Fate of Human Thyroid Tissue Autotransplants

Purpose. We conducted this study to establish whether human thyroid tissue autografts can survive and function in the absence of their native blood supply in muscle. The benefits of this potential could be incorporated in routine surgery to reduce the incidence of post-operative hypothyroidism.Methods. Fifteen patients with benign thyroid disorders, seven of whom had Graves' disease and eight, multinodular goiter (MNG), underwent modified subtotal thyroidectomy and the autotransplantation of thyroid tissue in the sternocleidomastoid muscle. About 3–5g of thyroid tissue was cut and implanted into the sternocleidomastoid muscle. Postoperative clinical assessment, thyroid function tests, and technetium scans of the neck were done to assess the function of remnant and transplanted thyroid tissue.Results. The transplanted tissue was functional in six of the eight patients with MNG and four of the seven with Graves' disease. All the patients with MNG and a functional transplant became euthyroid within 6 months postoperatively. Although the transplanted tissue was functional in four patients with Graves' disease, only one became euthyroid, while the other three required supplemental hormone therapy for postoperative hypothyroidism.Conclusions. These findings demonstrate the ability of autotransplanted thyroid tissue to survive, function, and grow in muscle.     

The Prevalence of Incidental Thyroid Carcinoma in Patients Who Underwent Thyroidectomy for Multinodular Goiter

The incidence of an incidental carcinoma following surgical treatment for MNG varies from 3 to 16%. The aims of this study are to determine the incidence of an incidental thyroid carcinoma (ITC) in patients with multinodular goiter (MNG) and to evaluate the primary surgical treatment modality for these patients. Between January 2010 and July 2015, a total of 3311 patients who underwent surgery for goiter were retrospectively evaluated. Demographic characteristics of the patients, previous medical history, thyroid hormone profiles, thyroid ultrasonography findings, fine-needle aspiration biopsy (FNAB) findings, thyroid scintigraphy findings, surgical techniques, early postoperative complications, and histopathological diagnoses were recorded. The patients were divided into two groups: those who were incidentially diagnosed with a thyroid carcinoma (ITC group; n = ?) and those with MNG (MNG group; n = ?). Of 3311 patients, FNAB was performed in 1524 (46%) patients. Of these, 1790 underwent total thyroidectomy (TT) or near total thyroidectomy (NTT), 1066 underwent bilateral subtotal thyroidectomy (BSTT), 354 underwent the Dunhill procedure, and 101 underwent unilateral lobectomy (ULL) due to the presence of unilateral MNG. Postoperative histopathological examinations revealed an incidental thyroid carcinoma (ITC) in 283 (8.54%) patients, papillary carcinoma in 201 patients (201/3311, 6%), follicular cancer in 68 patients (68/3311, 2%), medullary cancer in 13 patients (13/3311, 0.3%), follicular carcinoma in four patients (4/923, 0.4%), and anaplastic cancer in one patient (1/3311, 0.03%). Our study results suggest that TT should be the primary surgical treatment modality to avoid the complications of a complementary thyroidectomy.     

Total thyroidectomy for clinically benign disease of the thyroid gland

BACKGROUND: The role of total thyroidectomy in the treatment of patients with benign thyroid disease remains controversial. However, this procedure may be appropriate when both thyroid lobes are involved and when the risk of recurrence is significant. This study is a review of a 15-year experience of total thyroidectomy for benign disease. METHODS: Between 1988 and 2002, 834 patients underwent total thyroidectomy for clinically benign disease at the Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital. There were 128 men and 706 women with a mean age of 52 (range 16-91) years. Indications for surgery were euthyroid multinodular goitre (MNG), toxic MNG and Graves' disease in 730 (87.5 per cent), 57 (6.8 per cent) and 47 (5.6 per cent) respectively. A total of 74 patients had previously undergone partial thyroidectomy. RESULTS: The incidence of temporary recurrent laryngeal nerve palsy was 2.3 per cent and that of temporary hypoparathyroidism 14.4 per cent. Permanent recurrent laryngeal nerve palsy occurred in 1.1 per cent, and 2.4 per cent of patients had permanent hypoparathyroidism. Neither the initial clinical diagnosis nor a history of previous treatment significantly influenced the rate of complications. The incidence of malignancy, other than incidental microscopic papillary carcinoma, was 4.6 per cent. CONCLUSION: Total thyroidectomy has an important role in the management of patients with benign disease when both lobes of the thyroid gland are involved. This approach avoids disease recurrence and the increased risk of morbidity associated with secondary operation.     

Need for an Individualized and Aggressive Management of Multinodular Goiters of Endemic Zones by Specially Trained Surgeons: Experience in Western Nepal

Background The goals of the present study were to explore the presentation of multinodular goiter (MNG) and solitary thyroid nodules (STN) in the sub-Himalayan belt, including the risk of malignancy, and to evaluate whether specialized surgeon training in endocrine surgery has an effect on reducing complications. Methods This retrospective study (1998–2003) analyzed 624 patients with thyroid disorders seen in the thyroid clinic of a tertiary care hospital in western Nepal. The findings included 67.7% (n = 423: euthyroid, 297, toxic, 126) multinodular goiters (MNG) and 18.5% (n = 116) STN. Rest of patients of other thyroid disorders were excluded from the study. Ultrasonography and fine-needle aspiration cytology (FNAC) were the available diagnostic adjuncts. To evaluate the role of surgeon training, outcomes were compared between patients cared for by surgeons specially trained in endocrine surgery and those who were not. Prognostic markers indicated aggressiveness of cancers. Results Of the 539 MNG and STN patients in this series, 236 underwent operation. Of these, 25.7% (139/539) were toxic, and 11.31% had associated carcinoma. Aggressive cancers, like poorly differentiated (4.9%) and anaplastic types (18%), were more common than in series of patients from iodine-sufficient regions. Patients 40–55 years of age were more likely to have toxicity, and those > 60 years of age were more likely to have aggressive cancers. Postoperative complication rates were lower in the group treated by surgeons who had special training in endocrine surgery. Conclusions There is a higher incidence of toxicity and malignancy in MNG in an endemic goiter zone. The limited diagnostic and therapeutic facilities in the region under study warrant a high degree of clinical suspicion and judgment, sound knowledge of thyroid physiology, thorough interpretation of hormone test results, and meticulous surgical techniques. The treatment must be individualized with consideration of humanitarian and socioeconomic factors, without compromising the quality of care and its long-term consequences. Aggressive management of malignancy and toxicity with total thyroidectomy is needed as primary therapy in many instances. However, subtotal excision is more useful in carefully selected cases with a small remnant. Specialized training in thyroid surgery appears to be valuable in reducing complications.     

Familial Papillary Thyroid Carcinoma: Genetics, Criteria for Diagnosis, Clinical Features, and Surgical Treatment

Hereditable predisposition to papillary thyroid carcinoma (PTC) and multinodular goiter (MNG) without evidence of an association with other malignancies as a distinct entity was recognized only recently. A meta-review of the literature on familial PTC (FPTC) was undertaken, and characteristics of families with frequent occurrence of PTC or MNG (or both) were summarized. A database on thyroid cancer patients maintained in our institution was searched for potential FPTC families. Clinical examinations were performed in 6 of 12 Hannover kindreds identified, and blood samples of all family members were collected for genetic analyses. Clinical presentations and histopathologic features of the FPTC cases were compiled. Based on the FPTC meta-review and own experience, predictive criteria to identify families at risk were developed: Exclusion criteria were previous radiation exposure and coincidence with neoplasia syndromes. Primary criteria for susceptibility to FPTC are (1) PTC in two or more first-degree relatives and (2) MNG in at least three first- or second-degree relatives of a PTC patient. Secondary criteria are diagnosis in a patient younger than 33 years, multifocal or bilateral PTC, organ-exceeding tumor growth (T4), metastasis (N1, M1), and familial accumulation of adolescent-onset thyroid disease. A hereditary predisposition to PTC is considered if both primary criteria or one primary criterion plus three secondary criteria are present. Family history-taking is recommended for all PTC patients to identify FPTC kindreds at risk. Blood relatives of FPTC index patients who harbor MNG should undergo thorough and regular clinical screening. Suspicious lesions should prompt early surgical intervention.     

Clinical significance of thyroid nodule calcification

To confirm the predictive value of calcifications in thyroid nodules as a risk factor for malignancy and to detect specific aspects for tumours, in a set of 175 patients--30 papillary carcinoma (PC) and 145 multinodular goiters (MNG) with dominant nodule--calcifications were detected by ultrasound scan. Calcifications were significantly more frequent in PC than in MNG (40% vs 20.7% p < 0.05) but their considered characteristics (size, number, position, location in the gland, sonographic features of the nodule) did not show any particular difference between PC and MNG. The frequency of calcifications in our series was higher in older patients (mean age 58.7 +/- 13.3 vs 51.1 +/- 12.7 in patients without calcifications, p < 0.001) and this could imply that their onset is time-dependent. Calcifications can be a useful indicator of enhanced risk, to be considered in the overall process of surgical decision making.     

Symptomatic benign multinodular goiter: unilateral or bilateral thyroidectomy?

BACKGROUND: Symptomatic benign multinodular goiter (MNG) is extremely common in the north central United States. The extent of surgery for unilateral or bilateral disease is controversial. Bilateral resection should be associated with low recurrence rates, but potentially a higher technical morbidity. The long-term outcomes of patients with obvious unilateral MNG who had unilateral resection only is not commonly reported. To determine the optimal operation for patients with symptomatic MNG, we reviewed our single institutional results. METHODS: From May 1994 through November 2004, 883 patients underwent a thyroid operation at our institution. Of these, 237 (27%) underwent thyroidectomy for MNG. One hundred forty patients underwent unilateral lobectomy and 97 underwent total thyroidectomy. RESULTS: The mean age was 51 +/- 1 years and 196 (83%) were female. With up to 145 months' follow-up, there was a higher recurrence rate in the lobectomy group (11% vs 3%; P = .029). However, patients in the lobectomy group had a much lower complication rate (2% vs 9%; P = .007). Importantly, in patients who underwent reoperation for recurrent MNG after lobectomy, the complication rate was low (5.5%) and not significantly higher than the initial surgery. CONCLUSIONS: In patients with symptomatic MNG, 89% of those who underwent unilateral resection did not require further surgery. Unilateral thyroidectomy was associated with lower morbidity than bilateral resection. Furthermore, those patients who required operation for contralateral recurrence did not experience a significantly higher operative morbidity. Therefore, these data convincingly support recommending unilateral thyroid lobectomy as the procedure of choice for patients with symptomatic unilateral MNG.     

Comparison of Surgical Techniques for Treatment of Benign Toxic Multinodular Goiter

Controversy remains regarding the best surgical approach for toxic multinodular goiter (MNG). The aim of this study was to evaluate the results of various thyroid operations for managing toxic MNG. A group of 100 patients with toxic MNG were divided into three groups and managed with total thyroidectomy (TT; group I, n-17), near-total thyroidectomy (NTT; group II, n = 48), or bilateral subtotal thyroidectomy (BST; group III, n = 35). Patients were compared with regard to age, gender, surgical operations, complications, thyroid hormone status, duration of hospitalization, and the reoperation rate for incidentally found thyroid carcinomas. There were 14 men (14%) and 86 women (86 %) with a mean age of 47.03 ± 13.56 years (range 19–77 years). After the operation two patients had a hematoma, and one patient had a seroma. Four patients had unilateral vocal cord paralysis, and one had permanent paralysis. Moreover, 18 patients had transient and 2 patients permanent hypocalcemia. There was no significant difference between the groups regarding complications (p < 0.05). Permanent hypothyroidism was achieved in all patients in group I and 44 patients (92 %) in group II, whereas in group III only 10 (29%) patients had hypothyroidism. Conversely, hyperthyroidism, both subclinical and clinical, was noted only in group III (12 patients, 34 %) during follow-up. We think that TT and NTT are safe, effective approaches in the treatment of toxic MNG, preventing recurrence of thyrotoxicosis and reoperation for incidentally found thyroid cancers. The complication rates for TT and NTT were similar to that for BST. Hence these operation should be considered for patients referred for surgical treatment of toxic MNG.     

Safety and Efficacy of Surgical Management of Hyperthyroidism: 15-year Experience from a Tertiary Care Center in a Developing Country

Background Ideal management of toxic goiter still remains elusive. Though surgical management of toxic multinodular goiter (MNG) is well accepted, surgical treatment of Graves’ disease (GD) is still controversial in view of the presumed increased incidence of complications. In this paper, we discuss the experience of the surgical management of hyperthyroidism at a specialized tertiary care endocrine center in a developing country, highlighting the minimal morbidity and satisfactory outcome in experienced hands. Materials and methods We retrospectively reviewed 325 consecutive patients with hyperthyroidism managed surgically from 1990 to 2005. The etiologic diagnoses were Graves’ disease (185), toxic MNG (105), and autonomously functioning thyroid nodules (AFTN) (n = 35). The indications for surgery in Graves’ patients were large goiter, relapse after antithyroid drug therapy (ATD), Graves’ ophthalmopathy, and presence of nodule. The indications for surgery in toxic MNG were retrosternal extension (n = 15), compressive symptoms (n = 20), and large size (grade II). Among the AFTN nodule size, those greater than 4 cm (85%) formed the major indication for surgery. Subjects with GD and toxic MNG were subjected to subtotal thyroidectomy (n = 93 prior to 1995) or total thyroidectomy (n = 205 post-1995). Hemithyroidectomy was the procedure of choice in patients with AFTN. Results Patients with Graves’ disease were younger in age, with shorter mean duration of goiter when compared with the other 2 groups. Eight percent of patients with Graves’ disease without a clinically palpable nodule and 25% of those with nodules had associated differentiated carcinoma, including papillary, follicular, and medullary thyroid cancer. Four percent of patients with toxic MNG had malignancy. Complications included temporary hypocalcemia (24%), permanent hypocalcemia (3%), and permanent vocal-cord palsy (1%). Conclusions Surgery for hyperthyroidism has negligible mortality and acceptable morbidity in experienced hands. It is a definite option in selected cases. Immediate and permanent cure of hyperthyroidism is achieved, with no recurrences, after total thyroidectomy. The cosmetic outcome is good, with excellent patient satisfaction and acceptance.     

Autonomously functioning thyroid nodules in childhood and adolescence

Autonomously functioning thyroid nodules (AFTNs) in children and adolescents (under age 18) are unusual but are not as rare as earlier reports suggested. These lesions have a significantly different biologic potential than similar lesions in older patients. In the younger age group there is a more rapid progression toward toxicity and a higher incidence of thyroid carcinoma. Our experience with 12 patients is combined with those previously reported for identification of a total of 61 children and adolescents with AFTNs, of whom 53 have undergone operation. Hyperthyroidism was present in 15 patients (24.6%), and in six patients (11.3%) the AFTN was due to a well-differentiated thyroid carcinoma. Surgical treatment is advisable for all children and adolescents with AFTNs because of the risks of hyperthyroidism and thyroid carcinoma. Surgical excision (lobectomy is preferred) results in rapid restoration of a euthyroid state for the toxic AFTN and allows histopathologic diagnosis. Therapy with radioiodine is not advisable for treatment of AFTNs in this age group. Thyroid-stimulating hormone suppression should be used for all patients with a diagnosis of thyroid carcinoma.     

Carcinoma of the thyroid in patients with autonomous nodules

Over a period of 25 years (1961-1986), 30 consecutive patients were operated upon for solitary "HOT" nodules. The autonomy of these nodules was substantiated by cytomel nonsuppressibility on 131I or 123I scanning, or TSH stimulated enhancement of the remaining suppressed thyroid tissue (n = 24); or as a solitary toxic hot nodule with suppression of the remaining thyroid tissue (n = 6). Seventeen of these patients were euthyroid and 13 were thyrotoxic and required preoperative preparation with antithyroid medication. Five patients had a history of head and neck irradiation. The population consisted of 24 women and six men. Their ages ranged from 14 to 68 years. The tumors ranged in size from 1.5 to 7 cm. The pathologic findings consisted of "colloid" adenoma in nine patients, follicular adenoma in 19 patients, and a follicular carcinoma in two patients, for an incidence of 6 per cent. It is of interest that neither of the patients with thyroid carcinoma were toxic or had a history of radiation exposure. These findings support the concept that the incidence of carcinoma in truly autonomous "HOT" thyroid nodules is not negligible.     

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??Relationship between preoperative combined subclinical hypothyroidism and prognosis of papillary thyroid carcinoma LI Xiao-ke??ZHANG Qin??QIU Nian-cun??et al. Department of General Surgery??Chang Zheng Hospital Affiliated to Second Military Medical University??Shanghai 200003??China.
Corresponding author??QIU Ming??E-mail??qium127@sina.com
Abstract Objective To assess the difference between preoperative subclinical hypothyroidism and euthyroidism on prognosis and clinicopathological features of papillary thyroid carcinoma (PTC). Methods A total of 656 patients underwent surgery for PTC between January 2005 and December 2007 in Chang Zheng Hospital Affiliated to Second Military Medical University was enrolled in the study. All the clinical pathological factors between 70 patients with preoperative subclinical hypothyroidism and 514 patients with euthyroidism before the operation were compared. The difference factors were analyzed by multivariate logistic regression analysis. Results No significant difference was observed in tumour size??extrathyroidal extension and multifocality between subclinical hypothyroidism and euthyroid patients. But metastatic rate of lymph nodes in patients with subclinical hypothyroidism was less than that in euthyroid patients??8.6% vs. 21.8%??P=0.068??. Conclusion Subclinical hypothyroidism with elevated TSH is not an independent predictor of tumour aggressiveness and poor prognosis in PTC.     

Follicular carcinoma thyroid in Pendred syndrome

Pendred syndrome is a rare inherited disorder of bilateral sensorineural deafness with goitre. Presence of follicular carcinoma thyroid makes it even rarer. A case of a young girl is described with the features of Pendred syndrome and euthyroid state. Follicular carcinoma of thyroid was detected on histopathology requiring re-tailoring of the management.     

Bone mineral content in hypothyroid male patients with hormone replacement: a 3-year study

Several studies have reported that short-term thyroid replacement to the euthyroid state in hypothyroid patients produces loss of both cortical and trabecular bone. However, long-term follow-up studies on this subject have not been reported. We conducted a 3 year follow-up study on 35 white male patients, including 24 patients (group 1 and 2) with hypothyroidism receiving thyroid hormone replacement to the euthyroid state and 11 patients (groups 3 and 4) with Graves' disease. The bone mineral content of the distal radius was determined by single-photon absorption techniques with an iodine 125 source. It was found that there was no statistically significant difference in bone mineral content by year for any group, indicating no evidence of significant loss of cortical bone mineral by thyroid hormone replacement to the euthyroid state in hypothyroid patients.     

Micturition pattern in hyperthyroidism and hypothyroidism

Micturition pattern was investigated in 61 consecutive patients with thyroid disease. The patients were divided into three groups: hyperthyroid, hypothyroid, and euthyroid. Micturition pattern was examined after the first visit to the hospital and again six months later, when thyroid function had been restored to normal. Hyperthyroid patients had significantly increased micturition frequency as well as nocturia compared with their own control group when euthyroid (p less than 0.01). Hypothyroid patients had reduced micturition frequency compared with their own control group (p = 0.05). No significant changes were found in the euthyroid group. Which mechanisms might be responsible for the relationship between thyroid function and micturition pattern is debatable, and calls for further urodynamic and electrophysiologic studies. One conclusion is that thyroid disease should be borne in mind when patients present with unexplained urinary frequency or retention.     

Five-Year Follow-up of a Randomized Clinical Trial of Unilateral Thyroid Lobectomy with or Without Postoperative Levothyroxine Treatment

Background  

The aim of this study was to compare the prevalence of recurrent nodular goiter in the contralateral thyroid lobe among patients after unilateral thyroid lobectomy for unilateral multinodular goiter (MNG) receiving versus not receiving postoperative prophylactic levothyroxine (LT4) treatment.     

Surgery of thyroid pathologies in one-day surgery

The surgery of the thyroid pathologies in Day and/or One-Day-Surgery requires a thorough choice former of the surgery of the patients and the availability of the team specialist that could guarantee an adequate nursing after surgery. The authors describe the advantages and the limits of the short confined to stay in hospital for the surgery of the thyroid pathologies. The selection criteria for patients undergoing thyroidectomy in One-Day-Surgery have been: euthyroid patients with benign pathologies concentrate only thyroid lobe and lack of associated pathologies as cardiopathy, broncopathy, nephropathy, hepatopaty, diabetes, etc. Were executed in general anaesthesia forty lobectomies for uninodular thyroid disease and three enucleoresections for a nodule of pyramidal lobe, and only two cases the histological definitive diagnosis of carcinoma has caused a second hospital stay. In all forty-three cases was used a drainage, removed after 24 hours.     

Unilateral thyroidectomy for the treatment of benign multinodular goiter

Background

Benign multinodular goiter (MNG) is one of the most commonly treated thyroid disorders. Although bilateral resection is the accepted surgical treatment for bilateral MNG, the appropriate surgical resection for unilateral MNG continues to be debated. Bilateral resection generally has lower recurrence rates but higher complication rates than unilateral resection. Therefore, the purpose of this study was to define the recurrence and complication rates of unilateral and bilateral resections to determine the appropriate intervention for patients with unilateral, benign MNG.

Methods

We reviewed a prospectively maintained database of all patients who underwent a thyroidectomy for treatment of benign MNG at a single institution between May 1994 and December 2011. All patients with bilateral MNG were treated with bilateral resection. Surgical treatment for unilateral MNG was determined by surgeon preference, with all but one surgeon opting for unilateral resection to treat unilateral MNG. Data were reported as means ± standard error of the mean. Chi-squared analysis was used to determine statistical significance at a level of P < 0.05.

Results

A total of 683 patients underwent thyroidectomy for MNG. Of these patients, 420 (61%) underwent unilateral resection and 263 patients (39%) underwent total thyroidectomy. The mean age was 52 ± 17 y, and 542 patients (79%) were female. The mean follow-up time was 46.1 ± 1.9 mo. The rate of recurrent disease was similar between unilateral (2%, n = 10) and bilateral (1%, n = 3) resections (P = 0.248). Unilateral resection patients had a lower total complication rate than patients with bilateral resections (8% versus 26%, P < 0.001); however, there was no difference in the rate of permanent complications (0.2% versus 1%, P = 0.133). Thyroid hormone replacement was rare in unilateral resection patients but necessary in all patients with bilateral resection (19% versus 100%, P < 0.001).

Conclusions

Patients that had unilateral resections endured less overall morbidities than those who had bilateral resections, and their risk of recurrent disease was similar. They were also significantly less likely to require lifelong hormone replacement therapy postoperatively. Although bilateral resection remains the recommended treatment for bilateral MNG, these data strongly support the use of unilateral thyroidectomy for the treatment of unilateral, benign MNG.     

New Prognostic Scales LAST-1 and LAST-2: Supporting Prediction and Staging of Thyroid Cancer

Introduction Epidemiologically, thyroid gland tumors are lesions of the highest importance among endocrine tumors in humans. Although the results of surgical treatment of the highly differentiated (follicular and papillary) tumors seem to be satisfactory, treatment of the poorly differentiated (medullary and anaplastic) tumor still demands clinical and basic investigations. In this study the authors sought to evaluate clinical and molecular factors that could contribute to preoperative detection of more advanced thyroid cancers (i.e., those that exhibit extrathyroid spread and lymph node invasion). Methods A total of 27 patients operated on for thyroid cancer were evaluated according to age, sex, time from the onset of the disease, cytogenetic changes, and loss of heterozygosity (LOH) in 14 microsatellite markers. The output variables were defined according to postoperative findings and the TNM 2002 score. The T1-2 N0 M0 cases were defined as local malignancy (LM); and T3-4 any N any M, any T N1 any M, or any T any N M1 were considered advanced malignancy (AM). The control groups consisted of 25 patients with multinodular goiter (MNG) and 32 patients with follicular adenoma (FA). In all cases, clinical and molecular data similar to those listed above were collected, excluding staging and follow-up information. Results There was no predominant specific type of chromosomal aberration observed and no marker lost in more than five patients (18%). The logistic regression identified three input variables as contributing significantly to the dichotomized outcome measure (LM vs. AM): LOH in any of the examined loci, age of the patient at the presentation, and the sex of the patient. Furthermore, discriminant analysis revealed four input variables differentiating among TC, FA, and MNG patients. Based on the multivariate analysis results, two numeric prognostic scales were fashioned: LAST-1, a scale applicable to differentiation of thyroid cancers at different degrees of clinical advancement; and LAST-2, a scale applicable to differentiation of any thyroid lumps. Conclusions It was concluded that LOH and the age and sex of the patients can provide sufficient data to predict thyroid cancer with a high degree of clinical advancement. LAST-1 scale is a reliable tool for identifying these patients. The LAST-2 scale gives supportive information about the character of thyroid lumps, distinguishing TC from MNG and FA.     

The diagnosis and surgical treatment of nodular euthyroid and toxic goiter

The authors discuss their experience in treating 815 patients who underwent an operation for nodular euthyroid and toxic goiter. Thermography was used in the examination of 367 patients and the results were compared with those of radioisotope scanning of the thyroid, intraoperative findings, and the results of histological study. It was established that in complex with clinical methods of examination, thermography is very important in making the differential diagnosis of thyroid diseases. The specific features of surgical tactics in patients with nodular goiter are shown. Economical resection of the gland together with the node is recommended in nodular euthyroid goiter and subtotal subfascial resection of the involved lobe or the thyroid gland in nodular toxic goiter.