainly with one dose of Lugol solution about 90%, 95% children and 30% adults took iodine. The majority of the population (53.3%-74%) were given iodine in April. From May 1st to 5th 23.0-43.4% received iodine, but after May 5th very few persons. Iodine was well tolerated, but Lugol Solution was better tolerated than other kinds of iodine. Only 241 (4.4%) cases had side effects, mainly vomiting (143), symptoms such as stomach ache, diarrhea, dyspnoe, skinrash etc. in lesser numbers. 12% (29 persons) were seen by a physician. In the investigated population were 200 pregnant women aged 19-40 years of which the majority (177) delivered full term healthy babies. Only 1 interrupted pregnancy and 7 had spontaneous abortion. Changes in the thyroid were noticed by 187 persons (2.3%-11.7%) most of which were enlargement of the thyroid, but only a few were confirmed by a physician. In the studied population from 1989 to 1990 over 30% of the population had struma.(ABSTRACT TRUNCATED AT 400 WORDS)     

Study on consequences of radioactive iodine pollution and iodine prophylaxis after the Czernobyl accident in the Krakow region]

Program of investigations of effects of radiation and iodine prophylaxis undertaken after Czarnobyl accident in Kraków region had to be modified due to goiter endemy in this region. These modifications included: 1) Division of the region into 3 areas (voivodship Nowy Sacz, urban voivodship Kraków and area of Kielce and Swietokrzyskie mountains). 2) Study on iodine uptake in food and urinary secretion. 3) Examination of iodine level in drinking water, add an attempt of calculation of radiation dose absorbed by thyroid. Characterization of selected areas, principles of selection of study groups are presented as well as organizational details and methods of data collection.     

Iodine prophylaxis in children population on the Wielkopolska Region area from year 1992 to 2005

INTRODUCTION: The aim of the study was to evaluate of efficiency of iodine prophylaxis based on obligatory model of salt iodization. MATERIAL AND METHODS: The study included 1444 children from the rural and urban area, with the proportional sex and age (8-12 years) distribution--432 children in 1992 (before salt iodization), 558 children in 2000 and 454 children in 2005 (during salt iodization from 1996). RESULTS: The prevalence of goiter detected in children population in 1992 was 40% (recount by current criteria), in 2005 was reduced to 6% (p < 0.01). Parallel, median of urinary iodine concentration increased from 44 microg/l in 1992 to 107 microg/l (p < 0.01) in 2005. The increase of incidence of autoimmunological thyroid diseases is observed, especially chronic thyroiditis. CONCLUSIONS: The study proves high efficiency of iodine prophylaxis in Wielkopolska Region, but it is still the area with mild iodine deficiency.     

Incidental Thyroid Cancer in Toxic and Nontoxic Goiter: is TSH Associated with Malignany Rate? Results of A Meta-Analysis

ObjectiveIn the last 6 years, several studies reported a positive association between thyrotropin (TSH) and papillary cancer risk. The rationale is based on stimulatory action exerted by TSH on thyroid cell proliferation and/ or progression of a pre-existing papillary carcinoma. To validate this hypothesis, we performed a meta-analysis comparing the incidence of thyroid cancer in 2 groups of patients who underwent surgery for toxic or nontoxic nodular goiter.MethodsUsing data from 2,150 patients with toxic multinodular goiter (TMNG) and 873 patients with toxic adenoma (TA), the overall incidence of thyroid cancer (and 95% confidence interval [CIs]) was estimated to be 5.9% (3.9 to 8.3) for patients with TMNG and 4.8% (2.5 to 7.9) for patients with TA. Four studies were included in the meta-analysis with a total of 1,964 subjects undergoing thyroidectomy for allegedly benign thyroid disease (520 patients with TMNG or TA and 1,444 for multinodular goiter [MNG] or uninodular goiter [UNG]).ResultsWe did not find any significant differences in the risk of incidental thyroid cancer (ITC) in patients with TMNG versus MNG (odds ratio [OR]: 0.91, 95% CI: 0.47 to 1.77, I⁴: 62.6%), TA versus uninodular goiter (UNG) (OR: 0.46, 95% CI: 0.12 to 1.79, I⁵: 12%), and TMNG or TA versus MNG or UNG (pooled analysis) (OR: 0.86, 95% CI: 0.46 to 1.60, I⁶: 51.5%).ConclusionsThe results of this meta-analysis did not confirm an association between low TSH values and lower thyroid cancer rate, at least in patients with nodular disease. (Endocr Pract. 2013;19:212-218)     

Goiter in an eighteenth-century Sicilian mummy

Goiter is still a frequent pathological condition of the thyroid gland. Goiter consists of an enlargement of the gland caused by several physiopathologic events, the most important of which is deficient intake of iodine. A series of eighteenth-century mummies housed in the church of Santa Maria della Grazia in Comiso includes one individual showing a pathological condition, with a very large swelling in the antero-inferior region of the neck. X-rays showed small scattered radiopaque foci. Routine histology showed a large number of circular follicles immersed in fibrous tissue. Finally, immunohistochemistry revealed a strong reactivity for thyroglobulin. The data confirmed the nature of the tissue as thyroid, and the macroscopic diagnosis is that of thyroid goiter.     

Low serum selenium concentration as a possible factor for persistent goiter in Iranian school children

Selenium deficiency can have adverse effect on thyroid metabolism and response to iodine supplementation. The aim of this study was to determine relationship between prevalence of goiter, thyroid hormone profile, urinary iodine and serum selenium concentrations in Iranian schoolchildren. In a cross- sectional study, 1188 schoolchildren in the age group of 8-13 years were evaluated for goiter prevalence. Urine and serum samples were collected from 500 children and assayed for urinary iodine concentration, thyroid hormone profile and serum selenium concentration. The overall goiter prevalence was 39.6% and the median urinary iodine excretion, indicated to an adequate iodine intake. The mean serum selenium concentration was 119.1 +/- 31 mug/l with significant difference between boys and girls (108.4 +/- 26.2 mug/l vs 127.7 +/- 32.1 mug/l). An increase in free T4 concentration was observed in those with a lower selenium level and there was a significant relationship between the presence or absence of goiter and serum selenium concentration. Selenium supplementation may be an advisable measure to optimize thyroid hormone metabolism and decrease the prevalence of goiter in schoolchildren with low serum selenium concentration.     

新疆地区少数民族与汉族甲状腺疾病患者的临床特征比较

目的：比较新疆地区少数民族与汉族甲状腺疾病的患病情况和临床类型特点。方法：选择本院2009 年1月至2011 年12 月收治的312 例被确诊为甲状腺疾病的患者,统计分析其临床资料如民族、年龄、性别、病程间的分布。结果：新疆地区少数民族和汉族8 种常见甲状腺疾病如甲状腺瘤、甲亢、单纯性甲状腺肿、亚急性甲状腺炎、桥本氏病、毒性甲亢、甲减和结节性甲状腺肿的发病率比较均无统计学差异（P〉0.05）。少数民族和汉族男性和女性间常见甲状腺疾病的发病率比较均无显著性差异（P〉0.05）,但少数民族男女性患者和汉族男女性间常见甲状腺疾病的发病率比较的差异均有统计学意义（P〈0.05）。少数民族与汉族甲状腺功能减退症患者的发病年龄、病程以及居住地分布均无显著性差异（P〉0.05）。结论：新疆地区各少数民族几种常见甲状腺疾病发病情况与汉族比较无显著性差异。     

Ultrasound study in the differential diagnosis of thyroid focal lesions of various origin

The present study deals with the ultrasound differential diagnosis of thyroid lesions. A hundred and ninety-two patients, including 130 patients with benign diseases (nodular colloidal goiter) (36.9%), chronic autoimmune thyroiditis (30.7%), and adenomas (32.3%) and 62 patients with malignant diseases (thyroid cancer (88%), lymphoproliferative diseases (6.4%), and recurrent thyroid cancer) (4.8%), were clinically examined. Ultrasound studies (USS) were performed in the B- and (see text symbols) modes. The diagnosis was verified from cytological and histological findings with mandatory morphological confirmation. Interdisease comparison has shown that USS is both a screening and diagnostic technique in revealing thyroid changes and determining their site, sizes, and structure. Ultrasound pathognomonic signs were detected in different morphological types of adenomas, thyroiditis, and nodular colloidal goiter, in the classical, pseudoadenomatous and pseudocystic types of thyroid cancer. At the same time there were characteristic ultrasound parameters at the stage of pronounced changes in undifferentiated thyroid cancer (pseudothyroiditis), lymphoproliferative diseases, and acute thyroiditis. The exception was the diffuse form of chronic autoimmune thyroiditis in which both thyroid lobes were always altered.