Thyroid and Parathyroid Gland Pathology
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
Papillary thyroid carcinoma (PTC) is a malignant epithelial tumour showing follicular cell differentiation with characteristic nuclear features. It accounts for approximately 80% of all thyroid cancer and is also the commonest paediatric thyroid malignancy. In adults it typically occurs between the ages of 20 and 50 years with a female preponderance with less pronounced gender bias in patients over 50 years old. It normally carries an excellent prognosis, especially in younger patients. In areas of adequate dietary iodine, papillary thyroid carcinoma usually presents as a solitary thyroid nodule. In regions of iodine insufficiency multinodular goitre is common and papillary thyroid carcinoma can present as a more prominent or distinctive nodule. It has a propensity for lymphatogenous spread, initially to locoregional lymph nodes.
Endocrine Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
What are the causes of a multinodular goitre?Most MNGs are due to enlargement of a simple goitre, which develops due to TSH stimulation secondary to low levels of thyroid hormones. Iodine deficiency causes an endemic simple goitre, which appears in childhood and evolves into a colloid goitre at a later stage.The increased demand for thyroid hormone in pregnancy and puberty causes enlargement of a goitre.Dietary goitrous agents in brassica vegetables, lithium and carbimazole also induce goitres.Rare hereditary congenital defects in thyroid metabolism also cause goitres.Sporadic MNG can occur, commonly affecting middle-aged women.Previous radiotherapy to the neck (e.g. lymphoma) can also cause goitres.
The thyroid gland
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Although the nodular stage of simple goitre is irreversible, more than half of benign nodules will regress in size over 10 years. Most patients with multinodular goitre are asymptomatic and do not require operation. Surgery is indicated for nodular goitres with features of underlying malignancy, for swallowing symptoms if other causes have been excluded or for cosmetic reasons if the patient finds the goitre unsightly. If the goitre is causing tracheal compression then surgery should be considered. Many such patients are found incidentally and are asymptomatic and often very elderly. As these goitres often grow very slowly the risks and benefits of surgery should be considered carefully, particularly if a sternal split may be required for access.
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.
Substernal goiter excision in a Jehovah’s Witness
Published in Baylor University Medical Center Proceedings, 2020
Omar Kholaki, Todd R. Wentland, Roderick Y. Kim
Over 1 month, her hemoglobin improved from 10.8 g/dL to 11.8 g/dL and she was subsequently taken to the operating room for a left hemithyroidectomy. She was positioned in a reverse Trendelenburg tilt, along with a generous shoulder roll. An anterior cervical neck incision was made to expose the thyroid and provide access to surrounding structures. The strap muscles were then divided using ultrasonic cautery. We performed a superior-to-inferior approach completing dissection and ligation of the superior, middle, and inferior poles. Two negative pressure drains were placed prior to skin closure. The final specimen was an 11.0 × 6.5 × 4.5 cm multinodular goiter with no evidence of malignancy. Postoperatively, her hemoglobin level was 10.5 g/dL and she had an uneventful recovery with no hypocalcemia, dysphonia, or dysphagia. Her preoperative globus sensation and dyspnea resolved completely.
Thermal ablation for benign, non-functioning thyroid nodules: A clinical review focused on outcomes, technical remarks, and comparisons with surgery
Published in Electromagnetic Biology and Medicine, 2020
Roberto Negro, Pierpaolo Trimboli
Thyroid nodules are common disease in endocrine practice, with a prevalence at ultrasound examination of up to 50% in adult females and 30% in males (Hegedüs 2004). Most patients are euthyroid, in that their nodules are asymptomatic and cytologically benign, and do not require any treatment (Hegedüs 2004). In many cases, benign nodules have stable dimensions or grow slowly over the time, such that they can be safely followed at 2–3 year intervals (Durante et al. 2015; Negro 2014). However, a non-negligible number of nodules exhibit progressive growth, wherein patients experience pressure symptoms and/or complain of cosmetic concern. More rarely, and especially in the older population, nodules are characterized by autonomous function and cause subclinical or overt hyperthyroidism (Hamburger 1980). The presence of a single large nodule, or a dominant nodule within a multinodular goiter is a frequent reason for referral of patients for surgery; such interventions exhibit a negative histology in ¾ of patients in Europe and the United States (Mathonnet et al. 2017; Sun et al. 2013).
Related Knowledge Centers
- Benign Tumor
- Hyperthyroidism
- Iodine Deficiency
- Palpitations
- Tachycardia
- Thyroid
- Neck
- Cancer
- Throat
- Hypothyroidism