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Turkish Journal of Surgery 2018Missed gland is an extremely rare condition. It is a mediastinal thyroid mass found after total thyroidectomy. We report a case of missed gland. The patient underwent...
Missed gland is an extremely rare condition. It is a mediastinal thyroid mass found after total thyroidectomy. We report a case of missed gland. The patient underwent total thyroidectomy due to multinodular goiter and thyroid stimulating hormone levels did not increase after surgery. Pathological tests revealed a micropapillary carcinoma. Thyroid ultrasonography and scintigraphy scan revealed mediastinal thyroid mass. The patient underwent redo surgery without sternotomy and there was no morbidity after the second surgical procedure. Most missed thyroid gland cases are due to incomplete removal of plunging thyroid goiter during total thyroidectomy. They also can be attributed to a concomitant, unrecognized mediastinal goiter, which is not connected to the thyroid gland with vessels or a thin fibrous band. It should be noted that absence of signs like mediastinal mass or tracheal deviation in preoperative chest X-ray does not exclude substernal goiter. The presence of a missed thyroid gland should be kept in mind when postoperative thyroid stimulating hormone levels remain unchanged.
PubMed: 30023979
DOI: 10.5152/turkjsurg.2017.3206 -
Indian Journal of Otolaryngology and... Dec 2023Thyroid disorders are the most common endocrine disorder affecting the general population. Diseases of the thyroid glands present with either an alteration of hormone...
Thyroid disorders are the most common endocrine disorder affecting the general population. Diseases of the thyroid glands present with either an alteration of hormone secretion or as an enlargement of the thyroid gland. They vary from non-neoplastic to neoplastic lesions. The prevalence and pattern of these disorders depend on the factors like age, sex and geographic patterns. The aim of the study is to determine the histomorphological features of thyroid lesions in thyroidectomy specimens in patients who underwent thyroidectomy in tertiary care hospital. This is a retrospective study, conducted in tertiary care centre attached to government hospital. All thyroidectomy specimens received in the Department of Pathology, from January 2021 to January 2023 were included in the study. The patients who underwent thyroidectomy in view of thyroid swelling, over a period of 2 years, were selected. Data was collected from histopathological examinations done on the thyroidectomy specimens. Different histomorphological patterns were observed on microscopy. The thyroid lesions were classified into Neoplastic and Non-neoplastic based on histomorphological features and the data was segregated according to this and analysed. There was a total of 194 specimens, of which 175 were from female and 19 were from male patients. Maximum number of thyroid lesions were seen in the age group of 30-50 years. Among 194 patients, 52 (26.8%) were found to have neoplastic lesions, of whom, 25 (12.8%) patients had benign and 27(14%) patients had malignant lesion. 141(72.7%) patients had non neoplastic conditions. One patient had lymphoproliferative disorder (0.5%). In Neoplastic lesions, Among Benign lesions, Follicular adenoma was found be present in 25 patients. In malignant lesions, Papillary carcinoma was the most commonly found lesion (25 cases, 12.9%). 141(73%) patients had Non neoplastic conditions. Most commonly occurring Non neoplastic lesions were Nodular goiter (50 cases, 25.8%) followed by Colloid goiter (34cases, 17.5%), Multinodular goiter (33 cases, 17%), Hashimoto's thyroiditis (5 cases, 2.6%). Followed by Chronic lymphocytic thyroiditis (4 cases, 2.1%). The frequency of carcinoma is more common in females amongst the total thyroid lesions. Papillary carcinoma was the most frequent malignancy (12.9%) among the thyroidectomy specimens. Papillary carcinoma was the commonest malignant lesion with female preponderance whereas, nodular goiter and colloid goiter were the commonest non neoplastic lesions with female preponderance.
PubMed: 37974725
DOI: 10.1007/s12070-023-03916-w -
Journal of Endocrinological... Feb 2022Toxic multinodular goiter is a heterogeneous disease associated with hyperthyroidism frequently detected in areas with deficient iodine intake, and functioning and...
Gene expression profile in functioning and non-functioning nodules of autonomous multinodular goiter from an area of iodine deficiency: unexpected common characteristics between the two entities.
PURPOSE
Toxic multinodular goiter is a heterogeneous disease associated with hyperthyroidism frequently detected in areas with deficient iodine intake, and functioning and non-functioning nodules, characterized by increased proliferation but opposite functional activity, may coexist in the same gland. To understand the distinct molecular pathology of each entity present in the same gland, the gene expression profile was evaluated by using the Affymetrix technology.
METHODS
Total RNA was extracted from nodular and healthy tissues of two patients and double-strand cDNA was synthesized. Biotinylated cRNA was obtained and, after chemical fragmentation, was hybridized on U133A and B arrays. Each array was stained and the acquired images were analyzed to obtain the expression levels of the transcripts. Both functioning and non-functioning nodules were compared versus healthy tissue of the corresponding patient.
RESULTS
About 16% of genes were modulated in functioning nodules, while in non-functioning nodules only 9% of genes were modulated with respect to the healthy tissue. In functioning nodules of both patients and up-regulation of cyclin D1 and cyclin-dependent kinase inhibitor 1 was observed, suggesting the presence of a possible feedback control of proliferation. Complement components C1s, C7 and C3 were down-regulated in both types of nodules, suggesting a silencing of the innate immune response. Cellular fibronectin precursor was up-regulated in both functioning nodules suggesting a possible increase of endothelial cells. Finally, Frizzled-1 was down-regulated only in functioning nodules, suggesting a role of Wnt signaling pathway in the proliferation and differentiation of these tumors. None of the thyroid-specific gene was deregulated in microarray analysis.
CONCLUSION
In conclusion, the main finding from our data is a similar modulation for both kinds of nodules in genes possibly implicated in thyroid growth.
Topics: Cell Proliferation; Complement System Proteins; Cyclin D1; Cyclin-Dependent Kinase Inhibitor p21; Gene Expression Profiling; Gene Expression Regulation; Goiter, Nodular; Humans; Hyperthyroidism; Thyroid Function Tests; Thyroid Gland; Thyroidectomy; Tissue Array Analysis; Wnt Signaling Pathway
PubMed: 34405392
DOI: 10.1007/s40618-021-01660-y -
Annals of Medicine and Surgery (2012) Oct 2022the diagnosis of thyroid tuberculosis is often difficult, on account of its rarity even in countries with endemic tuberculosis, and on account of its non-specific...
INTRODUCTION AND IMPORTANCE
the diagnosis of thyroid tuberculosis is often difficult, on account of its rarity even in countries with endemic tuberculosis, and on account of its non-specific clinical, biological and radiological presentation.
CASE PRESENTATION
A 38-year-old woman presented with swelling in the anterior part of the neck for 7 years. Clinical and radiological examination found multinodular goiter and fine needle aspiration cytology showed colloidal cells with follicular cells. A total thyroidectomy was performed and histological examination of showed epithelioid and giganto-cellular granulomatous with caseous necrosis, confirming the diagnosis of tuberculous thyroiditis.
CLINICAL DISCUSSION
Tuberculosis of the thyroid gland is a very rare disease, the diagnosis is often made by fine needle aspiration cytology (FNAC), the treatment is mainly medical with antituberculosis drugs, but surgery remains a therapeutic means for some cases.
CONCLUSION
The diagnosis of thyroid TB should be suspected in the presence of a thyroid swelling or nodule, especially in countries with a high prevalence of TB, to allow for early and appropriate management.
PubMed: 36268325
DOI: 10.1016/j.amsu.2022.104724 -
The Journal of Surgical Research Sep 2022Surgical excision of substernal thyroid goiters (STG) can be challenging while minimizing postoperative morbidity. Postoperative complication rates associated with...
INTRODUCTION
Surgical excision of substernal thyroid goiters (STG) can be challenging while minimizing postoperative morbidity. Postoperative complication rates associated with transcervical and transthoracic approaches (i.e., partial or total sternotomy) for STG compared to multinodular goiters (MNG) limited to the neck (i.e., non-substernal) remains unclear. This study examines postoperative morbidity related to surgical approaches in the removal of STG and MNG.
METHODS
A retrospective review of prospectively collected data of 988 patients with STG and non-substernal MNG from a single institution between 2010 and 2021 was performed. Patients were stratified by STG and conventional non-substernal MNG limited to the neck excised by transcervical and transthoracic approach. Postoperative complications including neck hematoma requiring return to the operating room, permanent recurrent laryngeal nerve injury and hypocalcemia, and transient or temporary recurrent laryngeal nerve injury and hypocalcemia were identified. Demographics including age, sex, and race, among others, were analyzed.
RESULTS
Of the 988 cases, there were 887 (90%) MNG and 101 (10%) STG. Of the STG cohort, 11 (11%) required a partial sternotomy and 4 (4%) required a total sternotomy. Permanent complication rates for non-substernal MNG and STG patients were 1.5% and 0.9%, respectively. Only transient or temporary hypocalcemia rates were statistically different between the STG and MNG cohorts (9.9% versus 3.8%, P < 0.001).
CONCLUSIONS
Regardless of transcervical or transthoracic approach, postoperative complications associated with the surgical removal of STG are low in the hands of experienced, high-volume thyroid surgeons.
Topics: Goiter, Substernal; Humans; Hypocalcemia; Morbidity; Postoperative Complications; Recurrent Laryngeal Nerve Injuries; Retrospective Studies; Thyroidectomy
PubMed: 35504153
DOI: 10.1016/j.jss.2022.04.018 -
European Archives of... Feb 2017The anatomical approach to the intrathoracic goiter (ITG) was used to understand its etiology and to rationalize surgical technique of thyroidectomy. For a retrospective...
The anatomical approach to the intrathoracic goiter (ITG) was used to understand its etiology and to rationalize surgical technique of thyroidectomy. For a retrospective chart review, we selected cases of multinodular goiter with totally ITGs (n = 69; M 29, F 40), while 916 cases with cervical goiter were used for comparison. The topography of the thyroid gland was assessed against the tracheal rings and against the vertebrae. The regional anatomy of the thoracic inlet was assessed by its bony margins and the relations of structures traversing the area. Average tracheal-diameter-to-thoracic-inlet ratio was calculated. The ITG group consisted of 52 cases of retrosternal goiter (75.4 %), nine cases of retrotracheal goiter (13 %), and eight cases of retroesophageal goiter (11.6 %). In all but one analyzed cases, the goiters were removed via cervical incision. Mean weight of goiters was 183 g. The area of thoracic inlet in the cases of ITG had no difference in comparison with the cases of cervical goiter (F/M p = 0.11/0.15), but the tracheal-diameter-to-thoracic-inlet ratio was significantly smaller (F/M p = 0.06/0.04). In the ITG cases, the position of the upper edge of the isthmus of the thyroid was about 1.5 tracheal rings lower than in healthy individuals (p = 0.03). The area of the thoracic inlet, the neck size, and the anteroposterior diameter of the inlet do not affect the development of the ITG. The smaller tracheal-diameter-to-thoracic-inlet ratio and the lower position of the thyroid gland are the main indicators for the development of the ITG.
Topics: Adult; Female; Goiter, Substernal; Humans; Male; Middle Aged; Retrospective Studies; Thoracotomy; Thyroid Gland; Thyroidectomy; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27687679
DOI: 10.1007/s00405-016-4322-9 -
Indian Journal of Otolaryngology and... Sep 2017This study aims to evaluate surgical approaches to the management of retrosternal goitre. Between 2004 and 2014, 35 patients (eight males; mean age...
This study aims to evaluate surgical approaches to the management of retrosternal goitre. Between 2004 and 2014, 35 patients (eight males; mean age 67.4 ± 10.9 years) with retrosternal goitre (mainly right-sided in 9, left-sided in 14 and bilateral in 12) underwent surgery. A palpable neck mass was found in 11 (31.4%), stridor in 10 (28.6%) and thyrotoxicosis in 4 (11.4%) cases. 4 (11.4%) patients were asymptomatic. Tracheal compression was detected radiologically in 27 (77.2%) patients with deviation in 18 (51.4%). A collar incision was performed in 34 patients, 6 (17.1%) of whom required additional sternotomy, 1 (2.9%) was assisted by an anterior mediastinotomy. 1 (2.9%) had a right lateral thoracotomy. There was no operative mortality. Transient vocal changes occurred in 3 (8.6%) patients, recurrent laryngeal nerve palsy in 3, atrial fibrillation in 2, and wound complications in 2 (5.7%). Hospital stay ranged from 2 to 12 days (5.5 ± 2.0). Multinodular goitre was found in 33 patients, diffuse goitre in 1 and ectopic thyroid in 1. The average vertical length of goitres in the collar incision group was 7.6 cm compared to 10.6 cm in the sternotomy group. The average weight of specimens was 156.3 g in patients with collar incisions and 307.5 g in the sternotomy group. Removal of retrosternal goitre is more commonly performed via a cervical collar incision with mandatory availability of sternotomy. Radiological measurement of craniocaudal length may predict the risk of sternotomy. Surgical outcomes are not affected by surgical approach.
PubMed: 28929066
DOI: 10.1007/s12070-017-1151-0 -
Endocrinology, Diabetes & Metabolism... Jun 2022Mass effect from a goiter is a serious complication with potentially life-threatening consequences. In rare instances, a goiter can compress nearby vessels, compromising...
SUMMARY
Mass effect from a goiter is a serious complication with potentially life-threatening consequences. In rare instances, a goiter can compress nearby vessels, compromising cerebral blood flow, which can lead to an ischemic stroke. Ischemic strokes generally occur due to atherogenic or embolic phenomenon, albeit a rare etiology can be due to a mechanical obstruction of great vessels of the neck that provide blood supply to the brain. An unusual example of a similar obstruction is the mass effect of an expansive goiter on the carotid artery (CA) in the neck. We present a rare case of a 90-year-old female who had a historically untreated goiter for 13 years. She presented with symptoms of acute stroke, including right-sided weakness and dysarthria. CT angiogram of the neck revealed a massively enlarged thyroid gland causing compression and intermittent obstruction of the blood flow in the left common CA. Subsequently, the patient underwent a total thyroidectomy. Postoperatively, she had a remarkable recovery of her symptoms of right-sided weakness and dysarthria. Acknowledging stroke as a grave mechanical complication of a large multinodular goiter is crucial for timely and appropriate management to avoid serious consequences.
LEARNING POINTS
The natural history of euthyroid multinodular goiters include abnormal enlargement of the thyroid gland, which results in local compression of structures in the neck causing neurovascular injury. Timely diagnosis and surgical management of an enlarging goiter compressing the CA can reduce morbidity from an ischemic stroke. Ischemic stroke is a rare and dangerous complication of a giant multinodular goiter.
PubMed: 36103594
DOI: 10.1530/EDM-22-0247 -
Thyroid : Official Journal of the... Apr 2022Multinodular goiter (MNG) is the most common disorder of the thyroid gland. Aging and genetic mutations that impair thyroid hormone (TH) production have been implicated...
Multinodular goiter (MNG) is the most common disorder of the thyroid gland. Aging and genetic mutations that impair thyroid hormone (TH) production have been implicated in the development of MNG. XB130 is an adaptor/scaffold protein predominantly expressed in the thyroid gland. XB130 deficiency leads to transient postnatal growth retardation in mice due to congenital hypothyroidism. We studied the formation of MNG and possible mechanisms in elderly mice. Thyroid glands of male and female knockout (), heterozygous (), and wild-type () mice at the ages of 12-20 months were harvested for visual examination, histopathological, and immunohistological analyses. Blood and thyroid samples were collected after feeding elderly mice with a low iodine diet for I uptake and perchlorate discharge assay. The activity of thyroperoxidase (Tpo) was examined by spectrophotometric evaluation of iodide oxidation. While moderate MNG was seen in and mice, severe MNG, characterized by multiple nodules intermixed with dilated colloid-rich macrofollicles, was found only in mice at 18 months. Thyrocyte cytoskeletal structure and cell adhesion molecules were disorganized, and TH production was significantly reduced. Reduced iodide organification was seen in elderly mice and further enhanced in mice. In mice, Tpo shows high affinity with hydrogen peroxide (HO) throughout aging, but reduced affinity with iodide in an age-dependent manner. By contrast, in elderly mice, the affinity of Tpo for iodide remained high, but the affinity of Tpo for HO was reduced. The pathophysiological features in the thyroid glands of aged mice closely resemble the features of MNG in humans. Moderate MNG in elderly mice was dramatically aggravated by XB130 deficiency. Reduced affinity of Tpo for HO may contribute to MNG development via oxidative stress. This could be specific to XB130 deficiency but also could be a common mechanism in MNG. Its clinical relevance should be further investigated.
Topics: Aged; Animals; Congenital Hypothyroidism; Female; Goiter; Humans; Hydrogen Peroxide; Iodide Peroxidase; Iodides; Male; Mice; Thyroid Hormones
PubMed: 34915750
DOI: 10.1089/thy.2021.0458 -
Acta Endocrinologica (Bucharest,... 2022
PubMed: 36699173
DOI: 10.4183/aeb.2022.397