Background: Differentiating Graves hyperthyroidism from the other causes of hyperthyroidism, using serum TRAb testing is essential step for diagnosis. Objectives: To study importance of TRAb in the diagnosis of Graves...Background: Differentiating Graves hyperthyroidism from the other causes of hyperthyroidism, using serum TRAb testing is essential step for diagnosis. Objectives: To study importance of TRAb in the diagnosis of Graves’ disease, distinguishing it from thyroiditis, and comparing it with clinical features and other tests such as TPOAb, US thyroid and thyroid scintiscan. Methods: A cross-sectional study was conducted on 120 patients attending endocrine clinicErbil city. Patients were studied on clinical feature basis and investigated with serum TRAb, TPOAb, TSH, Free T4, and Ultrasound examination of thyroid gland. Fisher exact test and Chi Square test of independence, Correlation coefficient and t-test of independence were used. Results: Fifty-two patients were found to have Graves’ disease;There was significant correlation between TRAb positivity and diagnosis of Graves’ disease p 0.05. Conclusion: A positive correlation was found between TRAb titer and positivity and no significant relation between TPOAb levels between Graves’ disease patients compared with thyroiditis patients, respectively.展开更多
Purpose: To describe the aspects of the positive diagnosis of large goiters. Patients and Methods: We conducted a retrospective and prospective study including 115 patients from January, 2009 till December, 2014 (6 ye...Purpose: To describe the aspects of the positive diagnosis of large goiters. Patients and Methods: We conducted a retrospective and prospective study including 115 patients from January, 2009 till December, 2014 (6 years) in Central Hospital of University of Point G in Bamako (Mali). The diagnosis of large goiters was based on the measurements of the anterior neck swelling. Thus large goiter was defined as any goiter including the height or width was greater than or equal to 10 cm (centimeters). Results: We operated 115 cases of large goiters on 760 goiters operated either 15.1%. The average age of patients was 44, 43 years ±14, 3 with extremes of 9 and 80 years. There was 101 women (87.8%) and 14 men (12.2%) with a sex ratio of 7.2 in favor of women. The signs of compression were dyspnea in 40% of cases (46/115), dysphonia in 13.0% (15/115), and dysphagia in 8.6% (10/115). The average height of goiter was 12.1 cm ± 3.5 cm with extremes of 10 and 29 cm and the average width was 14.4 cm ± 5.4 cm with extremes of 10 and 32 cm. Thyroid ultrasound found large goiters multinodular in 100%. Cervical radiography found the tracheal deviation in 48.2% (42/87), tracheal compression in 20.6% (18/87), plunging goiters in 11.5% (10/87). Cytology found a benign goiter in 97.4% of cases (112/115), malignant (thyroid cancer) in 2.6% of cases (3/115). Conclusion: Diagnosis of large goiters was based on the measurement of the swelling in our context. The signs of compression are the severity of this condition.展开更多
Introduction: De Quervain’s subacute thyroiditis is an inflammatory granulomatosis with clinical presentation some time atypical leading eventually to misdiagnosis or inadequate treatment. In our area, physician shou...Introduction: De Quervain’s subacute thyroiditis is an inflammatory granulomatosis with clinical presentation some time atypical leading eventually to misdiagnosis or inadequate treatment. In our area, physician should be aware of this possible etiology in presence of recent and acute features of thyrotoxicosis with or without painful firm goiter. We illustrate this fact with two new observations from Sub-Saharan Africa. Observations: Our first patient is a 70-year-old Guinean woman presenting a painful nodular and hard goiter at palpation. Her history was recent in a context of deterioration of the general state with a sub clinical thyrotoxicosis syndrome. The diagnosis of probable malignant thyroid tumor was evoked initially and a thyroidectomy considered. She presented an important biological inflammatory syndrome and biological peripheral hyperthyroidism. Neck ultrasound examination showed heterogeneous patchy decreased echogenicity. The diagnosis of subacute De Quervain’s thyroiditis was set up. A corticosteroid therapy at a rate of 20 mg/day of prednisone was begun with a fast degression of dose. After 3 weeks of treatment, we noticed total clinical recovery normalization of biological parameters. The second observation was about a 52-year-old Senegalese women living in Bamako. She presented cervical pains evolving for 2 months in a context of flu-like syndrome associated with thyrotoxicosis and marked biological inflammatory syndrome. The thyroid ultrasound showed global heterogeneity with characteristic aspect of “geography map” leading to the diagnosis of subacute thyroiditis. A combination therapy with low dose of prednisone, ß-blockers and tranquillizers. We noticed fast disappearance of clinical and biological signs. At 5 mg per day of prednisone, there were moderate signs of relapse with rapid favorable evolution after few days under increased dose of prednisone up to 10 mg/day. Conclusion: De Quervain’s thyroiditis can appear under misleading features opening out to make wandering diagnosis. A good clinical evaluation coupled with hormonal and ultrasound thyroid examination may help for right management. The use of low dose of corticosteroid had enabled us to obtain a fast control of main clinical and biological abnormalities.展开更多
Aim: The purpose of this study was to determine the frequency of the hurts of the inferior laryngeal nerve, according to its anatomical reports with the inferior thyroid artery during the thyroid surgery. Methodology:...Aim: The purpose of this study was to determine the frequency of the hurts of the inferior laryngeal nerve, according to its anatomical reports with the inferior thyroid artery during the thyroid surgery. Methodology: We realized a forward-looking and retrospective study from January, 1979 till December, 2017 in the service of surgery “B” to the University hospital of the Point G of Bamako and in the service of ENT and cervico-facial surgery of the Teaching Hospital “Mother-Child”, the Luxembourg of Bamako (Mali). All the patients operated in both services for mild goiters were retained. Cancers and other thyroid pathologies were not included. The diagnosis of mild goiter was paused by the histological examination realized on all the surgical specimens. Results: On 2109 dissections of the inferior laryngeal nerve realized during the surgical operations on the thyroid, the frequency of lesion of the inferior laryngeal nerve was 1.09% (20 cases) when it passed dorsally with regard to the inferior thyroid artery (1837 cases) and when 4.04%, it was transvascular or prevascular (272 cases). Conclusion: The prevascular route or transvascular of the inferior laryngeal nerve favors its lesion per operating.展开更多
Amyloid goiter (AG) is a rare but well-established disease entity that may occur in a number of conditions. In the following article, we will report two cases of AG. Both patients were young males: 28 & 24 years o...Amyloid goiter (AG) is a rare but well-established disease entity that may occur in a number of conditions. In the following article, we will report two cases of AG. Both patients were young males: 28 & 24 years old, presented with rapidly enlarging thyroid gland manifested with pressure effects (dyspnea and hoarseness of voice). Provisional clinical diagnosis was malignant thyroid neoplasm. One of the patients was markedly hypothyroid while the other was euthyroid. Histopathological evaluation revealed extracellular deposition of deep pink homogenous material that was confirmed as amyloid with congo red. Patient in case 1 was primary localized AG while patient in case 2 was systemic amyloidosis secondary to interstitial pulmonary fibrosis (IPF) that was first manifested by AG. The main aims of the article were to describe histopathological features of amyloidosis of the thyroid gland and to raise awareness of AG to be included in the differential diagnosis in patients presented with rapidly enlarging goiter with mass effects.展开更多
Thyroid gland is one of most important endocrine glands in the body. It plays vital role in growth control and its measurements tends to change in respect to age, sex, weight and ethnic group of the individual. This s...Thyroid gland is one of most important endocrine glands in the body. It plays vital role in growth control and its measurements tends to change in respect to age, sex, weight and ethnic group of the individual. This study aimed to assess endemic goiter and to estimate the measurement of normal thyroid gland dimensions and thyroid hormones level in school-aged children using Ultrasonography and ELISA Technique in Eastern Sudan (Kassala state). A total of 100 subjects is 6 - 18 years (43 males, 57 females), and mean of age (9.73 ± 2.54 years). This study was done in the period from April 2016 to February 2017. All the subject undergone thyroid ultrasound and thyroid hormone level test. Subjects with history of goiter were excluded from the study, by thyroid dimension (length, height and diameter). Thyroid volume was estimated using ellipsoid formula and thyroid hormones (TSH, T3 and T4) using Toso full automation. The study revealed that 12 subjects of the study (12%) with goiter, 7 female (7%) and 5 males (5%) with age ranged 6 - 11 years with increase in TSH and T3 and decrease in T4 level. The mean of thyroid volumes for normal subject and subject of goiter are 4.93 ± 0.63, 5.4 ± 1.4 mL, respectively, and TSH, T3, T4 (1.8 ± 0.97, 2.4 ± 0.86 UIu/nL), (3.61 ± 0.32, 3.8 ± 0.55 Pg/Nl), (1.35 ± 1.23 ng/DI level respectively). It concluded that there was positive correlations between the age and the thyroid volume (p = 0.65). It increases with increase of the age. The Rt lobe is larger than the Lt lobe;the thyroid volume is higher in male than female, and this study found the TSH and T3 decreased with ages while T4 increased with ages in normal subject;TSH and T3 level increased and T4 level decreased in goiter children.展开更多
Purpose: The incidence of hyperplastic thyroid nodular disease has been consistently rising over the last decades. In addition, unsuspected papillary thyroid carcinoma (PTC) can be found in up to 34% of patients opera...Purpose: The incidence of hyperplastic thyroid nodular disease has been consistently rising over the last decades. In addition, unsuspected papillary thyroid carcinoma (PTC) can be found in up to 34% of patients operated for benign thyroid lesions. PTC tends to occur multi-focally and is commonly of polyclonal origin. We set out to test the hypothesis that in benign thyroid disease, a unique genetic signature can already be identified in the benign pathology, which is associated with a susceptibility of the thyroid tissue to neoplastic transformation in the context of additional growth promoting stimuli. Patients and Methods: We obtained a set of 23 samples from patients with multinodular goiter (MNG), 12 of whom also harbored an unsuspected PTC. We used global gene expression analysis to evaluate for dissimilarities in the gene expression patterns between these two groups. We also compared these patterns to the profiles of 3 normal thyroid and 7 PTC samples. Results: We were able to accurately distinguish between hyperplastic nodules of patients with multinodular goiter and those that were associated with a PTC. One of the strongest differentially expressed genes, CDC42, has been implicated to respond to environmental factors such as UVB radiation and might point to novel factors contributing to PTC genesis in the setting of pre-existing benign proliferative disease. Conclusion: While the comparison between histologically identical samples cannot distinguish the two groups of goiters, unsupervised or supervised approaches allowed us to identify a molecular signature associated with PTC susceptibility in multinodular goiter.展开更多
Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Dep...Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Department of Obstetrics and Gynecology at Microcitemico Pediatric Hospital, Cagliari, for suspected fetal goiter at 32 gestational weeks. The case was monitored regularly by ultrasound and treated successfully with intra-amniotic levothyroxine (L-T4) administration. Fetal goiter was observed to decrease after this treatment and the thyroid ultrasound findings were also normal both at birth and in subsequent follow-ups. Our case report confirms the feasibility of conservative treatment with L-T4, which can effectively prevent complications related to fetal goiter.展开更多
文摘Background: Differentiating Graves hyperthyroidism from the other causes of hyperthyroidism, using serum TRAb testing is essential step for diagnosis. Objectives: To study importance of TRAb in the diagnosis of Graves’ disease, distinguishing it from thyroiditis, and comparing it with clinical features and other tests such as TPOAb, US thyroid and thyroid scintiscan. Methods: A cross-sectional study was conducted on 120 patients attending endocrine clinicErbil city. Patients were studied on clinical feature basis and investigated with serum TRAb, TPOAb, TSH, Free T4, and Ultrasound examination of thyroid gland. Fisher exact test and Chi Square test of independence, Correlation coefficient and t-test of independence were used. Results: Fifty-two patients were found to have Graves’ disease;There was significant correlation between TRAb positivity and diagnosis of Graves’ disease p 0.05. Conclusion: A positive correlation was found between TRAb titer and positivity and no significant relation between TPOAb levels between Graves’ disease patients compared with thyroiditis patients, respectively.
文摘Purpose: To describe the aspects of the positive diagnosis of large goiters. Patients and Methods: We conducted a retrospective and prospective study including 115 patients from January, 2009 till December, 2014 (6 years) in Central Hospital of University of Point G in Bamako (Mali). The diagnosis of large goiters was based on the measurements of the anterior neck swelling. Thus large goiter was defined as any goiter including the height or width was greater than or equal to 10 cm (centimeters). Results: We operated 115 cases of large goiters on 760 goiters operated either 15.1%. The average age of patients was 44, 43 years ±14, 3 with extremes of 9 and 80 years. There was 101 women (87.8%) and 14 men (12.2%) with a sex ratio of 7.2 in favor of women. The signs of compression were dyspnea in 40% of cases (46/115), dysphonia in 13.0% (15/115), and dysphagia in 8.6% (10/115). The average height of goiter was 12.1 cm ± 3.5 cm with extremes of 10 and 29 cm and the average width was 14.4 cm ± 5.4 cm with extremes of 10 and 32 cm. Thyroid ultrasound found large goiters multinodular in 100%. Cervical radiography found the tracheal deviation in 48.2% (42/87), tracheal compression in 20.6% (18/87), plunging goiters in 11.5% (10/87). Cytology found a benign goiter in 97.4% of cases (112/115), malignant (thyroid cancer) in 2.6% of cases (3/115). Conclusion: Diagnosis of large goiters was based on the measurement of the swelling in our context. The signs of compression are the severity of this condition.
文摘Introduction: De Quervain’s subacute thyroiditis is an inflammatory granulomatosis with clinical presentation some time atypical leading eventually to misdiagnosis or inadequate treatment. In our area, physician should be aware of this possible etiology in presence of recent and acute features of thyrotoxicosis with or without painful firm goiter. We illustrate this fact with two new observations from Sub-Saharan Africa. Observations: Our first patient is a 70-year-old Guinean woman presenting a painful nodular and hard goiter at palpation. Her history was recent in a context of deterioration of the general state with a sub clinical thyrotoxicosis syndrome. The diagnosis of probable malignant thyroid tumor was evoked initially and a thyroidectomy considered. She presented an important biological inflammatory syndrome and biological peripheral hyperthyroidism. Neck ultrasound examination showed heterogeneous patchy decreased echogenicity. The diagnosis of subacute De Quervain’s thyroiditis was set up. A corticosteroid therapy at a rate of 20 mg/day of prednisone was begun with a fast degression of dose. After 3 weeks of treatment, we noticed total clinical recovery normalization of biological parameters. The second observation was about a 52-year-old Senegalese women living in Bamako. She presented cervical pains evolving for 2 months in a context of flu-like syndrome associated with thyrotoxicosis and marked biological inflammatory syndrome. The thyroid ultrasound showed global heterogeneity with characteristic aspect of “geography map” leading to the diagnosis of subacute thyroiditis. A combination therapy with low dose of prednisone, ß-blockers and tranquillizers. We noticed fast disappearance of clinical and biological signs. At 5 mg per day of prednisone, there were moderate signs of relapse with rapid favorable evolution after few days under increased dose of prednisone up to 10 mg/day. Conclusion: De Quervain’s thyroiditis can appear under misleading features opening out to make wandering diagnosis. A good clinical evaluation coupled with hormonal and ultrasound thyroid examination may help for right management. The use of low dose of corticosteroid had enabled us to obtain a fast control of main clinical and biological abnormalities.
文摘Aim: The purpose of this study was to determine the frequency of the hurts of the inferior laryngeal nerve, according to its anatomical reports with the inferior thyroid artery during the thyroid surgery. Methodology: We realized a forward-looking and retrospective study from January, 1979 till December, 2017 in the service of surgery “B” to the University hospital of the Point G of Bamako and in the service of ENT and cervico-facial surgery of the Teaching Hospital “Mother-Child”, the Luxembourg of Bamako (Mali). All the patients operated in both services for mild goiters were retained. Cancers and other thyroid pathologies were not included. The diagnosis of mild goiter was paused by the histological examination realized on all the surgical specimens. Results: On 2109 dissections of the inferior laryngeal nerve realized during the surgical operations on the thyroid, the frequency of lesion of the inferior laryngeal nerve was 1.09% (20 cases) when it passed dorsally with regard to the inferior thyroid artery (1837 cases) and when 4.04%, it was transvascular or prevascular (272 cases). Conclusion: The prevascular route or transvascular of the inferior laryngeal nerve favors its lesion per operating.
文摘Amyloid goiter (AG) is a rare but well-established disease entity that may occur in a number of conditions. In the following article, we will report two cases of AG. Both patients were young males: 28 & 24 years old, presented with rapidly enlarging thyroid gland manifested with pressure effects (dyspnea and hoarseness of voice). Provisional clinical diagnosis was malignant thyroid neoplasm. One of the patients was markedly hypothyroid while the other was euthyroid. Histopathological evaluation revealed extracellular deposition of deep pink homogenous material that was confirmed as amyloid with congo red. Patient in case 1 was primary localized AG while patient in case 2 was systemic amyloidosis secondary to interstitial pulmonary fibrosis (IPF) that was first manifested by AG. The main aims of the article were to describe histopathological features of amyloidosis of the thyroid gland and to raise awareness of AG to be included in the differential diagnosis in patients presented with rapidly enlarging goiter with mass effects.
文摘Thyroid gland is one of most important endocrine glands in the body. It plays vital role in growth control and its measurements tends to change in respect to age, sex, weight and ethnic group of the individual. This study aimed to assess endemic goiter and to estimate the measurement of normal thyroid gland dimensions and thyroid hormones level in school-aged children using Ultrasonography and ELISA Technique in Eastern Sudan (Kassala state). A total of 100 subjects is 6 - 18 years (43 males, 57 females), and mean of age (9.73 ± 2.54 years). This study was done in the period from April 2016 to February 2017. All the subject undergone thyroid ultrasound and thyroid hormone level test. Subjects with history of goiter were excluded from the study, by thyroid dimension (length, height and diameter). Thyroid volume was estimated using ellipsoid formula and thyroid hormones (TSH, T3 and T4) using Toso full automation. The study revealed that 12 subjects of the study (12%) with goiter, 7 female (7%) and 5 males (5%) with age ranged 6 - 11 years with increase in TSH and T3 and decrease in T4 level. The mean of thyroid volumes for normal subject and subject of goiter are 4.93 ± 0.63, 5.4 ± 1.4 mL, respectively, and TSH, T3, T4 (1.8 ± 0.97, 2.4 ± 0.86 UIu/nL), (3.61 ± 0.32, 3.8 ± 0.55 Pg/Nl), (1.35 ± 1.23 ng/DI level respectively). It concluded that there was positive correlations between the age and the thyroid volume (p = 0.65). It increases with increase of the age. The Rt lobe is larger than the Lt lobe;the thyroid volume is higher in male than female, and this study found the TSH and T3 decreased with ages while T4 increased with ages in normal subject;TSH and T3 level increased and T4 level decreased in goiter children.
文摘Purpose: The incidence of hyperplastic thyroid nodular disease has been consistently rising over the last decades. In addition, unsuspected papillary thyroid carcinoma (PTC) can be found in up to 34% of patients operated for benign thyroid lesions. PTC tends to occur multi-focally and is commonly of polyclonal origin. We set out to test the hypothesis that in benign thyroid disease, a unique genetic signature can already be identified in the benign pathology, which is associated with a susceptibility of the thyroid tissue to neoplastic transformation in the context of additional growth promoting stimuli. Patients and Methods: We obtained a set of 23 samples from patients with multinodular goiter (MNG), 12 of whom also harbored an unsuspected PTC. We used global gene expression analysis to evaluate for dissimilarities in the gene expression patterns between these two groups. We also compared these patterns to the profiles of 3 normal thyroid and 7 PTC samples. Results: We were able to accurately distinguish between hyperplastic nodules of patients with multinodular goiter and those that were associated with a PTC. One of the strongest differentially expressed genes, CDC42, has been implicated to respond to environmental factors such as UVB radiation and might point to novel factors contributing to PTC genesis in the setting of pre-existing benign proliferative disease. Conclusion: While the comparison between histologically identical samples cannot distinguish the two groups of goiters, unsupervised or supervised approaches allowed us to identify a molecular signature associated with PTC susceptibility in multinodular goiter.
文摘Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Department of Obstetrics and Gynecology at Microcitemico Pediatric Hospital, Cagliari, for suspected fetal goiter at 32 gestational weeks. The case was monitored regularly by ultrasound and treated successfully with intra-amniotic levothyroxine (L-T4) administration. Fetal goiter was observed to decrease after this treatment and the thyroid ultrasound findings were also normal both at birth and in subsequent follow-ups. Our case report confirms the feasibility of conservative treatment with L-T4, which can effectively prevent complications related to fetal goiter.
