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Frontiers in Endocrinology 2023The use of iodinated contrast media (ICM) can lead to thyrotoxicosis, especially in patients with risk factors, such as Graves' disease, multinodular goiter, older age,...
INTRODUCTION
The use of iodinated contrast media (ICM) can lead to thyrotoxicosis, especially in patients with risk factors, such as Graves' disease, multinodular goiter, older age, and iodine deficiency. Although hyperthyroidism may have clinically relevant effects, whether high-risk patients should receive prophylactic treatment before they are administered ICM is still debated.
AIM OF THE STUDY
We aimed to demonstrate the safety and efficacy of prophylactic treatment with sodium perchlorate and/or methimazole to prevent ICM-induced hyperthyroidism (ICMIH) in a population of high-risk cardiac patients. We ran a cost analysis to ascertain the most cost-effective prophylactic treatment protocol. We also aimed to identify possible risk factors for the onset of ICMIH.
MATERIALS AND METHODS
We performed a longitudinal retrospective study on 61 patients admitted to a tertiary-level cardiology unit for diagnostic and/or therapeutic ICM-procedures. We included patients with available records of thyroid function tests performed before and after ICM were administered, who were at high risk of developing ICMIH. Patients were given one of two different prophylactic treatments (methimazole alone or both methimazole and sodium perchlorate) or no prophylactic treatment. The difference between their thyroid function at the baseline and 11-30 days after the ICM-related procedure was considered the principal endpoint.
RESULTS
Twenty-three (38%) of the 61 patients were given a prophylactic treatment. Thyroid function deteriorated after the administration of ICM in 9/61 patients (15%). These cases were associated with higher plasma creatinine levels at admission, higher baseline TSH levels, lower baseline FT4 levels, and no use of prophylactic treatment. The type of prophylaxis provided did not influence any onset of ICMIH. A cost-benefit analysis showed that prophylactic treatment with methimazole alone was less costly per person than the combination protocol. On multivariate analysis, only the use of a prophylactic treatment was independently associated with a reduction in the risk of ICMIH. Patients not given any prophylactic treatment had a nearly five-fold higher relative risk of developing ICMIH.
CONCLUSION
Prophylactic treatment can prevent the onset of ICMIH in high-risk populations administered ICM. Prophylaxis is safe and effective in this setting, especially in cardiopathic patients. Prophylaxis with methimazole alone seems to be the most cost-effective option.
Topics: Humans; Contrast Media; Methimazole; Retrospective Studies; Hyperthyroidism; Graves Disease; Risk Factors
PubMed: 37255974
DOI: 10.3389/fendo.2023.1154251 -
International Journal of Endocrinology 2017Thyroid nodules are a common clinical problem worldwide. Although thyroid cancer accounts for a small percentage of thyroid nodules, the majority are benign....
Thyroid nodules are a common clinical problem worldwide. Although thyroid cancer accounts for a small percentage of thyroid nodules, the majority are benign. 8-Hydroxy-2'-deoxyguanosine (8-OHdG) levels are a marker of oxidative stress and play a key role in the initiation and development of a range of diseases and cancer types. This study evaluates cytokinesis-block micronucleus cytome (CBMN-cyt) assay parameters and plasma 8-OHdG levels and their association with thyroid nodule size and thyroid hormones in patients with multinodular goiter. The study included 32 patients with multinodular goiter and 18 age- and sex-matched healthy controls. CBMN-cyt assay parameters in peripheral blood lymphocytes of patients with multinodular goiter and controls were evaluated, and plasma 8-OHdG levels were measured. The micronucleus (MN) frequency (chromosomal DNA damage), apoptotic and necrotic cells (cytotoxicity), and plasma 8-OHdG levels (oxidative DNA damage) were significantly higher among patients with multinodular goiter. Our study is the first report of increased chromosomal and oxidative DNA damage in patients with multinodular goiter, which may predict an increased risk of thyroid cancer in these patients. MN frequency and plasma 8-OHdG levels may be markers of the carcinogenic potential of multinodular goiters and could be used for early detection of different cancer types, including thyroid cancer.
PubMed: 28373882
DOI: 10.1155/2017/2907281 -
Current Oncology (Toronto, Ont.) Jun 2019syndrome is an autosomal dominant tumour predisposition syndrome associated with a wide variety of cancerous and noncancerous conditions, including ovarian sex...
BACKGROUND
syndrome is an autosomal dominant tumour predisposition syndrome associated with a wide variety of cancerous and noncancerous conditions, including ovarian sex cord-stromal tumours and thyroid conditions, including multinodular goiter. The most common ovarian sex cord-stromal tumour associated with syndrome is Sertoli-Leydig cell tumour, with germline mutations present in more than 50% of cases. We present a case in which a patient in her late 30s was diagnosed with a Sertoli-Leydig cell tumour in the background of a strong family history of multinodular goiter and Sertoli-Leydig cell tumour with a germline mutation in .
CASE PRESENTATION
A 38-year-old woman with history of multinodular goiter was found to have stage iiic ovarian Sertoli-Leydig cell cancer after presenting with abdominal pain. She underwent multiple surgeries and chemotherapy. The patient developed rapid disease progression and died 7 months after diagnosis. Seven years earlier, a daughter had experienced the same disease and was found to have a germline mutation. The mother had not undergone testing before her own diagnosis.
SUMMARY
The co-occurrence of Sertoli-Leydig cell tumour and multinodular goiter is highly suggestive of syndrome. The recognition of syndrome within a family is essential for increased awareness and potential early recognition of complications. Most conditions associated with syndrome occur in childhood, and most of the current screening recommendations are specific for childhood and young adulthood. Cancer risks and findings for the adult population are not as well defined. Clinicians who encounter syndrome should review recommendations for genetic testing and surveillance and enrol patients in the registry.
Topics: Adult; DEAD-box RNA Helicases; Female; Goiter; Humans; Mutation; Ovarian Neoplasms; Ribonuclease III; Sertoli-Leydig Cell Tumor; Syndrome
PubMed: 31285663
DOI: 10.3747/co.26.4727 -
Endocrine May 2020Since its cloning more than 30 years ago, the thyrotropin receptor (TSHR) has emerged as a pivotal player in thyroid physiology and pathophysiology. In particular,... (Review)
Review
Since its cloning more than 30 years ago, the thyrotropin receptor (TSHR) has emerged as a pivotal player in thyroid physiology and pathophysiology. In particular, hyperthyroidism due to autoimmune disease or thyroid autonomy is linked with TSHR activation via autoantibodies or mutations respectively. This review summarises clinical aspects of constitutive TSH receptor activation by naturally occurring somatic or germline TSHR mutations resulting in TSH-independent thyroid function and cell proliferation.
Topics: Humans; Hyperthyroidism; Mutation; Receptors, Thyrotropin; Thyrotropin
PubMed: 32303903
DOI: 10.1007/s12020-020-02270-z -
International Journal of Surgery Case... 2018Amyloid goiter is due to the deposition of amyloid in the thyroid, resulting with enlargement of the gland and compressive symptoms.
INTRODUCTION
Amyloid goiter is due to the deposition of amyloid in the thyroid, resulting with enlargement of the gland and compressive symptoms.
CASE
We herein present a case of a 45-year-old male patient who complained of a big swelling in the neck. Ultrasound showed an enlarged thyroid gland with mediastinal involvement. The multinodular appearance was consistent with the diagnosis of multinodular goiter. He had a history of multiple myeloma but no sign of systemic amyloidosis.
DISCUSSION
Thyroid gland was removed and the histopathological examination revealed a diffuse deposition of amyloid associated with metaplastic lipomatosis of the stroma.
CONCLUSIONS
The treatment of choice in patients with amyloid goiter is total thyroidectomy to solve compression symptoms.
PubMed: 30408741
DOI: 10.1016/j.ijscr.2018.10.033 -
Orvosi Hetilap Jan 2016Radioiodine therapy for benign and malignant thyroid diseases was introduced about 70 years ago, however, there is still a lack of consensus regarding indications, doses... (Review)
Review
Radioiodine therapy for benign and malignant thyroid diseases was introduced about 70 years ago, however, there is still a lack of consensus regarding indications, doses and procedure. This review covers treatment results in immunogenic hyperthyroidism including the problem of orbitopathy. Radioiodine therapy for toxic and non-toxic multinodular goiter is also discussed with striking possibility of enhanching the radioiodine uptake. In this respect the recombinant human thyrotropin should be mentioned. Thyroid cancer treatment protocol has changed, too, due to ineffectivity in low-risk patients. More attention is needed to the carcinogenecity of radioiodine. The numerous problems mentioned above require large and well-designed prospective trials to resolve the fundamental questions. The author emphasizes that radioiodine dose should be administered in doses as low as reasonably achievable.
Topics: Carcinogens; Goiter, Nodular; Graves Ophthalmopathy; Humans; Hyperthyroidism; Iodine Radioisotopes; Radiotherapy Dosage; Thyroid Neoplasms; Treatment Failure; Treatment Outcome
PubMed: 26750728
DOI: 10.1556/650.2016.30322 -
Cells Mar 2022Congenital hypothyroidism is a genetic condition in which the thyroid gland fails to produce sufficient thyroid hormone (TH), resulting in metabolic dysfunction and...
Congenital hypothyroidism is a genetic condition in which the thyroid gland fails to produce sufficient thyroid hormone (TH), resulting in metabolic dysfunction and growth retardation. Xb130 mice exhibit perturbations of thyrocyte cytoskeleton and polarity, and develop postnatal transient growth retardation due to congenital hypothyroidism, leading ultimately to multinodular goiter. To determine the underlying mechanisms, we performed transcriptomic analyses on thyroid glands of mice at three age points: week 2 (W2, before visible growth retardation), W4 (at the nadir of growth); and W12 (immediately before full growth recovery). Using gene set enrichment analysis, we compared a defined set of thyroidal genes between Xb130 and Xb130 mice to identify differentially enriched gene clusters. At the earliest postnatal stage (W2), the thyroid glands of Xb130 mice exhibited significantly downregulated gene clusters related to cellular metabolism, which continued to W4. Additionally, mutant thyroids at W4 and W12 showed upregulated gene clusters related to extracellular matrix, angiogenesis, and cell proliferation. At W12, despite nearly normal levels of serum TH and TSH and body size, a significantly large number of gene clusters related to inflammatory response were upregulated. Early postnatal TH deficiency may suppress cellular metabolism within the thyroid gland itself. Upregulation of genes related to extracellular matrix and angiogenesis may promote subsequent thyroid growth. Chronic inflammatory responses may contribute to the pathogenesis of multinodular goiter in later life. Some of the pathoadaptive responses of Xb130 mice may overlap with those from other mutations causing congenital hypothyroidism.
Topics: Animals; Congenital Hypothyroidism; Goiter; Growth Disorders; Mice; Mice, Knockout; Thyroid Hormones; Transcriptome
PubMed: 35326426
DOI: 10.3390/cells11060975 -
Computer Methods and Programs in... Dec 2022Hyperthyroidism, hypothyroidism, goiter and cancer are some of the dysfunctions that can occur concerning the thyroid, an important body homeostasis regulatory gland...
BACKGROUND AND OBJECTIVE
Hyperthyroidism, hypothyroidism, goiter and cancer are some of the dysfunctions that can occur concerning the thyroid, an important body homeostasis regulatory gland located in the cervical region. These disorders are mostly caused by changes in metabolism and can impair quality of life. This study presents a non-invasive approach that can detect changes in thyroid metabolism through the finite element analysis and medical images. The objective of this work was to develop a numerical model to represent the temperature distribution in the human neck with and without the presence of thyroid nodules. The patient-specific computational model for the case with thyroid nodules was calibrated with infrared thermography.
METHODS
A three-dimensional geometrical model of the neck was constructed based on the segmentation of magnetic resonance (MR) images. The Finite Element Method (FEM) was used to simulate heat diffusion and convection in the cervical region. The infrared thermography image was used to calibrate the heat transfer constants to obtain the surface temperature of the human neck model containing the enlarged thyroid with nodules. Subsequently, another case for the entire neck with an abnormally large thyroid without the nodules was simulated using the calibrated physical constants.
RESULTS
Results of the simulations with and without the presence of thyroid nodules were compared, showing the influence of the generation of heat from the nodules, allowing observation of the thermal differences on the cervical surface and at the thyroid itself. The model with nodules presented higher skin temperature distribution in the anterior triangle region when compared to the case without nodules. An average of 0.36C of absolute error and 1% of relative error was obtained for the calibration between the simulated model and the infrared image.
CONCLUSIONS
This research consists of an innovative approach by comparing the results obtained via FEM simulation and the corresponding infrared image of the same neck region under study. Since there are great variability and uncertainties in the determination of the thermal constants, we applied a procedure for calibrating them based on a patient-specific case, which involves a multinodular goiter accompanied by hyperthyroidism. This proof-of-concept study allows the creation of comparative scenarios between the FEM simulations and the corresponding infrared image. Thus, it is expected that, in the future, this approach could be used to include the effect of drugs in the treatment strategies of thyroid diseases and disorders.
Topics: Humans; Thyroid Nodule; Finite Element Analysis; Temperature; Quality of Life; Hyperthyroidism; Goiter
PubMed: 36375419
DOI: 10.1016/j.cmpb.2022.107234 -
BMJ Case Reports Mar 2023A woman in her early 70s presented to the family medicine clinic with shortness of breath and an inability to lie flat for several months. When lying flat or on lifting...
A woman in her early 70s presented to the family medicine clinic with shortness of breath and an inability to lie flat for several months. When lying flat or on lifting her arms above her head, her face would turn bright red and she felt lightheaded. The patient also had hair loss and skin colour changes of the upper extremities. On examination, the thyroid was palpated and felt normal without enlargement or nodularity. Considering the patient's 70-90 pack-year smoking history, a malignant process of the lung causing superior vena cava syndrome was suspected. CT chest with intravenous contrast revealed a markedly enlarged thyroid with substernal extension of a multinodular goitre producing a mass effect in the upper mediastinum. Thyroid-stimulating hormone was normal. The patient had a total thyroidectomy performed by endocrine surgery. Pathology revealed multinodular hyperplasia and chronic lymphocytic thyroiditis. The patient recovered well postoperatively and her compressive symptoms resolved.
Topics: Female; Humans; Superior Vena Cava Syndrome; Goiter, Substernal; Hypertrophy; Hyperplasia
PubMed: 36858428
DOI: 10.1136/bcr-2022-252827 -
Frontiers of Hormone Research 2016A deep understanding of thyroid pathophysiology is the basis for diagnosing and treating benign thyroid diseases with radioactive materials, known as... (Review)
Review
A deep understanding of thyroid pathophysiology is the basis for diagnosing and treating benign thyroid diseases with radioactive materials, known as radiopharmaceuticals, which are introduced into the body by injection or orally. After the radiotracer administration, the patient becomes the emitting source, and several devices have been studied to detect and capture these emissions (gamma or beta-negative) and transform them into photons, parametric images, numbers and molecular information. Thyroid scintigraphy is the only technique that allows the assessment of thyroid regional function and, therefore, the detection of areas of autonomously functioning thyroid nodules. Scintigraphy visualizes the distribution of active thyroid tissue and displays the differential accumulation of radionuclides in the investigated cells, thus providing a functional map. Moreover, this technique is a fundamental tool in the clinical and surgical management of thyroid diseases, including: single thyroid nodules with a suppressed thyroid-stimulating hormone level, for which fine-needle aspiration biopsy (FNAB) is used to identify hot nodules; multinodular goiters, especially larger ones, to identify cold or indeterminate areas requiring FNAB and hot areas that do not need cytologic evaluation, and to evaluate mediastinal extension; the diagnosis of ectopic thyroid tissue; subclinical hyperthyroidism to identify occult hyperfunctioning tissue; follicular lesions to identify a functioning cellular adenoma that could be benign, although such nodules are mostly cold on scintigraphy; to distinguish low-uptake from high-uptake thyrotoxicosis, and to determine eligibility for radioiodine therapy.
Topics: Humans; Thyroid Diseases; Tomography, Emission-Computed
PubMed: 27003181
DOI: 10.1159/000442275