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Analytical Cellular Pathology... 2023This study aimed to examine the incidence of incidental papillary microcarcinoma (PMC) and papillary thyroid carcinoma (PTC) in patients with benign multinodular goiter...
INTRODUCTION
This study aimed to examine the incidence of incidental papillary microcarcinoma (PMC) and papillary thyroid carcinoma (PTC) in patients with benign multinodular goiter (MNG) and to compare their relationship with some prognostic factors from a new perspective.
METHODS
Bilateral total thyroidectomy (BTT) was used to evaluate the data of 716 patients who underwent a surgery for MNG. The prognostic data for these tumors and the relationship between patients with bilateral and multifocal tumors were evaluated using statistical tests.
RESULTS
Papillary carcinomas were detected in 201 patients, PMC in 134 of them, and PTCs in 67. Bilaterality was more common in patients with PTCs than in those with PMC. The incidence of bilaterality in male patients with PTC was statistically more common. The presence of intra-tumoral lymphocytes was higher in multifocal PTC cases than in unifocal PTC cases.
CONCLUSION
The results revealed that the number of PMC s was high in incidental tumors, and patients with PTC with male sex, bilaterality, multifocality, and tumor capsule invasion were associated with poor prognosis.
Topics: Humans; Male; Thyroid Cancer, Papillary; Thyroid Neoplasms; Carcinoma, Papillary; Goiter; Retrospective Studies
PubMed: 36691406
DOI: 10.1155/2023/2768344 -
Mymensingh Medical Journal : MMJ Apr 2022Thyroid swellings are common clinical problem throughout the world and also in Bangladesh. Most of thyroid swellings are multinodular, but a good percentage is solitary...
Thyroid swellings are common clinical problem throughout the world and also in Bangladesh. Most of thyroid swellings are multinodular, but a good percentage is solitary thyroid nodule. There is no robust, feasible method for malignancy differentiation has not been well established. The study evaluated thyroid nodules for risk of malignancy and compared history, clinical, sonographic features and FNAC findings with histopathology. This was a cross sectional study on 160 consecutive subjects of thyroid nodules done in the department of ENT and Head Neck Surgery of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh during from July 2018 to December 2019. All patients were admitted and diagnosed by detail history, clinical examination, investigations and underwent thyroidectomy. Detailed history, clinical examination, ultrasonographic finding and FNAC variables were documented retrospectively and a mathematical model was established for malignancy prediction. In this study mean age of the patients of thyroid nodules was 37.54±11.49 years and majority of the patients were within 21-40 years of age. Frequency of thyroid nodules is more in female with male female ratio 1:7. Most of the thyroid nodules appeared in this study within 0-2 years (61.9%). In this series of thyroid nodules constituted 88.1% firm, 8.8% hard, 3.1% cystic. Among the patients 89(55.6%) cases have solitary thyroid nodule and 71(44.4%) cases have multinodular goitre Majority of the nodules were warm 57.5% followed by cold 42.5%. FNAC showed nodular goitre 72.5%, Follicular neoplasm 1.3%, Papillary carcinoma of thyroid 7.5%, colloid goitre 9.4%, suspicious papillary carcinoma 3.8% and lymphocytic thyroiditis 1.3%. In this study out of 85 solid nodule, 69(81.18%) were benign and 16(18.82%) was malignant and out of 3 cystic nodule 3(100%) were benign. In this study most of the benign and malignant nodules were predominantly solid. Study showed the malignancy is significantly (p=0.001) more in solid than cystic nodules. Final diagnosis in this study was done on the basis of histopathological reports. Out of 160 patients, histopathologically benign lesion was 120(75%) and malignant was 40(25%). Among malignant cases 36(22.5%) cases were papillary carcinoma, 1 case was medullary carcinoma and 3 cases were follicular carcinoma.
Topics: Adult; Carcinoma, Papillary; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Retrospective Studies; Thyroid Neoplasms; Thyroid Nodule
PubMed: 35383753
DOI: No ID Found -
Journal of Clinical Medicine Aug 2021Thyroid peroxidase (TPO) deficiency is the most common enzymatic defect causing congenital hypothyroidism (CH). We aimed to characterize the long-term outcome of...
INTRODUCTION
Thyroid peroxidase (TPO) deficiency is the most common enzymatic defect causing congenital hypothyroidism (CH). We aimed to characterize the long-term outcome of patients with TPO deficiency.
METHODS
Clinical and genetic data were collected retrospectively.
RESULTS
Thirty-three patients with primary CH caused by TPO deficiency were enrolled. The follow-up period was up to 43 years. Over time, 20 patients (61%) developed MNG. Eight patients (24%) underwent thyroidectomy: one of them had minimal invasive follicular thyroid carcinoma. No association was found between elevated lifetime TSH levels and the development of goiter over the years.
CONCLUSIONS
This cohort represents the largest long-term follow up of patients with TPO deficiency. Our results indicate that elevated TSH alone cannot explain the high rate of goiter occurrence in patients with TPO deficiency, suggesting additional factors in goiter development. The high rate of MNG development and the risk for thyroid carcinoma indicate a need for long-term follow up with annual ultrasound scans.
PubMed: 34501348
DOI: 10.3390/jcm10173898 -
Revista Da Associacao Medica Brasileira... Mar 2022Thyroid neoplasm incidence has increased worldwide, mostly due to the advancements in medical imaging and screening rates. The aberrant Wnt/β-catenin pathway has been...
OBJECTIVE
Thyroid neoplasm incidence has increased worldwide, mostly due to the advancements in medical imaging and screening rates. The aberrant Wnt/β-catenin pathway has been identified as a key mechanism, and it has also been related to the metastatic activity of differentiated thyroid cancer. We aimed to verify the difference in the expression of Wnt3a, a canonical activator of the β-catenin signaling, and CDX-2, a transcription factor upregulated by Wnt/β-catenin pathway, in multinodular goiter and differentiated thyroid cancer and to determine their prognostic value.
METHODS
We included 194 thyroid tissue surgical specimen and their clinicopathological data: study group (differentiated thyroid cancer, n=154) and control group (multinodular goiter, n=40). Immunohistochemistry (IHC) was performed on formalin-fixed, paraffin-embedded tissue by the primary antibodies Wnt3a and CDX-2.
RESULTS
High Wnt3a expression was significantly associated with differentiated thyroid cancer (p=0.031). CDX-2 was negative in all differentiated thyroid cancer cases (100%) and also in multinodular goiter. Wnt3a expression was significantly associated with tumors ≤20 mm (p=0.044) and with the absence of capsule invasion (p=0.031). The multivariate analyses suggested that older age (≥55), independent of capsular invasion and tumor size, was an independent prognostic factor for Wnt3a expression (p=0.058).
CONCLUSIONS
Wnt3a expression but not CDX-2 is correlated with differentiated thyroid cancer samples in comparison to multinodular goiter. Although its prognostic value was limited to tumor size and capsule invasion, a combined model in a panel of immune markers can add accuracy in the classification of challenging thyroid follicular-derived lesions.
Topics: Adenocarcinoma; CDX2 Transcription Factor; Goiter; Humans; Thyroid Neoplasms; Wnt Signaling Pathway; Wnt3A Protein; beta Catenin
PubMed: 35442371
DOI: 10.1590/1806-9282.20211132 -
Nuclear Medicine Communications Apr 2020Thyroglobulin is routinely used as a tumor marker in follow up of patients with thyroid carcinoma, but is also elevated in patients with toxic nodular goiter. The aim of...
OBJECTIVES
Thyroglobulin is routinely used as a tumor marker in follow up of patients with thyroid carcinoma, but is also elevated in patients with toxic nodular goiter. The aim of this study was to evaluate the role of thyroglobulin measurement prior to and after the radioiodine therapy (RIT) in patients with toxic nodular goiter and to compare the results with the therapy outcome.
PATIENTS AND METHODS
In 109 patients with toxic nodular goiter (102 females, 7 males, aged 45-85 years), 61 with multinodular toxic goiter and 48 with toxic adenoma, thyroglobulin level was measured before RIT and during the first 12 months after the treatment and compared to therapy outcome, defined as euthyroid, hypothyroid and persistent hyperthyroidism.
RESULTS
In patients with euthyroid and hypothyroid outcome, a significant fall of thyroglobulin level was noted during the first 12 months after RIT, more prominent in the latter group. In patients with persistent hyperthyroidism, the initial thyroglobulin level was higher than in other two groups and no significant decrease was noted by the end of the first year after therapy, especially in patients with multinodular toxic goiter.
CONCLUSIONS
The significant fall of thyroglobulin after RIT observed in patients in whom euthyroidism and hypothyroidism was achieved indicates that thyroglobulin values can be related to the treatment outcome. In patients with high initial thyroglobulin levels (above 400 ng/l), and possible unfavorable RIT outcome, higher radioiodine activities or other treatment options might be considered.Video abstract: http:/links.lww.com/NMC/A163.
Topics: Aged; Aged, 80 and over; Female; Goiter, Nodular; Humans; Iodine Radioisotopes; Male; Middle Aged; Thyroglobulin; Treatment Outcome
PubMed: 31977753
DOI: 10.1097/MNM.0000000000001153 -
Scientific Reports Sep 2022DICER1 syndrome is caused by germline pathogenic mutations in the DICER1 gene. Multinodular goiter (MNG) is a common clinical feature of DICER1 syndrome in children and...
DICER1 syndrome is caused by germline pathogenic mutations in the DICER1 gene. Multinodular goiter (MNG) is a common clinical feature of DICER1 syndrome in children and adults. The aim of this study was to determine the ultrasound (US) characteristics of MNG in patients with DICER1 syndrome. This retrospective study evaluated thyroid US in patients with DICER1 germline mutations (DICER1mut+) performed between 2011 and 2018 at a single center by the same pediatric endocrinologist, and the images were re-examined by an independent pediatric radiologist from another academic center. Patients < 18 years with DICER1mut+ and DICER1mut+ parents without previous thyroidectomy were included. Ultrasound phenotypes of MNG in the setting of DICER1 mutations were compared with known US features of thyroid malignancy. Thirteen DICER1mut+ patients were identified (10 children, 3 adults). Three children had a normal thyroid US; therefore, thyroid abnormalities were assessed in seven children and three adults. In both children and adults, multiple (≥ 3) mixed (cystic/solid) nodules predominated with single cystic, single cystic septated and single solid nodules, occasionally with a "spoke-like" presentation. All solid lesions were isoechogenic, and in only one with multiple solid nodules, intranodular blood flow on power/color Doppler was observed. Remarkably, macrocalcifications were present in all three adults. The spectrum of ultrasonographic findings of MNG in DICER1mut+ patients is characteristic and largely distinct from typical features of thyroid malignancy and therefore should inform physicians performing thyroid US of the possible presence of underlying DICER1 syndrome.
Topics: DEAD-box RNA Helicases; Goiter, Nodular; Humans; Neoplastic Syndromes, Hereditary; Retrospective Studies; Ribonuclease III; Thyroid Neoplasms; Thyroidectomy
PubMed: 36151231
DOI: 10.1038/s41598-022-19709-0 -
The Journal of Clinical Endocrinology... Jul 2020Long-term studies evaluating the treatment of toxic multinodular goiter (TMNG) with fixed activities of radioiodine (RAI) are lacking.
CONTEXT
Long-term studies evaluating the treatment of toxic multinodular goiter (TMNG) with fixed activities of radioiodine (RAI) are lacking.
OBJECTIVE
The objective of this work is to describe the effects of 15 mCi on thyroid volume, function, and autoimmunity in the long term.
DESIGN AND SETTING
A population-based, retrospective analysis with up to 12 years of follow-up was conducted in Siena, Italy.
PARTICIPANTS
Adult patients (n = 153) with TMNG, naive to RAI, were included.
METHODS
Evaluation was performed of thyroid function, antithyroid antibodies, and ultrasound scans before and yearly after RAI.
MAIN OUTCOME MEASURES
Evaluations included hyperthyroidism cure, hypothyroidism, volume reduction, nadir and regain, and antibody titer change.
RESULTS
The study revealed mean volume reductions greater than or equal to 50% at 3 years after RAI; the greatest annual reduction was observed during the first year (30 ± 17.8%; P < .001). Most patients (60%) achieved their volume nadir 3 to 6 years after RAI. Although 22% patients showed volume regain, the net reduction was statistically significant as late as 9 years after RAI (P = .005). The mean time to hypothyroidism was 2.7 ± 2.4 years, and it was associated with greater reductions in volume (P = .01). During the first 3 years after treatment, hyperthyroid patients decreased approximately by 50% per year without additional RAI. There was no statistically significant association of antibody titers with thyroid function except for antithyrotropin receptor antibodies and hyperthyroidism (P = .004). At the end of follow-up there were 61.6% euthyroid patients, 11% hyperthyroid (4.8% overt), and 27.4% hypothyroid patients (2.7% overt). Hyperthyroidism was cured in 89%.
CONCLUSIONS
The treatment of TMNG with 15 mCi of RAI induced low hypothyroidism rates while providing high cure rates and significant volume reduction, which was maintained in the long term.
Topics: Adult; Aged; Aged, 80 and over; Autoimmunity; Female; Goiter, Nodular; Humans; Iodine Radioisotopes; Italy; Male; Middle Aged; Organ Size; Retrospective Studies; Thyroid Function Tests; Thyroid Gland; Ultrasonography
PubMed: 32320467
DOI: 10.1210/clinem/dgaa214 -
Laryngoscope Investigative... Apr 2022The standard treatment for endemic goiter is usually total thyroidectomy. In low- and middle-income countries, the management of thyroid disease, which is commonplace in...
BACKGROUND
The standard treatment for endemic goiter is usually total thyroidectomy. In low- and middle-income countries, the management of thyroid disease, which is commonplace in fully developed countries, is not always possible. The purpose of this study is to establish a treatment algorithm to calculate the extent of thyroidectomy based on the risk factors of each patient.
METHODS
This is a retrospective observational study conducted during the period between 2017 and 2019. A total of 287 patients with thyroid pathology were treated in Maragua Hospital (Kenya). The results of surgical treatment were analyzed after the implementation of an individualized treatment protocol.
RESULTS
One hundred and sixty patients with different types of goiter underwent surgery: solitary nodule (54.4%), multi-nodular goiter (30.6%), diffuse goiter (10.6%), and intrathoracic goiter (3.8%). The techniques used were hemithyroidectomy (78.8%), Dunhill thyroidectomy (9.4%), bilateral subtotal thyroidectomy (6.9%), and total thyroidectomy (3.1%). There was no mortality. The surgical morbidity rate was 16% (only one major complication (3b)). Two cases of dysphonia were resolved in the first week. There were three cases of symptomatic hypocalcaemia, two of which resolved in the first week and the other of which was definitive. The follow-up at 6 months was 67%. The cancer rate found in the resection specimens was 5%.
DISCUSSION
The implementation of individualized surgical protocols for thyroid surgery in sub-Saharan Africa can improve outcomes. The cooperation projects can increase access to complex surgical treatment for patients with limited resources in low- and middle-income countries.
PubMed: 35434333
DOI: 10.1002/lio2.764 -
Familial Cancer Oct 2023DICER1 syndrome is an inherited condition associated with an increased risk of developing hamartomatous and neoplastic lesions in diverse organs, mainly at early ages....
DICER1 syndrome is an inherited condition associated with an increased risk of developing hamartomatous and neoplastic lesions in diverse organs, mainly at early ages. Germline pathogenic variants in DICER1 cause this condition. Detecting a variant of uncertain significance in DICER1 or finding uncommon phenotypes complicate the diagnosis and can negatively impact patient care. We present two unrelated patients suspected to have DICER1 syndrome. Both females (aged 13 and 15 years) presented with multinodular goiter (thyroid follicular nodular disease) and ovarian tumours. One was diagnosed with an ovarian Sertoli-Leydig cell tumour (SLCT) and the other, with an ovarian juvenile granulosa cell tumour, later reclassified as a retiform variant of SLCT. Genetic screening showed no germline pathogenic variants in DICER1. However, two potentially splicing variants were found, DICER1 c.5365-4A>G and c.5527+3A>G. Also, typical somatic DICER1 RNase IIIb hotspot mutations were detected in the thyroid and ovarian tissues. In silico splicing algorithms predicted altered splicing for both germline variants and skipping of exon 25 was confirmed by RNA assays for both variants. The reclassification of the ovarian tumour, leading to recognition of the association with DICER1 syndrome and the characterization of the germline intronic variants were all applied to recently described DICER1 variant classification rules. This ultimately resulted in confirmation of DICER1 syndrome in the two teenage girls.
Topics: Male; Female; Adolescent; Humans; Sertoli-Leydig Cell Tumor; Germ-Line Mutation; Ovarian Neoplasms; Thyroid Gland; Ribonuclease III; Neoplastic Syndromes, Hereditary; Germ Cells; Mutation; DEAD-box RNA Helicases
PubMed: 37248399
DOI: 10.1007/s10689-023-00336-1 -
Annales D'endocrinologie Sep 2019Cardiothyreosis (CT) or thyrotoxic heart disease is associated with higher morbidity and mortality than the other forms of hyperthyroidism. Its risk factors have been...
UNLABELLED
Cardiothyreosis (CT) or thyrotoxic heart disease is associated with higher morbidity and mortality than the other forms of hyperthyroidism. Its risk factors have been analyzed in a limited number of studies. The aims of our study were to investigate the prevalence of CT and its risk factors in patients with hyperthyroidism.
METHODS
We identified 538 patients with a hospital discharge diagnosis of hyperthyroidism from January 2000 to December 2015. Among them, 35 patients were diagnosed as having CT. Their demographic, clinical and biological characteristics were studied and compared with those of 72 controls (patients admitted for hyperthyroidism without CT) randomly selected using univariate and multivariate analysis.
RESULTS
The prevalence of CT in patients hospitalized with overt hyperthyroidism was 6.5%. The cardiac complications seen were atrial fibrillation (AF) in 33 cases (6.1%) and cardiac heart failure (CHF) in 11 cases (2%). The risk factors of CT were age greater than 50 years (OR=13.1; 95% CI [4.9-34.4]), low socioeconomic status (OR=2.8; 95% CI [1.2-6.7]), low educational level (OR=3.1; 95% CI [1.2-8.3]), personal history of hypertension (OR=3.5; 95% CI [1.1-11.2]) and a multinodular toxic goiter as the etiology of hyperthyroidism (OR=4.6; 95% CI [1.6-13.9]). After multivariate analysis, age greater than 50 years was the only independent risk factor of CT (adjusted OR=11.6; 95% CI [2.7-49.5]). Severe biological hyperthyroidism (FT4 >3 times normal) was associated with a lower risk of CT (adjusted OR=0.2; 95% CI [0.1-0.9]).
CONCLUSIONS
The prevalence of CT in patients with overt hyperthyroidism was relatively low. Cardiac complications were AF and CHF with a clear predominance of AF. Advanced age was the only independent risk factor of CT. Cardiac complications may be seen even if hyperthyroidism is not biologically severe.
Topics: Adolescent; Adult; Aged; Atrial Fibrillation; Case-Control Studies; Child; Child, Preschool; Female; Goiter, Nodular; Heart Diseases; Heart Failure; Humans; Hypertension; Hyperthyroidism; Male; Middle Aged; Prevalence; Retrospective Studies; Risk Factors; Thyrotoxicosis; Young Adult
PubMed: 31235068
DOI: 10.1016/j.ando.2017.11.004