General Thermography
James Stewart Campbell, M. Nathaniel Mead in Human Medical Thermography, 2023
Goiter refers to a swelling of the neck caused by enlargement of the thyroid gland. Whether the swelling will appear warm via thermography depends on the underlying etiology.137 Hyperthyroid goiter appears diffusely warm, while hypothyroid goiter often shows a cool gland area. Hashimoto's thyroiditis may have variable thermal findings depending on the state of the disease process – active or quiescent. Graves' disease is characterized by a diffusely hyper-vascularized thyroid, showing high yet variable temperatures over the gland.138 Thermography also offers an assessment tool for patients with active thyroid eye disease (TED), with good accuracy and specificity.139 TED patients with active ophthalmopathy showed orbital temperatures around 3°C (5.4°F) higher than normal, and had eyelid temperatures above 37°C (98.6°F).140 More severe cases of TED may present with systemic fever of unknown origin.141
Thyroid nodules and multinodular goiter
David S. Cooper, Jennifer A. Sipos in Medical Management of Thyroid Disease, 2018
The incidence of goiter, either due to iodine deficiency or environmental goitrogens, varies with the geographic region examined. Iodine deficiency is the most common worldwide etiology of goiter. Denmark, a region marked by mild to moderate iodine-deficiency, has a goiter prevalence of 15 to 23% (6). In contrast, in Great Britain, an area with adequate iodine intake, nonendemic or sporadic goiter affects 5% of the adult population (7). Iodine deficiency had been a frequent cause of goiter in the United States in the early 20th century, but with the iodinization of salt, the incidence of goiter decreased. There has been a concern that a re-emergence of iodine deficiency goiter would occur with the declining American dietary iodine intake; results from the NHANES I (1971–1974) and NHANES III (1988–1994) studies showed a decrease in median urinary iodine concentration from 320 mcg/L to 145 mcg/L. More recently, however, the levels have stabilized with a median urinary iodine concentration of 168 mcg/L and 164 mcg/L in the NHANES 2001–2002 and 2007–2008 evaluations, respectively (8). Although from a public health point of view, the median iodine intake of adults is adequate compared to the recommended intake of 150 mcg/day by the WHO, a significant proportion of the population will have a mildly insufficient iodine intake, which may contribute to goiter and nodule formation.
Defects in Tg Gene Expression and Tg Secretion
Geraldo Medeiros-Neto, John Bruton Stanbury in Inherited Disorders of the Thyroid System, 2019
Baas et al.130 examined chromosomal DNA prepared from members of three families in whom a defect in the synthesis or structure of Tg was detected. The DNA was digested with 15 different endonu-cleases and only one restriction fragment length polymorphism (RFLP) of the Tg gene was found, with loss of a Hindlll site due to a single base pair substitution, that caused a small insertion resulting in a new fragment which was 0.5 kb longer. An autosomal dominant mode of inheritance was claimed for this defect. In another study Targovnik et al.131 examined genomic DNA from several patients with congenital goiter and impaired Tg synthesis. The DNA was restricted with different endonucleases and no gross gene deletion of coding sequences in the Tg gene was found. These studies were recently confirmed by Lacka et al.,114 who were unable to find genetic linkage with the detected RFLPs and the phenotype abnormalities of the goitrous subjects. An increased level of Tg mRNA was found by Monticelli et al.132 in the thyroid glands of two patients with familial goiter. The increased levels of Tg mRNA may have resulted from chronic TSH stimulation by endogenous TSH.
Anatomy and motor function of extra-laryngeal branching patterns of the recurrent laryngeal nerve; an electrophysiological study of 1001 nerves at risk
Published in Acta Chirurgica Belgica, 2023
This prospective study on the surgical anatomy of the RLN was conducted by consecutively including all patients who underwent primary thyroid surgery between January 2013 and December 2020. The study was approved by the Institutional Review Board, and informed consent was given by patients prior to intervention. We excluded cases of recurrent goiter with secondary thyroid surgery. The primary outcome was the presence and branching location of ETB of the RLN in relation with the ITA, the secondary outcome was the presence motor nerve fibers of all branches, measured by IONM during surgery. The presence of terminal branches of the nerve was macroscopically observed and recorded. The location of division point along the cervical course of the RLN was determined and classified according to the point of intersection between the RLN and the ITA.
Insulin resistance is associated with larger thyroid volume in adults with type 1 diabetes independently from presence of thyroid autoimmunity
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2018
Anita Rogowicz-Frontczak, Stanislaw Pilacinski, Anna Teresa Chwialkowska, Dariusz Naskret, Dorota Zozulinska-Ziolkiewicz
This study is the first description of the increased thyroid volume in subjects with T1DM with insulin resistance. Possible limitations of this study include relatively small sample size and insufficient control of all factors that may affect thyroid volume. Thyroid volume has been associated with multiple factors such as age, gender, BMI, body surface, iodine supply and deficiency, TSH level, smoking and genetic factors [36]. Iodine remains the major environmental risk factor of goiter. The people who were recruited to our study come from the western region of Poland. This region has had iodized salt since 1989 (not obligatory) and obligatory since 1997. Proper iodine supply in this region has been confirmed by the measurement of iodine concentration in the urine since then. Our research population is relatively young with a median age of 29 years, which minimizes the effects of iodine [37]. Genetic factors and a number of non-iodine factors play a role in the etiology of goiter. Among the non-genetic factors, environmental pollutants, selenium deficiency and tobacco smoking can also be considered [36]. In addition, we cannot observe the correlation between nodular goiter and IR in a relatively young T1DM population as the higher incidence of thyroid nodules is observed in the older population (over 40 years) [38].
Hemodynamic Instability during Thyroidectomy in Graves’ Disease
Published in Journal of Investigative Surgery, 2022
Sami Acar, Candas Ercetin, Nuri Alper Sahbaz, Fırat Tutal, Yunus Yapalak, Fulya Cosan, Yesim Erbil
The patients were analyzed for their demographics, duration of the disease (period of medical treatment), history of smoking, presence of ophthalmopathy, choice of medication, preoperative need for plasmapheresis or use of Lugol’s iodine solution, weight of the resected specimen, TRAb values, type of surgery, and hemodynamic instability patterns. The patients were diagnosed with goiter disease by evaluating palpable diffuse goiter on physical examination, clinical signs of thyrotoxicosis, laboratory results, and results of diffuse radioactive iodine uptake in thyroid tissue on scintigraphy. The included patients also had at least one of the following conditions: ophthalmopathy in a physical examination, antithyroglobulin (antiTg) antibodies, TRAb, and/or positive anti-thyroid peroxidase (antiTPO) in blood tests.
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