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Thyroid disease
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Pregnancy is characterised by a significant demand for iodine with thyroid iodine uptake increasing. However, more iodine is excreted through renal clearance subsequent to the increased glomerular filtration rate of pregnancy, and there is transfer of iodine to the developing fetus4. The thyroid gland compensates for the increased loss of iodine by enlarging. A goitre that is clinically apparent suggests an iodine deficiency or some other kind of pathology3. In women with severe iodine deficiency, trapping mechanisms override fetal demand, conserving iodine for maternal use but this results in congenital iodine deficiency syndrome (poor growth and intellectual deficiency)5.
Thyroid disease
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Pregnancy is characterised by a significant demand for iodine with thyroid iodine uptake increasing. However, more iodine is excreted through renal clearance subsequent to the increased glomerular filtration rate of pregnancy and there is transfer of iodine to the developing fetus (Blackburn, 2007; Girling, 2006; Ramsey, 1998). The thyroid gland compensates for the increased loss of iodine by enlarging. Kenyon and Nelson-Piercy (2005) suggest a physiological goitre (enlarged thyroid) may be seen on ultrasound, but it would not be apparent when looking at the woman. A goitre that is clinically apparent suggests an iodine deficiency or some other kind of pathology. In women with severe iodine deficiency, trapping mechanisms override fetal demand, conserving iodine for maternal use but resulting in fetal cretinism (poor growth and mental retardation).
The minerals
Published in Geoffrey P. Webb, Nutrition, 2019
In severe iodine deficiency, there are symptoms of thyroid hormone deficiency. In children, iodine deficiency can lead to cretinism, a condition characterised by impaired mental and physical development. In adults, iodine deficiency causes not only goitre but can also lead to impaired mental functioning, low metabolic rate, hypotension, weight gain and other symptoms of thyroid hormone deficiency. In places where goitre is endemic it causes increased rates of spontaneous abortion and stillbirth and the birth of large numbers of children with congenital physical and neurological abnormalities e.g. deaf-mutism, spasticity and mental deficiency. There is a general impairment of intellectual performance and psychomotor skills in children from iodine-deficient areas. If goitre is very large, it may lead to problems with breathing or swallowing that may require surgery, and occasionally large nodular goitres may become malignant.
Clinical and ultrasound characteristics distinguishing benign and malignant thyroid nodules in Johannesburg, South Africa
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2023
Kershlin Naidu, Victoria Saksenberg, Nasrin Goolam Mahyoodeen
In Southern Africa, endemic goitre is usually associated with iodine deficiency. This was initially described in 1954 in a goitre belt extending from Limpopo province through Swaziland and Lesotho into the Eastern Cape.23 Prevalence rates of endemic goitre in Africa range between 1% and 90% depending on the study region.24 Mandatory iodinisation of table salt in South Africa was introduced on 1 December 1995 and the Iodine Global Network now classifies South Africa’s iodine intake as adequate.25 A retrospective review at the endocrine unit of Chris Hani Baragwanath Academic Hospital compared thyroid ultrasound features with FNA and histology results. There was good correlation between the ATA ultrasound classification and cytopathology and histopathology results.26 Non-diagnostic thyroid FNA rates in South African studies range between 9% and 10%.26,27
Prevalence and clinical relevance of thyroid autoantibodies in patients with goitre in Nigeria
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2019
OA Ojo, RT Ikem, BA Kolawole, OE Ojo, MO Ajala
In a study carried out by Olusi et al.8 4.6% of patients with goitre were found to have significantly positive autoantibody titres against thyroglobulin (Tg) while none of the 59 normal controls matched for age and sex had demonstrable autoantibodies. Isichei et al.,9 in a survey of endemic goitre in Jos, showed that goitre is highly endemic in the area with prevalence varying from 1% to 23%. Females showed a markedly higher prevalence of goitre. Though urine samples indicated that iodine excretion was similar to that in iodine-deficient areas of the world, no relationship was observed between the prevalence of goitre and urinary iodine. It could therefore not be concluded that the aetiology of endemic goitre in this area was associated with iodine deficiency. It was thus concluded that endemic goitre may be an interplay of multiple factors of aetiological importance. Okosieme et al.,10 in a study on the prevalence of thyroid antibodies in Nigerian patients, found that TgAb and TPOAb were found in 4% and 7%, respectively, of healthy adult controls, 11.6% and 76.8% of patients with GD, 25% and 12.5% of patients with toxic nodular goitre (TNG) and 9.52% and 14.29% of patients with simple non-toxic goitre (SNTG). The prevalence of thyroid autoantibodies found by Okosieme et al.10 was higher than that reported in previous studies in Africans.11,12 This may be due to the use of agglutination method in previous studies, a less sensitive method compared with enzyme-linked immunosorbent assay (ELISA), which was used by Okosieme et al.
Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules
Published in International Journal of Hyperthermia, 2018
R. Cesareo, A. M. Naciu, M. Iozzino, V. Pasqualini, C. Simeoni, A. Casini, G. Campagna, S. Manfrini, G. Tabacco, A. Palermo
Minimally invasive hyperthermic techniques are increasingly used in daily clinical practice for percutaneous debulking of benign thyroid nodules. These techniques offer several advantages when compared with surgery: they are low-cost outpatient procedures, do not result in cervical scarring or loss of thyroid function and are nearly completely devoid of the risk of permanent complications. Our study shows that nodule size may be a significant predictive factor of the efficacy of RFA for treating AFTNs. In particular, we demonstrate that a single RFA session is effective in restoring euthyroidism in patients with AFTN, mainly in those patients with small nodules. Nodule volume appears to be a significant predictive factor of the efficacy of RFA in treating AFTN. The possibility of having another therapeutic option for the treatment of this disease, even if limited to functioning small nodules, could be a part of the present trend in managing nodular thyroid goitre, which suggests a customised therapeutic approach.