Nodular goiter and cancer of the thyroid

Among 3229 patients with diseases of the thyroid gland aged from 6 to 83 years there were 2924 patients who had nodular forms of goiter and 71 patients who had malignant tumors of the thyroid. Thyroidolymphography with aimed trepanbiopsy was used to make more exact diagnosis. Complex clinico-radiological examination, thyroidolymphography with aimed biopsy before operation are considered to facilitate making more exact diagnosis and choosing the adequate treatment.     

Papillary carcinoma of the thyroid in intrathoracic goiter

Intrathoracic goiter (more than 80% of tissue in the thoracic cavity) represents very rare clinical entity (less than 1% of total number of thyroid gland surgical procedures). Cancer incidence in these goiter is 0-5%. The aim of this article is to present a case report of intrathoracic thyroid papillary carcinoma with multiple compressive syndrome and review of compressive intrathoracic syndrome of thyroid etiology. In our patient we have found: tracheal and oesophageal deviation and compression, superior vena cava syndrome, downhill varices, chylothorax, pericardial effusion, compress of the left a. subclavia, unilateral lesion of recurrent and phrenic nerve, and brachial plexopathy. This was a unique case with multiple compressive syndrome between 3000 patients surgically treated for all kinds of thyroid diseases. Intrathoracic goiter can cause all the known symptoms and syndromes of intrathoracic compression with possibility of rapid deterioration and fatal end.     

Liposarcoma of the thyroid gland mimicking retrosternal goiter

Primary liposarcoma of the thyroid gland is extremely rare with only two previous reports in the literature. We report two further cases, both patients presenting with rapid airways compression. Patient 1 had clinical, radiographic, and biopsy appearances suggesting benign goiter. Patient 2 had a long-term history of benign goiter, a previous partial thyroidectomy, and more recent biopsies showing liposarcoma. The management of such rare conditions is always challenging.     

Management of goiter and thyroid nodules in an area of endemic goiter

This article discusses the diagnostic and therapeutic measures we have used during the past five years to treat 861 patients from an edemic goiter area with various thyroid disorders. The similarities and differences between these patients, with nontoxic goiter, toxic goiter, and thyroid cancer, were compared with those seen in patients with thyroid problems who live in iodine-rich areas.     

CCR7在结节性甲状腺肿与甲状腺癌中的表达及其与EMT关系的研究

目的 研究并探讨趋化因子受体-7(chemokine receptor 7,CCR7)在结节性甲状腺肿与甲状腺乳头状癌中与上皮间质转化(epithelial mesenchymal transition,EMT)的关系.方法 采用免疫组化检测CCR7、N-cadherin与基质金属蛋白酶-9(matrix metalloproteinase 9,MMP9)在50例结节性甲状腺肿与50例甲状腺乳头状癌中的表达,分析其与患者病理资料的关系.结果 CCR7、N-cadherin在结节性甲状腺肿的结节期滤泡上皮均呈高表达(分别为83.7％、90.7％),且为正相关(P＜0.01),而在胶质贮存期滤泡上皮(分别为2.0％,8.2％)与结节期纤维组织(分别为6.7％,31.1％)低表达.CCR7、N-cadherin与MMP9在甲状腺乳头状癌的淋巴结转移组的阳性表达率为87.1％,90.3％,96.8％,而无淋巴结转移组的阳性表达率为42.1％,57.9％,63.2％,差异有统计学意义(P ＜0.01);CCR7与N-cadherin、MMP9在甲状腺乳头状癌的表达呈正相关(P＜0.01).结论 CCR7在结节性甲状腺肿与甲状腺乳头状癌中均与EMT的指标具有相关性,CCR7可能参与调节滤泡上皮EMT发生.     

Endemic goiter and endemic thyroid disorders

The primary role of iodine deficiency in goitrogenesis and the prevention and treatment of endemic goiter by iodine supplementation is firmly established. Unfortunately, implementation of iodine prophylaxis programs has met with considerable technical and socioeconomic difficulties. Besides, lack of knowledge concerning some of the other causative factors of endemic goiter has prevented development of appropriate measures for its complete eradication in those areas where goiter persists in spite of prolonged and adequate iodine supplementation. At present, no less than 5% of the world's population have goiters and associated disorders, resulting in a public health and socioeconomic problem of major proportions. Seventy-five percent of people with goiter live in less developed countries where iodine deficiency is prevalent. Goiter prevalence rates of more than 50% and the highest frequency of severe cases of iodine deficiency disorders, namely, cretinism, congenital hypothyroidism, and various degrees of impairment of growth and mental development are found in endemic areas with extreme iodine deficiency. Goiters are usually multinodular and of very large size, producing, on occasion, signs of compression that require surgery. Recurrence rates are as high as 25–30% and second surgery accounts for 16% of all thyroidectomies. Unfortunately, most of these goiters occur in areas with highly restricted medical and surgical facilities. Twenty-five percent of people with goiters live in more developed countries where goiter continues to occur in certain areas despite iodine prophylaxis. Iodine-sufficient goiters are associated with autoimmune thyroiditis, hypothyroidism, hyperthyroidism, and thyroid carcinoma. Goiter is of considerable surgical significance in iodine-sufficient endemic areas and, to a lesser degree, in nonendemic areas where it is called sporadic goiter. Recurrence rates of iodine-sufficient goiter are 10–19% following thyroidectomy. Since most of these goiters grow by mechanisms other than increased thyrotropin (TSH) stimulation, treatment with suppressive doses of L-thyroxine is inefficient and, because of possible complications, not recommended. Although Graves' hyperthyroidism is not directly related to endemic goiter, it does relate adversely with ingestion or administration of iodine. At present, Graves' disease is treated with¹³¹I or antithyroid drugs in more than 90% of the cases. The incidence rates of papillary, follicular, and anaplastic thyroid carcinomas appear to be related to endemic goiter and iodine supplementation, with surgery being required in essentially all of these cases.

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Resumen El papel primario de la deficiencia de yodo en la bociogénesis y en la prevención y tratamiento del bocio endémico mediante suplemento dietario de yodo, está bien establecido. Desafortunadamente los programas profilácticos mediante suplementación de yodo han encontrado dificultades de carácter técnico y socio-económico. Además, la falta de conocimientos relativos a otros factores causales de bocio endémico ha impedido el desarrollo de medidas adecuadas para lograr su total erradicación en áreas donde el bocio persiste a pesar de una adecuada suplementación de yodo. En la actualidad no menos del 5% de la población mundial está afectada por bocio y desórdenes asociados, lo cual resulta en problemas socio-económicos y de salud de proporciones mayores. Setenta y cinco por ciento de las personas afectadas por bocio residen en naciones de menor desarrollo, donde es frecuente la deficiencia de yodo. Tasas de prevalencia de bocio superiores a 50% y la mayor incidencia de casos graves de alteraciones por deficiencia de yodo, tales como cretinismo, hipotiroidismo congénito, y desarrollo mental anormal, se presentan en las regiones donde hay deficiencia extrema de yodo; los bocios son generalmente multinodulares y de gran tamaño, capaces de producir comprensión mecánica que demanda cirugía. Las tasas de recurrencia llegan hasta 25–30%, y la segunda cirugía representa el 16% de todas las tiroidectomías. Infortunadamente la mayoría de estos bocios se presentan en áreas donde las facilidades médicas y quirúrgicas son restringidas. El 25% de las personas con bocio viven en países de mayor desarrollo donde el bocio continúa presentándose a pesar de la profilaxis mediante suplementación dietaria. Los bocios con suficiencia de yodo se asocian con tiroiditis autoinmune, hipotiroidismo, hipertiroidismo, y carcinoma tiroideo. El bocio es de considerable pertinencia quirúrgica en áreas de bocio endémico con suficiencia de yodo, y en menor grado en áreas no endémicas, donde el bocio es de tipo esporádico. Las tasas de recurrencia del bocio con suficiencia de yodo son de 10–19% después de tiroidectomía. Puesto que la mayoría de estos bocios se desarrollan por mecanismos diferentes del estímulo por tirotropina (TSH) aumentada, el tratamiento con dosis supresoras de L-tiroxina es ineficaz y, por sus potenciales complicaciones, no recomendable. Aunque el hipertiroidismo de Graves no aparece directamente relacionado con el bocio endémico, sí se observan efectos adversos con la ingestión o la administración de yodo. En la actualidad la enfermedad de Graves es tratada con¹³¹I o con drogas antitiroideas en más del 90% de los casos. La incidencia de carcinomas tiroideos papilares, foliculares, y anaplásicos parece estar relacionada con el bocio endémico y con la suplementación de yodo, y la cirugia se halla indicada esencialmente en la totalidad de los casos.

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Résumé Le rôle essentiel de la carence en iode dans la genèse du goitre et la prévention et le traitement du goitre endémique grâce à un apport en iode sont établis avec certitude. Cependant, les programmes prophylactiques d'apport en iode ont rencontré d'énormes difficultés et techniques et socio-économiques. En outre, le manque de connaissances des autres facteurs qui provoquent le goitre endémique ont empêché le développement des mesures nécessaires à son éradication totale dans les cas où le goitre persiste malgré l'apport supplémentaire prolongé et suffisant d'iode. Aujourd'hui, au moins 5% de la population mondiale a un goitre et des désordres associés provoquant un grave problème dans la santé publique et en économie sociale. Soixante-quinze pour cent des gens avec goitre vivent dans les pays sous développés où le manque d'iode est fréquent. Des taux de goitres dépassant 50% de la population, et la grande fréquence de cas graves des désordres du manque d'iodine, en particulier le crétinisme, l'hypothyroïdisme congénital et les retards de croissance psychomotrice à des degrés divers se rencontrent dans les pays endémiques avec un déficit en iode. Les goitres sont en général multinodulaires et de grande taille, provoquant à l'occasion des signes de compression qui relèvent de la chirurgie. Les taux de récidive s'élèvent à 25–30% et la chirurgie secondaire compte 16% du nombre total des thyroïdectomies. Malheureusement, la plupart de ces goitres surviennent dans des régions où les possibilités médicales et chirurgicales sont extrêmement réduites. Vingt cinq pour cent des patients qui ont un goitre vivent dans des pays plus développés où il continue d'apparaître en dépit de l'apport prophylactique suffisant en iode. Les goitres survenant sans déficit en iode sont alors fréqemment associés à la thyroïdite auto-immune, à l'hypothyroïdie, à l'hyperthyroïdie et au cancer de la thyroïde. Le goitre occupe une place thérapeutique chirurgicale immense dans les pays d'endémie où l'iode ne manque pas et, à un degré moindre, dans les endroits non endémiques où il est appelé goitre sporadique. Le taux de récidive des goitres normoiodés est de 19% après thyroïdectomie. Puisque la plupart de ces goitres augmentent de volume autrement que par une stimulation accrue de thyrotropine, le traitement avec des doses suppressives de L-thyroxine est inefficace et, en raison des risques de complication, peu indiqué. Bien que la Maladie de Basedow ne soit pas directement en rapport avec le goitre endémique, elle est en rapport conversé avec l'ingestion d'iode. Elle se traite aujourd'hui avec¹³¹I ou des médicaments antithyroidiens dans plus de 90% des cas. L'incidence de cancers papillaires, folliculaires, et anaplasiques semblent être en rapport avec le goitre endémique et l'augmentation d'iode: la chirurgie est indiquée dans pratiquement tous ces cas.

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Supported by grants from the Veterans Administration Medical Research Service of the United States and the Colombian National Science Foundation (COLCIENCIAS).     

Multi-nodal euthyroid goiter and carcinoma of the thyroid gland

In 66 patients carcinoma was formed on background of euthyroid multinodal goiter (MNG). There was established, that the malignant tumours in patients with euthyroid MNG in principal are the papillare thyroid carcinoma of a small size, do not invade the capsula of thyroid gland, that testifying relatively favourable course of the disease.     

Tumours of accessory parotid glands. Case reports

Tumours arising in accessory parotid glands are a distinct entity and a pitfall for the unwary . The diagnosis is made on the basis of clinical examination and a high index of suspicion is essential. Treatment is by wide exposure and careful dissection because of the relationship of the accessory parotid gland to the facial nerve and parotid duct. Four cases are described.     

Imaging of the thyroid and parathyroid glands

Current multimodal imaging techniques offer practicing providers the adequate framework to plan and accomplish care for patients with thyroid and parathyroid disorders. Available imaging modalities include ultrasonography (US), nuclear scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI). US remains the most cost-effective and the safest approach for the initial evaluation of the thyroid gland. Parathyroid subtraction scintigraphy provides localization of pathologic parathyroid glands with the greatest sensitivity. Localizing imaging studies allow for surgical planning with minimal risk and morbidity to the patient. CT scan and MRI play an adjunctive role in the further characterization of neck pathology.