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Multinodular Goiter

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101. Bilateral subtotal thyroidectomy versus hemithyroidectomy plus subtotal resection (Dunhill procedure) for benign goiter: long-term results of a prospective, randomized study. (Abstract)

Bilateral subtotal thyroidectomy versus hemithyroidectomy plus subtotal resection (Dunhill procedure) for benign goiter: long-term results of a prospective, randomized study. Two recent meta-analyses of mostly retrospective studies have shown high recurrence rates following subtotal resection of bilateral multinodular goiter. Therefore, many endocrine centers have changed their operative procedures in favor of thyroidectomy. Consequently, the rate of complications, especially hypoparathyroidism (...) , has increased. Hemithyroidectomy plus subtotal resection (Dunhill operation) overcomes some disadvantages of bilateral subtotal resection (BST). We performed a prospective, randomized trial to compare the Dunhill operation (DO) and BST for benign goiters.Between October 1994 and March 1997, a total of 200 consecutive patients were randomized into two study groups. Primary outcome measure was the incidence of recurrent goiter. Secondary outcome measures were incidence of recurrent nerve palsy

2013 World Journal of Surgery Controlled trial quality: uncertain

102. Horner's syndrome following a subtotal thyroidectomy for a benign nodular goitre Full Text available with Trip Pro

Horner's syndrome following a subtotal thyroidectomy for a benign nodular goitre We present a case of Horner's syndrome occurring as a complication of thyroidectomy. A 42-year-old female patient presented with eyelid drop which developed immediately after thyroidectomy for goitre. Ophthalmic examination revealed eyelid ptosis, miosis and anhidrosis. Preoperative ultrasonography showed multiple isohyperechogenic solid nodules in each lobe, consistent with multinodular goitre. Therefore (...) , the patient underwent subtotal thyroidectomy. The ophthalmic findings did not improve at the end of 6 months follow-up. Similar cases have been reported related to neck tumours or their surgery, mediastinum-located goitre and retropharyngeal abscess surgeries, but not after benign nodular goitre surgery. Several possible mechanisms have been proposed to explain this phenomenon; anatomical variations making the patient susceptible to damage to the sympathetic chain seem to be most likely in our patient.

2013 BMJ case reports

103. Selection of appropriate size endotracheal tube in cases of large goiters causing tracheal compression Full Text available with Trip Pro

Selection of appropriate size endotracheal tube in cases of large goiters causing tracheal compression Tracheal compression due to any cause can lead to difficulty in either ventilating or intubating the patient. Most often, it is due to a large thyroid swelling. Often the anesthetist is completely guided by the radiological findings to plan the airway management, giving much less importance to the patient's clinical picture. We report two cases of large multinodular goiter that caused tracheal

2012 Anesthesia, essays and researches

104. Toxic Nodular Goiter and Cancer: A Compelling Case for Thyroidectomy. (Abstract)

), and rates were not significantly different between institutions. A significantly greater cancer rate was noted in toxic multinodular goiter versus single toxic nodule patients (21 vs. 4.5 %, P < 0.05). Mean tumor size was 0.71 cm (range 0.1-1.5 cm; 23 % ≥1 cm). Most patients underwent total or near-total thyroidectomy. There were no significant differences in tumor sizes among institutions (P > 0.05). No significant cancer association was noted with age, preoperative dominant nodule size, lymphocytic (...) Toxic Nodular Goiter and Cancer: A Compelling Case for Thyroidectomy. Recent American Thyroid Association guidelines call for thyroidectomy or (131)I (Recommendation 31) in managing hyperthyroidism due to toxic nodular goiter (TNG). Concern for concomitant malignancy favors surgery. A 3 % thyroid cancer incidence in TNG patients has been reported, yet recent studies suggest this rate is underestimated. This multi-institutional study examined cancer incidence in TNG patients referred

2012 Annals of Surgical Oncology

105. NON-TOXIC GOITER TREATMENT WITH I-TRIIODOTHYRONINE AND I-THYROXINE Full Text available with Trip Pro

NON-TOXIC GOITER TREATMENT WITH I-TRIIODOTHYRONINE AND I-THYROXINE Twenty-one patients with goiters-four diffuse and 17 nodular-were treated with I-triiodothyronine and I-thyroxine in doses to tolerance. The four diffuse goiters were barely palpable at the end of the treatment. The average dose of I-triiodothyronine required was 100 mcg. per day. The average dose of I-thyroxine was 0.3 mg. per day. Of the 17 multinodular goiters, 11 showed at least a 50 per cent reduction in size. The average (...) dose of I-triiodothyronine used was 125 mcg. In six cases the gland did not change in size; in three of the six the lesion was diagnosed, at operation, as microfollicular and macrofollicular colloid goiter. Hypermetabolic symptoms may occur when doses of 100 mcg. or more of I-triiodothyronine are used. Results indicated that suppressive therapy with thyroid hormone to tolerance is effective in diffuse goiters. It is only partially effective in the treatment of multinodular goiters. In the cases

1963 California Medicine

106. Variants Near FOXE1 Are Associated with Hypothyroidism and Other Thyroid Conditions: Using Electronic Medical Records for Genome- and Phenome-wide Studies. Full Text available with Trip Pro

(OR = 0.60, p = 5.7 × 10(-6)). A phenome-wide association study (PheWAS) that was performed on this locus with 13,617 individuals and more than 200,000 patient-years of billing data identified associations with additional phenotypes: thyroiditis (OR = 0.58, p = 1.4 × 10(-5)), nodular (OR = 0.76, p = 3.1 × 10(-5)) and multinodular (OR = 0.69, p = 3.9 × 10(-5)) goiters, and thyrotoxicosis (OR = 0.76, p = 1.5 × 10(-3)), but not Graves disease (OR = 1.03, p = 0.82). Thyroid cancer, previously associated (...) Variants Near FOXE1 Are Associated with Hypothyroidism and Other Thyroid Conditions: Using Electronic Medical Records for Genome- and Phenome-wide Studies. We repurposed existing genotypes in DNA biobanks across the Electronic Medical Records and Genomics network to perform a genome-wide association study for primary hypothyroidism, the most common thyroid disease. Electronic selection algorithms incorporating billing codes, laboratory values, text queries, and medication records identified

2011 American Journal of Human Genetics

107. Increase of Circulating CXCL9 and CXCL11 Associated with Euthyroid or Subclinically Hypothyroid Autoimmune Thyroiditis. Full Text available with Trip Pro

Increase of Circulating CXCL9 and CXCL11 Associated with Euthyroid or Subclinically Hypothyroid Autoimmune Thyroiditis. Recently, CXCL9 and CXCL11 have been shown to be involved in autoimmune thyroid disorders; however, no data are present about CXCL9 and CXCL11 circulating levels in thyroid autoimmunity.Our objective was to evaluate circulating CXCL9 and CXCL11 in autoimmune thyroiditis (AIT). DESIGN AND PATIENTS OR OTHER PARTICIPANTS: Serum CXCL9 and CXCL11 have been measured in 141 (...) consecutive patients with newly diagnosed AIT (AIT-p), 70 euthyroid controls, and 35 patients with nontoxic multinodular thyroid. The three groups were similar in gender distribution and age; among the AIT-p, 26% had subclinical hypothyroidism.Serum CXCL9 and CXCL11 levels were significantly (P < 0.0001 for both) higher in AIT-p (143 ± 164 and 121 ± 63 pg/ml, respectively) than in controls (68 ± 37 and 65 ± 19 pg/ml, respectively) or patients with multinodular thyroid (87 ± 43 and 71 ± 20 pg/ml

2011 Journal of Clinical Endocrinology and Metabolism

108. Subtotal Versus Total Thyroidectomy for Benign Goiter

bilateral thyroid disease. Condition or disease Intervention/treatment Phase Goiter Procedure: thyroid resection Not Applicable Detailed Description: The extent of thyroid resection in bilateral multinodular non-toxic goiter remains controversial. Surgeons still continue to debate whether the potential benefits of total thyroidectomy outweigh the potential complications. Most low-volume surgeons avoid to perform total thyroidectomy owing to the possible complications such as permanent recurrent (...) laryngeal nerve palsy and permanent hypoparathyroidism. On the other hand, the increasing number of total thyroidectomies are currently performed in high-volume endocrine surgery units, and the indication for this procedure include thyroid cancer, Graves disease and multinodular goiter. Recently there has been increasing acceptance for performing total thyroidectomy for bilateral multinodular non-toxic goiter as it removes the disease process completely, lowers local recurrence rate and avoids

2011 Clinical Trials

109. Tracheal laceration after laser ablation of nodular goitre Full Text available with Trip Pro

Tracheal laceration after laser ablation of nodular goitre A tracheal perforation was discovered after Nd-YAG laser thermal ablation (LTA) of a thyroid nodule. The LTA is a relatively new method of treatment of thyroid nodules, which consists of delivering laser energy into the thyroid by means of two optical fibres. The patient presented with a multinodular goitre and initially refused surgery, then underwent an LTA of a thyroid nodule. Fifty days after the procedure she started to have (...) symptoms related to a tracheal stenosis and, after tracheoscopy, a tracheal perforation was diagnosed and she underwent a total thyroidectomy plus tracheal repair. The results of the histological examination revealed a goitre with a focal area of papillary carcinoma. This particular complication is likely the first of its kind to be described after the LTA of a thyroid nodule.

2011 Interactive cardiovascular and thoracic surgery

110. Terminal ligature of inferior thyroid artery branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels. (Abstract)

Terminal ligature of inferior thyroid artery branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels. To evaluate the impact of truncal versus terminal branch ligature of the inferior thyroid artery (ITA) on postoperative calcium and PTH plasma levels in patients undergoing total thyroidectomy for multinodular goiter.A prospective randomized study was performed comparing a group of patients that underwent either truncal ligature (...) of the ITA (group 1) or terminal ligature of ITA branches (group 2).A series of 126 consecutive patients with non-toxic euthyroid multinodular goiter underwent total thyroidectomy. Truncal ligature of the ITA was performed in 63 patients (group 1) and terminal branch ITA ligature in 63 patients (group 2). Postoperative ionized serum calcium (mmol/L) at 24 hours was significantly lower in group 1 than in group 2 patients (1.22 ± 0.06 vs. 1.25 ± 0.05, P<0.05) and at 48 hours (1.20 ± 0.05 vs. 1.23 ± 0.05, P

2010 Journal of visceral surgery Controlled trial quality: uncertain

111. Five-year follow-up of a randomized clinical trial of total thyroidectomy versus Dunhill operation versus bilateral subtotal thyroidectomy for multinodular nontoxic goiter. (Abstract)

Five-year follow-up of a randomized clinical trial of total thyroidectomy versus Dunhill operation versus bilateral subtotal thyroidectomy for multinodular nontoxic goiter. The extent of thyroid resection in multinodular nontoxic goiter (MNG) is controversial. The aim of the present study was to evaluate results of various thyroid resection modes, with special emphasis put on the recurrence rate and morbidity rate, in a 5-year follow-up.From 01/2000 through 12/2003, 600 consenting patients (...) with MNG qualified for thyroidectomy at our institution were randomized to three groups equal in size, n = 200 in each. Patients in group A underwent total thyroidectomy (TT); patients in group B underwent Dunhill operation (DO), whereas patients in group C underwent bilateral subtotal thyroidectomy (BST). All patients were subjected to ultrasonographic, cytological, and biochemical follow-up at least for 60 months postoperatively. The primary outcome measure was prevalence of recurrent goiter and need

2010 World Journal of Surgery Controlled trial quality: uncertain

112. Radioiodine plus recombinant human thyrotropin do not cause acute airway compression and are effective in reducing multinodular goiter. (Abstract)

Radioiodine plus recombinant human thyrotropin do not cause acute airway compression and are effective in reducing multinodular goiter. Recombinant human thyrotropin (rhTSH) reduces the activity of radioiodine required to treat multinodular goiter (MNG), but acute airway compression can be a life-threatening complication. In this prospective, randomized, double-blind, placebo-controlled study, we assessed the efficacy and safety (including airway compression) of different doses of rhTSH (...) months, 7 patients were hypothyroid (N = 3 in group I and N = 2 in groups II and III). rhTSH plus a 1.11-GBq fixed 131I activity did not cause acute or chronic changes in TCA. After 6 and 12 months, TV reduction was more pronounced among patients treated with rhTSH plus 131I.

2010 Brazilian journal of medical and biological research = Revista brasileira de pesquisas médicas e biológicas / Sociedade Brasileira de Biofísica ... [et al.] Controlled trial quality: predicted high

113. Mutations of GNAS and TSHR genes in subclinical toxic multinodular goiter. (Abstract)

Mutations of GNAS and TSHR genes in subclinical toxic multinodular goiter. This study aimed to detect the mutations of the GNAS and TSHR genes in subclinical toxic multinodular goiter (sTMG) and to evaluate the relationship between these mutations and sTMG.Forty-four patients with sTMG and 20 matched controls (multinodular goiter) were recruited into this study. All of the patients underwent subtotal thyroidectomy. Gene mutations were analyzed by direct DNA sequencing of the polymerase chain

2010 Rhinology and Laryngology

114. High-intensity focused ultrasound for symptomatic benign thyroid nodules

be a single thyroid nodule (solitary nodule) or multiple thyroid nodules (multinodular goitre). Some thyroid nodules produce thyroxine or triiodothyronine and cause thyrotoxicosis. These are called hyperfunctioning or toxic thyroid nodules. Current treatments 2.2 Treatment of benign thyroid nodules may be needed if they cause symptoms or cosmetic problems. Conventional treatment includes surgery. Other less invasive approaches than surgery include ethanol ablation, percutaneous laser ablation

2019 National Institute for Health and Clinical Excellence - Interventional Procedures

115. Thyroid disease: assessment and management

and monitoring subclinical hypothyroidism 36 T ests for people with confirmed thyrotoxicosis 38 Initial management in primary/non-specialist care for people with thyrotoxicosis 39 Treatment for adults with Graves' disease 40 Thyroid disease: assessment and management (NG145) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 53Treatment for adults with toxic nodular goitre 42 Treatment for children and young people (...) of different treatment options on new and existing thyroid eye disease (for example, radioactive iodine may precipitate or worsen thyroid eye disease) the need for thyroid hormone replacement if treatment leads to life-long hypothyroidism. Th Thyroid enlargement (also known as goitre yroid enlargement (also known as goitre) ) 1.1.6 Provide people with thyroid enlargement, and their family or carers if appropriate, with written and verbal information on: the causes of thyroid enlargement, including the fact

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

116. Assessment of thyroid mass

observing known microcarcinomas is to use restraint in biopsying lesions less than 1 cm in diameter. Differentials Colloid nodule Thyroid adenoma or hyperplastic nodule, single (solid or complex) Non-toxic multinodular goitre Differentiated thyroid cancer (papillary, follicular) Toxic adenoma, single Toxic multinodular goitre Medullary thyroid cancer Anaplastic thyroid cancer Lymphoma Simple epithelial-lined thyroid cyst Thyroglossal duct cyst Acute suppurative thyroiditis Subacute granulomatous

2019 BMJ Best Practice

117. Overview of thyroid dysfunction

for hypothyroidism (primary) is undertaken, this is generally done with detection of an elevated TSH. Further testing (e.g, radioactive iodine uptake) may be used subsequently to clarify aetiologies in some cases. Graves' disease is an autoimmune thyroid disease and is the most common form of hyperthyroidism in most areas of the world. Hyperthyroidism is caused by stimulatory TSH receptor antibodies (TRAb). The combination of a diffuse goitre, recent onset of orbitopathy, and symptoms of hyperthyroidism (...) is diagnostic of Graves' disease. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-1421. https://www.liebertpub.com/doi/full/10.1089/thy.2016.0229 http://www.ncbi.nlm.nih.gov/pubmed/27521067?tool=bestpractice.com In questionable cases, measurement of TRAb is used as a diagnostic test. A toxic multinodular goitre (MNG) contains multiple autonomously functioning

2018 BMJ Best Practice

118. Overview of thyroid dysfunction

for hypothyroidism (primary) is undertaken, this is generally done with detection of an elevated TSH. Further testing (e.g, radioactive iodine uptake) may be used subsequently to clarify aetiologies in some cases. Graves' disease is an autoimmune thyroid disease and is the most common form of hyperthyroidism in most areas of the world. Hyperthyroidism is caused by stimulatory TSH receptor antibodies (TRAb). The combination of a diffuse goitre, recent onset of orbitopathy, and symptoms of hyperthyroidism (...) is diagnostic of Graves' disease. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-1421. https://www.liebertpub.com/doi/full/10.1089/thy.2016.0229 http://www.ncbi.nlm.nih.gov/pubmed/27521067?tool=bestpractice.com In questionable cases, measurement of TRAb is used as a diagnostic test. A toxic multinodular goitre (MNG) contains multiple autonomously functioning

2018 BMJ Best Practice

119. Assessment of thyroid mass

observing known microcarcinomas is to use restraint in biopsying lesions less than 1 cm in diameter. Differentials Colloid nodule Thyroid adenoma or hyperplastic nodule, single (solid or complex) Non-toxic multinodular goitre Differentiated thyroid cancer (papillary, follicular) Toxic adenoma, single Toxic multinodular goitre Medullary thyroid cancer Anaplastic thyroid cancer Lymphoma Simple epithelial-lined thyroid cyst Thyroglossal duct cyst Acute suppurative thyroiditis Subacute granulomatous

2018 BMJ Best Practice

120. Recommendation on screening adults for asymptomatic thyroid dysfunction in primary care

(e.g., Hashimoto thyroiditis) or occurs as a sequela of hyperthyroidism treatment, which can render the thyroid gland nonfunctional. Hyperthyroidism results from an overproduction of thyroid hormone, leading to the suppression of TSH. Causes of hyperthyroidism include Graves disease, toxic multinodular goitre and toxic adenoma. Signs and symptoms of thyroid dysfunction are variable between patients and often nonspecific. For hypothyroidism, symptoms may include tiredness, sensitivity to cold, dry (...) in asymptomatic nonpregnant adults is not likely to confer clinical benefit, but could lead to unnecessary treatment for some patients and consume resources. Treating asymptomatic adults for screen-detected hypothyroidism may result in little to no difference in clinical outcomes. Clinicians should remain alert to signs and symptoms suggestive of thyroid dysfunction and investigate accordingly. This guideline from the Canadian Task Force on Preventive Health Care focuses on screening for thyroid dysfunction

2019 Canadian Task Force on Preventive Health Care

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