scholarly journals Hyperfunctioning Thyroid Nodules in Toxic Multinodular Goiter Share Activating Thyrotropin Receptor Mutations with Solitary Toxic Adenoma1

1998 ◽  
Vol 83 (2) ◽  
pp. 492-498
Author(s):  
Massimo Tonacchera ◽  
Luca Chiovato ◽  
Aldo Pinchera ◽  
Patrizia Agretti ◽  
Emilio Fiore ◽  
...  
Keyword(s):  
Multinodular Goiter ◽  
Thyroid Nodules ◽  
Thyrotropin Receptor ◽  
Toxic Multinodular Goiter

scholarly journals Identification of Constitutively Activating Somatic Thyrotropin Receptor Mutations in a Subset of Toxic Multinodular Goiters1

1997 ◽  
Vol 82 (12) ◽  
pp. 4229-4233 ◽  
Author(s):  
Hans-Peter Holzapfel ◽  
Dagmar Führer ◽  
Peter Wonerow ◽  
Gerhard Weinland ◽  
Werner A. Scherbaum ◽  
...  
Keyword(s):  
Multinodular Goiter ◽  
The Other ◽  
Tsh Receptor ◽  
Surrounding Tissue ◽  
Additional Patient ◽  
Thyrotropin Receptor ◽  
Activating Mutations ◽  
Gsα Gene ◽  
Toxic Multinodular Goiter ◽  
Tshr Gene

Constitutively activating mutations in the TSH receptor (TSHR) gene and in the Gsα gene are frequent molecular causes for solitary toxic nodules of the thyroid. However, the etiology of toxic multinodular goiter is still largely unknown. Therefore, DNA from nodular and quiescent surrounding tissue of six patients with toxic multinodular goiters was screened for mutations in exons 9 and 10 of the TSHR gene and exons 7–10 of the Gsα gene by direct automated sequencing. In one patient, two different somatic TSHR mutations were identified in two different toxic nodules (L632I and F631L). In another patient, two different toxic nodules harbored the same TSHR mutation (I630L), whereas only one TSHR mutation (F631L) was identified in one of the two toxic nodules of an additional patient. In the other three patients, no mutations could be found in exons 9 and 10 of the TSHR gene or in exons 7–10 of the Gsα gene. Our results demonstrate that not only solitary toxic adenomas but also toxic multinodular goiters can be caused by constitutively activating mutations of the TSHR. In addition to mutations in the TSHR and possibly in Gsα, there are probably other still unknown mechanisms that cause hot nodules in toxic multinodular goiters.

Influence of iodine application during radioiodine therapy in case of impending therapy failure

2000 ◽  
Vol 39 (04) ◽  
pp. 108-112 ◽  
Author(s):  
V. Urbannek ◽  
M. Schmidt ◽  
D. Moka ◽  
H. W. Hillger ◽  
E. Voth ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Half Life ◽  
Multinodular Goiter ◽  
Thyroid Nodules ◽  
Radioiodine Therapy ◽  
Graves Disease ◽  
Therapy Failure ◽  
Autonomously Functioning Thyroid Nodules ◽  
Toxic Multinodular Goiter ◽  
Iodine 131

Summary Aim: We investigated whether additional application of “cold” iodine after therapy with radioiodine could result in a prolongation of the effective half life of iodine-131 and would thus lead to an increase of the effective thyroid radiation dose. Methods: Time-activitycurves after therapy with radioiodine were analysed in 25 patients (16 women, 9 men). Nine patients suffered from autonomously functioning thyroid nodules, 5 from autonomous multinodular goiter and 11 from Graves’ disease. These patients had an effective half life shorter than 4 days resulting in an undertreatment of > 20% with respect to the desired effective thyroid radiation dose. 2-4 days after therapy with radioiodine all patients received “cold” iodine for three days in a dose of 3 × 200 μg per day. Results: In 14 of the 25 patients an increase of the effective half life was observed. Patients with an autonomously functioning thyroid nodule showed a mean increase of the effective thyroid radiation dose of 40 ± 44 Gy, patients with toxic multinodular goiter of 29 ± 30 Gy and patients with Graves’ disease of 37 ± 37 Gy. Conclusion: Additional application of “cold” iodine after therapy with radioiodine can prolong the effective half life in selected patients. We suspect a correlation with the thyroid iodine pool. This will be the basis for further investigations hopefully resulting in a better patient preselection to determine who might respond to this therapy.

scholarly journals Navigating the Debate on Large (4+cm) Thyroid Nodules: Local Insight on a Persisting Problem

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A867-A867
Author(s):  
Samantha Steinmetz-Wood ◽  
Amanda Kennedy ◽  
Bradley Tompkins ◽  
Matthew Philip Gilbert
Keyword(s):  
Thyroid Cancer ◽  
Multinodular Goiter ◽  
Thyroid Nodules ◽  
False Negative ◽  
Needle Aspiration ◽  
Molecular Testing ◽  
Fine Needle ◽  
Neck Irradiation ◽  
Toxic Multinodular Goiter ◽  
History Of

Abstract Background: Thyroid nodules are a common clinical finding, however discordant practice guidelines for managing large nodules may result in unnecessary surgeries and excess costs. Recent data suggest similar false negative rates in fine needle aspiration (FNA) biopsies between small (<4cm) and large (4+ cm) nodules, indicating that monitoring rather than surgery may be appropriate for large nodules. Evaluating current management strategies may reveal insights regarding excess surgeries, costs and opportunities for improvement. Objectives: The goal of this project was to describe the patients at our institution with large thyroid nodules and determine the proportion of potentially unnecessary surgeries and the associated predictors. Methods: This was a retrospective cohort study that included patients who received a FNA of nodule (s) ≥4cm between 11/1/2014 and 10/31/2019 at our tertiary care institution. Patient demographics, sonographic nodule size, fine needle aspiration cytology, molecular testing results, final surgical pathology, history of neck irradiation, family history of thyroid cancer, presence of compressive symptoms or presence of a toxic nodule or toxic multinodular goiter, were compared between patients who had surgery and those who did not. A surgery was considered inappropriate if the FNA result was benign in the absence of any of the following: a suspicious result on molecular testing, compressive symptoms, family history of thyroid cancer in a first degree relative, history of neck irradiation, toxic nodule or toxic multinodular goiter or substernal extension. Continuous variables were evaluated using Wilcoxon rank-sum test while categorical variables were tested using chi-square or Fisher’s exact test. Results: A total of 177 patients had a 4+ cm nodule during the timeframe. Half of patients (54.2%)with 4+ cm nodules had surgery. Patients who underwent surgery were significantly younger (51.5 years vs 62 years; P<0.001), more likely to report obstructive symptoms (34.4% vs 12.1%; P=0.001) and have a larger nodule size (5.0 cm vs 4.7 cm; P=0.26) than patients who did not have surgery. Forty-one patients with benign (Bethesda II) FNA results went on to have surgery. All 41 patients were found to be negative at surgery, yielding a false negative rate of 0.0% in our cohort. Twenty-three surgeries (24.0%) were considered inappropriate and overall 13% (23/177) of patients with 4+cm nodules had unnecessary surgery. The median charge for these surgeries was $13,183. Conclusion: Approximately half of our patients with 4+ cm nodules had surgery, especially patients who are younger, report obstructive symptoms, and have larger nodule sizes. Overall 13% of our patients with 4+cm nodules had unnecessary surgery revealing opportunities for improving care and costs.

scholarly journals Remarkable Presentation: Anaplastic Thyroid Carcinoma Arising from Chronic Hyperthyroidism

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Habib G. Zalzal ◽  
Jeffson Chung ◽  
Jessica A. Perini
Keyword(s):  
Thyroid Carcinoma ◽  
Multinodular Goiter ◽  
Thyroid Nodules ◽  
Anaplastic Thyroid Carcinoma ◽  
Anaplastic Carcinoma ◽  
Protective Measure ◽  
Thyroid Malignancy ◽  
Tracheal Compression ◽  
Anaplastic Transformation ◽  
Toxic Multinodular Goiter

Background. Undifferentiated anaplastic carcinoma rarely develops from chronic hyperthyroidism. Although acute hyperthyroidism can develop prior to anaplastic transformation, chronic hyperthyroidism was thought to be a protective measure against thyroid malignancy. Methods. A 79-year-old female presented acutely to the hospital with dyspnea. She had been taking methimazole for chronic hyperthyroidism due to toxic thyroid nodules, previously biopsied as benign. Upon admission, imaging showed tracheal compression, requiring a total thyroidectomy with tracheostomy for airway management. Results. Pathology demonstrated undifferentiated anaplastic thyroid carcinoma. The patient passed away shortly after hospital discharge. Despite treatment with methimazole for many years, abrupt enlargement of her toxic multinodular goiter was consistent with malignant transformation. Chronic hyperthyroidism and toxic nodules are rarely associated with thyroid malignancy, with only one previous report documenting association with anaplastic thyroid carcinoma. Conclusion. Progressive thyroid enlargement and acute worsening of previously controlled hyperthyroidism should promote concern for disease regardless of baseline thyroid function.

Rare association of primary hyperparathyroidism and toxic multinodular goiter

2018 ◽  
Author(s):  
Hamza Elfekih ◽  
Mouna Elleuch ◽  
Dorra Ghorbel ◽  
Faten Hadjkacem ◽  
Mouna Ammar ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Multinodular Goiter ◽  
Rare Association ◽  
Toxic Multinodular Goiter

Lack of Reported Mutations in a Japanese Case of Toxic Multinodular Goiter

ORL ◽  
2002 ◽  
Vol 64 (4) ◽  
pp. 275-277
Author(s):  
Masakazu Hanamitsu ◽  
Eiji Takeuchi ◽  
Tsuyoshi Kitanishi ◽  
Hironori Sakurai ◽  
Hiroshi Tanaka ◽  
...  
Keyword(s):  
Multinodular Goiter ◽  
Japanese Case ◽  
Toxic Multinodular Goiter

Major post-operative complications of thyroid surgery: Preventable or not?

2009 ◽  
Vol 34 (3) ◽  
pp. 99-103 ◽  
Author(s):  
M.A. Majid ◽  
Md. Ibrahim Siddique
Keyword(s):  
Total Thyroidectomy ◽  
Vocal Cord ◽  
Thyroid Surgery ◽  
Multinodular Goiter ◽  
Vocal Cord Palsy ◽  
Subtotal Thyroidectomy ◽  
Permanent Hypoparathyroidism ◽  
Respiratory Obstruction ◽  
Operative Complications ◽  
Toxic Multinodular Goiter

Factors responsible for major complications following thyroid surgery in 598 patients were studied. Patients with non toxic multinodular goiter involving both lobes of thyroid constituted the maximum bulk subjected to thyroidectomy. The most frequent procedure was bilateral subtotal thyroidectomy. Reactionary hemorrhage occurred in 6 patients, all following bilateral procedures and among them 5 patients developed tension hematoma with respiratory obstruction despite the presence of a drain. Temporary vocal cord palsy was observed in 7 patients whereas one patient subjected to total thyroidectomy with neck dissection for papillary carcinoma of thyroid developed permanent right vocal cord palsy. Temporary parathyroid insufficiency was seen in 51 patients and one patient developed permanent hypoparathyroidism. Incidence of parathyroid insufficiency was higher in bilateral procedures as compared to unilateral ones. There was no operation related death in this series, but complications like hemorrhage, vocal cord palsy and parathyroid insufficiency following thyroid surgery are still a deep concern. Keywords: Complication; Post-operative; Thyroid surgeryOnline: 29-1-2009DOI: 10.3329/bmrcb.v34i3.1973     Bangladesh Med Res Counc Bull 2008; 34: 99-103. 

scholarly journals The Rare Coincidence: Nonrecurrent Laryngeal Nerve Pointed by a Zuckerkandl's Tubercle

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Emin Gurleyik ◽  
Sami Dogan ◽  
Omer Gunal ◽  
Mevlut Pehlivan
Keyword(s):  
Multinodular Goiter ◽  
Laryngeal Nerve ◽  
Inferior Laryngeal Nerve ◽  
Adjacent Structures ◽  
Toxic Multinodular Goiter ◽  
Posterior Extension ◽  
Right Lobe ◽  
Nonrecurrent Laryngeal Nerve ◽  
The Right ◽  
Case Based

The safety of thyroid operations mainly depends on complete anatomical knowledge. Anatomical and embryological variations of the inferior laryngeal nerve (ILN), of the thyroid gland itself and unusual relations between ILN and the gland threaten operation security are discussed. The patient with toxic multinodular goiter is treated with total thyroidectomy. During dissection of the right lobe, the right ILN which has nonrecurrent course arising directly from cervical vagus nerve is identified and fully isolated until its laryngeal entry. At the operation, we observe bilateral Zuckerkandl's tubercles (ZTs) as posterior extension of both lateral lobes. The left ILN has usual recurrent course in the trachea-esophageal groove. The right ZT is placed between upper and middle third of the lobe points the nonrecurrent ILN. The coincidence of non-recurrent ILN pointed by a ZT is rare anatomical and embryological feature of this case. Based on anatomical and embryological variations, we suggest identification and full exposure of ILN before attempting excision of adjacent structures, like the ZT which has surgical importance for completeness of thyroidectomy.

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