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The Annals of Thoracic Surgery Apr 1985The literature on substernal goiter from the seventeenth century to the present is reviewed. Substernal goiter may be defined as any thyroid enlargement that has its... (Review)
Review
The literature on substernal goiter from the seventeenth century to the present is reviewed. Substernal goiter may be defined as any thyroid enlargement that has its greater mass inferior to the thoracic inlet. Truly ectopic mediastinal goiters are rare, and most substernal goiters arise from and maintain some attachment to the cervical thyroid gland. Patients are generally in the fifth decade of life, and women predominate. Most patients experience dyspnea, stridor, or dysphagia, but 15 to 50% are asymptomatic; symptoms are often positional, and acute stridor may occur. Ten to twenty percent have no cervical mass or tracheal deviation on examination, and virtually all patients are euthyroid. Standard chest roentgenograms are often diagnostic, but computed tomographic or radioactive iodine scans may be helpful. The presence of a substernal goiter in all but the highest-risk patients is an indication for resection, usually through a cervical collar incision; an occasional patient will require sternotomy or thoracotomy. Death or major complications should be rare postoperatively. Substernal goiters are adenomatous and benign, but carcinoma occurs in 2 to 3% and may be occult. Patients should be followed closely, as these goiters may recur.
Topics: Adolescent; Adult; Aged; Female; Goiter, Substernal; History, 19th Century; History, 20th Century; Humans; Male; Methods; Middle Aged; Postoperative Complications; Thyroid Function Tests
PubMed: 3885887
DOI: 10.1016/s0003-4975(10)62645-8 -
La Revue Du Praticien Jun 2008
Review
Topics: Diagnosis, Differential; Goiter; Humans; Thyroid Nodule
PubMed: 18689126
DOI: No ID Found -
Lancet (London, England) Feb 2024Thyrotoxicosis causes a variety of symptoms and adverse health outcomes. Hyperthyroidism refers to increased thyroid hormone synthesis and secretion, most commonly from... (Review)
Review
Thyrotoxicosis causes a variety of symptoms and adverse health outcomes. Hyperthyroidism refers to increased thyroid hormone synthesis and secretion, most commonly from Graves' disease or toxic nodular goitre, whereas thyroiditis (typically autoimmune, viral, or drug induced) causes thyrotoxicosis without hyperthyroidism. The diagnosis is based on suppressed serum concentrations of thyroid-stimulating hormone (TSH), accompanied by free thyroxine and total or free tri-iodothyronine concentrations, which are raised (overt hyperthyroidism) or within range (subclinical hyperthyroidism). The underlying cause is determined by clinical assessment, detection of TSH-receptor antibodies and, if necessary, radionuclide thyroid scintigraphy. Treatment options for hyperthyroidism include antithyroid drugs, radioactive iodine, and thyroidectomy, whereas thyroiditis is managed symptomatically or with glucocorticoid therapy. In Graves' disease, first-line treatment is a 12-18-month course of antithyroid drugs, whereas for goitre, radioactive iodine or surgery are preferred for toxic nodules or goitres. Evidence also supports long-term treatment with antithyroid drugs as an option for patients with Graves' disease and toxic nodular goitre.
Topics: Humans; Antithyroid Agents; Goiter, Nodular; Iodine Radioisotopes; Thyroid Neoplasms; Hyperthyroidism; Graves Disease; Thyrotoxicosis; Thyroiditis
PubMed: 38278171
DOI: 10.1016/S0140-6736(23)02016-0 -
Annales de Chirurgie 1999Despite its high prevalence, at least in areas with even mild iodine deficiency, the aetiopathogenesis of multinodular goitre is poorly understood. The combination of... (Review)
Review
Despite its high prevalence, at least in areas with even mild iodine deficiency, the aetiopathogenesis of multinodular goitre is poorly understood. The combination of genetic and environmental factors, the likely involvement of endocrine para and autocrine goitrogenic agents and the remarkable heterogenicity of thyroid tissue complicate elucidation of the mechanisms involved. Multinodular goitre follows an initial phase of hyperplastic goitre or results from the generation of several individual nodules. Alterations of the stromal and vascular tissues as well as the occurrence of somatic mutations are contributing factors. In many instances, multinodular goitres become autonomous in the long term.
Topics: Adolescent; Adult; Goiter, Nodular; Humans; Hyperplasia; Thyroid Gland; Thyroidectomy
PubMed: 10339866
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... May 2007The prevalence of large goiter is low in Norway compared with that for areas of iodine deficiency. Benign multinodular goiter is the most common cause. The most... (Review)
Review
BACKGROUND
The prevalence of large goiter is low in Norway compared with that for areas of iodine deficiency. Benign multinodular goiter is the most common cause. The most important differential diagnoses are cancer and autoimmune thyroid disease. Most multinodular goiters grow slowly and even large ones usually cause little discomfort.
MATERIAL AND METHODS
We present an overview of the most common causes, diagnostic procedures, complications and treatment of large goiters based on our own experience and selected literature.
RESULTS AND INTERPRETATION
The work-up aims at finding the cause and complications of goiter; i.e. hyperthyreosis, compression or cosmetic complaints. If cancer is considered, fine needle aspiration cytology, preferably ultrasound-guided, is the most important diagnostic tool. Imaging techniques do not differentiate precisely between benign and malignant lesions, but ultrasound is useful in guiding cytological sampling. Treatment of patients with multinodular goiter complications is influenced by general health, surgical risk and patient preferences. It is not necessary to treat all patients. The main treatments are thyroidectomy, partial resection and single or repeated radioiodine therapy. Pre-treatment with recombinant human thyroid stimulating hormone may increase the effect of radioiodine treatment and thereby expand the indication for non-surgical treatment.
Topics: Aged; Diagnosis, Differential; Female; Goiter; Goiter, Nodular; Humans; Hypothyroidism; Male; Risk Factors; Sex Factors; Thyroid Neoplasms; Thyroiditis, Autoimmune
PubMed: 17479138
DOI: No ID Found -
The Medical Clinics of North America Jan 1991Nodular goiter is a worldwide problem involving millions of persons. Endemic goiter, and associated cretinism, is totally preventable by ensuring an adequate dietary... (Review)
Review
Nodular goiter is a worldwide problem involving millions of persons. Endemic goiter, and associated cretinism, is totally preventable by ensuring an adequate dietary iodine intake and eliminating malnutrition and dietary goitrogens. Therapy, on the other hand, is difficult in that the goiters often do not regress and the cretinoid changes are irreversible. Nonendemic goiter due to autoimmune thyroid disease, genetic defects in thyroid hormone biosynthesis, and environmental goitrogens or neoplasia is not usually preventable. The usual therapy, involving TSH suppression by administration of L-thyroxine orally, will frequently bring about regression of early, diffuse goiters but is often ineffective in bringing about regression of large, multinodular goiters. In these patients, surgical removal of the goiter may be necessary for alleviation of obstructive symptoms. Further research is needed to elucidate the factors involved in the development of these multinodular goiters and to control the autocrine and paracrine factors involved in nodule growth.
Topics: Goiter, Endemic; Goiter, Nodular; Humans
PubMed: 1987443
DOI: 10.1016/s0025-7125(16)30479-5 -
Archives of Endocrinology and Metabolism 2017This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal...
OBJECTIVE
This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension.
SUBJECTS AND METHODS
A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter.
RESULTS
The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients.
CONCLUSION
This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.
Topics: Adult; Aged; Case-Control Studies; Female; Goiter; Goiter, Substernal; Humans; Laryngopharyngeal Reflux; Laryngoscopy; Male; Middle Aged; Prevalence; Retrospective Studies; Thyroidectomy
PubMed: 28658344
DOI: 10.1590/2359-3997000000266 -
Pediatric Clinics of North America Aug 1987Goiters can be detected in about 5 per cent of school-aged children. Goiters appearing during childhood are the result of distinct diseases and should be investigated... (Review)
Review
Goiters can be detected in about 5 per cent of school-aged children. Goiters appearing during childhood are the result of distinct diseases and should be investigated rather than attributed to "physiologic hyperplasia." The etiology of the diffuse goiter can often be established by clinical evaluation, performing thyroid function tests, and measurement of serum thyroid antibodies. Unlike diffuse goiters, thyroid nodules frequently require tissue examination to exclude malignancy. The goal in evaluating children with nodular goiters is to be as selective as possible in submitting children to surgery without missing cases of cancer. The decision to perform an open biopsy should be based on detecting increased risk for cancer in the medical history, physical examination, or laboratory tests as outlined in Figure 1. Ultrasonography and fine-needle aspiration of nodules are two new methods that aid in the selection of patients for surgery or a trial of thyroid hormone suppression.
Topics: Adolescent; Biopsy, Needle; Diagnosis, Differential; Female; Goiter; Goiter, Nodular; Humans; Infant, Newborn; Male; Thyroid Function Tests; Thyroid Neoplasms
PubMed: 3302898
DOI: 10.1016/s0031-3955(16)36293-9 -
Acta Medica Portuguesa 2003The author refers to the changes occurred in thyroid dimensions during pregnancy, evaluated clinically and echographically. He also describes the changes in thyroid...
The author refers to the changes occurred in thyroid dimensions during pregnancy, evaluated clinically and echographically. He also describes the changes in thyroid normal function on pregnant women and the different stages of the fetal thyroid maturation. Some complementary tests must be carried out, when there is a presence of a goitre nodule, which opportunity and relevance the need are discussed. The possibility of thyroid carcinoma is referred as its most adequate treatment.
Topics: Female; Goiter; Humans; Pregnancy; Pregnancy Complications
PubMed: 14750279
DOI: No ID Found -
The Medical Clinics of North America Sep 1975Nontoxic goiters are very common. A single hyperfunctioning nodule is never malignant. Treatment is required only if the patient is hyperthyroid. Most single...
Nontoxic goiters are very common. A single hyperfunctioning nodule is never malignant. Treatment is required only if the patient is hyperthyroid. Most single hypofunctioning thyroid nodules are cool and most are benign; however, it is important to rule out malignancy. The presence of microcalcification is consistent with psammoma bodies and the presence of papillary cancer of the thyroid. An elevated plasma calcitonin level with a further increase in calcitonin after calcium infusion is usually characteristic of medullary cancer of the thyroid. Needle biopsy of the thyroid is recommended when an experienced surgeon and pathologist are available. The treatment of benign thyroid lesions may include a trial of fully suppressive doses of thyroxine.
Topics: Biopsy, Needle; Goiter; Goiter, Nodular; Humans; Thyroid Function Tests; Thyroid Hormones; Thyroid Neoplasms; Thyroiditis, Autoimmune
PubMed: 1174255
DOI: 10.1016/s0025-7125(16)31970-8