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Laszlo Hegedüs - One of the best experts on this subject based on the ideXlab platform.
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thyroidectomy improves tracheal anatomy and airflow in patients with Nodular Goiter a prospective cohort study
European thyroid journal, 2017Co-Authors: Jesper Roed Sorensen, Steen Joop Bonnema, Laszlo Hegedüs, Jeppe Killerich Lauridsen, Helle Dossing, Nina N T T Nguyen, Christian GodballeAbstract:Objective: A large Goiter may cause compression of the trachea. The aim of this study was to investigate the impact of thyroidectomy on tracheal anatomy and airflow and to correlate this with changes in health-related quality of life (HRQoL) in patients with benign Nodular Goiter. Methods: Magnetic resonance images of the neck and respiratory flow-volume curves, including both inspiration and expiration, were performed prior to and 6 months following surgery. HRQoL was measured by selected scales from the thyroid-specific patient-reported outcome (ThyPRO). Cohen’s effect size (ES) was calculated as mean change divided by standard deviation at baseline. ES of 0.2–0.5 were defined as small, 0.5–0.8 as moderate, and values >0.8 as large. Results: Sixty-five patients completed all examinations. Median Goiter volume was 58 mL (range, 14–642 mL) before surgery with surgical removal of a median of 43 g (range, 8–607 g). Six months after surgery, tracheal narrowing and deviation were diminished by a median of 26% (ES = 0.67, p < 0.001) and 33% (ES = 0.61, p < 0.001), respectively. Correspondingly, each 10% decrease in Goiter volume resulted in 1.0% less tracheal narrowing (p < 0.001). Concomitantly, a small improvement was seen in forced inspiratory flow at 50% of forced vital capacity (ES = 0.32, p < 0.001). A reduction in tracheal narrowing was associated with improvements in the Impaired Daily Life scale (0.33 points per 1% decrease in tracheal narrowing, p = 0.03) of the ThyPRO questionnaire. Conclusions: In patients with symptomatic benign Nodular Goiter, thyroidectomy resulted in substantial improvements in tracheal anatomy and improvements in inspiratory flow, which were followed by gains in HRQoL. This information is pertinent when counseling patients before choice of treatment.
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Quality-of-Life Impairments Persist Six Months After Treatment of Graves' Hyperthyroidism and Toxic Nodular Goiter: A Prospective Cohort Study
Thyroid : official journal of the American Thyroid Association, 2016Co-Authors: Per Cramon, Kristian Hillert Winther, Torquil Watt, Steen Joop Bonnema, Jakob B. Bjorner, Ola Ekholm, Mogens Groenvold, Laszlo Hegedüs, Ulla Feldt-rasmussen, Åse Krogh RasmussenAbstract:Background: The treatment of hyperthyroidism is aimed at improving health-related quality of life (HRQoL) and reducing morbidity and mortality. However, few studies have used validated questionnaires to assess HRQoL prospectively in such patients. The purpose of this study was to assess the impact of hyperthyroidism and its treatment on HRQoL using validated disease-specific and generic questionnaires. Methods: This prospective cohort study enrolled 88 patients with Graves' hyperthyroidism and 68 with toxic Nodular Goiter from endocrine outpatient clinics at two Danish university hospitals. The patients were treated with antithyroid drugs, radioactive iodine, or surgery. Disease-specific and generic HRQoL were assessed using the thyroid-related patient-reported outcome (ThyPRO) and the Medical Outcomes Study 36-item Short Form (SF-36), respectively, evaluated at baseline and six-month follow-up. The scores were compared with those from two general population samples who completed ThyPRO (n = 739) and SF-3...
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Graves' Disease and Toxic Nodular Goiter Are Both Associated with Increased Mortality But Differ with Respect to the Cause of Death: A Danish Population-Based Register Study
Thyroid : official journal of the American Thyroid Association, 2013Co-Authors: Frans Brandt, Laszlo Hegedüs, Marianne Thvilum, Dorthe Almind, Kaare Christensen, Anders Green, Thomas Heiberg BrixAbstract:Background: Hyperthyroidism has been associated with increased all-cause mortality. Whether the underlying cause of hyperthyroidism influences this association is unclear. Our objectives were to explore whether mortality risk and cause of death differ between Graves' disease (GD) and toxic Nodular Goiter (TNG). Methods: This is an observational cohort study, using record-linkage data from nationwide Danish health registers. A total of 1291 subjects with GD and 861 with TNG, treated in a hospital setting, were identified and followed for a mean period of 11 years. Cases were matched 1:4 with nonhyperthyroid controls with respect to age and sex. The hazard ratio (HR) for mortality was calculated using Cox regression analyses. All analyses were adjusted for comorbidity using the Charlson score. Results: Both GD (HR=1.42 [95% confidence interval (CI) 1.25–1.60]) and TNG (HR=1.22 [CI 1.07–1.40]) were associated with increased all-cause mortality. After stratification for the cause of death, GD was associated w...
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serum thyroxine and age rather than thyroid volume and serum tsh are determinants of the thyroid radioiodine uptake in patients with Nodular Goiter
Journal of Endocrinological Investigation, 2011Co-Authors: Steen Joop Bonnema, Viveque Egsgaard Nielsen, Soren Fast, Henrik Boeljorgensen, Peter Grupe, Peter B Andersen, Laszlo HegedüsAbstract:Background: Radioiodine (131|) therapy is widely used for treatment of non-toxic Goiters. A limitation for this treatment is a low thyroid radioiodine uptake (RAIU), often encountered in these patients. Aim: To estimate the impact of various factors on the thyroid RAIU. Methods: We examined prospectively 170 patients (146 females; age range: 22–87 yrs) with Nodular Goiter (median 64 ml, range: 20–464 ml) selected for 131| therapy. Serum TSH was sub-normal in 42.4%. None were treated with anti-thyroid drugs. The thyroid RAIU was determined at 24h and 96h. The Goiter volume was measured by ultrasound (no.=127), or by magnetic resonance imaging (no.=43). Results: The 24h and the 96h RAIU were 34.2±9.8(SD)% (range: 11.4–66.0%) and 34.0±10.0% (range: 10.5–60.9%), respectively. Sixty-one patients had a 24h RAIU <30% and these individuals were older than patients with a 24h RAIU ≥30% (median 58 vs 51 yrs, p=0.02). These two subgroups did not differ significantly in other variables. Overall, the 24h RAIU was positively correlated to the serum (s) free T4-index (r=0.20, p=0.01), and negatively to age (r=−0.18, p=0.02), but not significantly related to serum TSH or thyroid volume. Age correlated positively with thyroid volume (r=0.31, p<0.001). In a regression analysis, s-free T4-index and age remained as the only determinants of the 24h and the 96h RAIU. Conclusions: In patients with a symptomatic Nodular Goiter, serum T4 and age are the major determinants of the thyroid RAIU. A sub-normal serum TSH is not a marker of a compromised thyroid RAIU but reflects that the iodine is confined to a few ‘hot spots’.
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recombinant human thyrotropin stimulated radioiodine therapy of Nodular Goiter allows major reduction of the radiation burden with retained efficacy
The Journal of Clinical Endocrinology and Metabolism, 2010Co-Authors: Soren Fast, Laszlo Hegedüs, Viveque Egsgaard Nielsen, Peter Grupe, Christa Bluhme, Lars Bastholt, Steen Joop BonnemaAbstract:Context and Objective: Stimulation with recombinant human TSH (rhTSH) before radioiodine (131I) therapy augments Goiter volume reduction (GVR). Observations indicate that rhTSH has a preconditioning effect beyond increasing thyroid 131I uptake. We test the hypothesis that an equivalent GVR might be obtained by an absorbed thyroid dose well below what has been used previously. Patients and Design: In a double-blinded setup, 90 patients (78 women; median age, 52 yr; range, 22–83) with a nontoxic Nodular Goiter (median size, 63 ml; range, 25–379 ml) were randomized to either 0.1 mg rhTSH (n = 60) followed by a thyroid dose of 50 Gy or placebo followed by 100 Gy (n = 30). Results: At 12 months, the mean relative GVR in the placebo and the rhTSH group was identical (35 ± 3%; P = 0.81). The median administered 131I-activity was 170 MBq (45–1269) in the rhTSH group and 559 MBq (245–3530) in the placebo group (70% reduction, P < 0.0001). According to the official radiation regulation, hospitalization was required...
Steen Joop Bonnema - One of the best experts on this subject based on the ideXlab platform.
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thyroidectomy improves tracheal anatomy and airflow in patients with Nodular Goiter a prospective cohort study
European thyroid journal, 2017Co-Authors: Jesper Roed Sorensen, Steen Joop Bonnema, Laszlo Hegedüs, Jeppe Killerich Lauridsen, Helle Dossing, Nina N T T Nguyen, Christian GodballeAbstract:Objective: A large Goiter may cause compression of the trachea. The aim of this study was to investigate the impact of thyroidectomy on tracheal anatomy and airflow and to correlate this with changes in health-related quality of life (HRQoL) in patients with benign Nodular Goiter. Methods: Magnetic resonance images of the neck and respiratory flow-volume curves, including both inspiration and expiration, were performed prior to and 6 months following surgery. HRQoL was measured by selected scales from the thyroid-specific patient-reported outcome (ThyPRO). Cohen’s effect size (ES) was calculated as mean change divided by standard deviation at baseline. ES of 0.2–0.5 were defined as small, 0.5–0.8 as moderate, and values >0.8 as large. Results: Sixty-five patients completed all examinations. Median Goiter volume was 58 mL (range, 14–642 mL) before surgery with surgical removal of a median of 43 g (range, 8–607 g). Six months after surgery, tracheal narrowing and deviation were diminished by a median of 26% (ES = 0.67, p < 0.001) and 33% (ES = 0.61, p < 0.001), respectively. Correspondingly, each 10% decrease in Goiter volume resulted in 1.0% less tracheal narrowing (p < 0.001). Concomitantly, a small improvement was seen in forced inspiratory flow at 50% of forced vital capacity (ES = 0.32, p < 0.001). A reduction in tracheal narrowing was associated with improvements in the Impaired Daily Life scale (0.33 points per 1% decrease in tracheal narrowing, p = 0.03) of the ThyPRO questionnaire. Conclusions: In patients with symptomatic benign Nodular Goiter, thyroidectomy resulted in substantial improvements in tracheal anatomy and improvements in inspiratory flow, which were followed by gains in HRQoL. This information is pertinent when counseling patients before choice of treatment.
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Quality-of-Life Impairments Persist Six Months After Treatment of Graves' Hyperthyroidism and Toxic Nodular Goiter: A Prospective Cohort Study
Thyroid : official journal of the American Thyroid Association, 2016Co-Authors: Per Cramon, Kristian Hillert Winther, Torquil Watt, Steen Joop Bonnema, Jakob B. Bjorner, Ola Ekholm, Mogens Groenvold, Laszlo Hegedüs, Ulla Feldt-rasmussen, Åse Krogh RasmussenAbstract:Background: The treatment of hyperthyroidism is aimed at improving health-related quality of life (HRQoL) and reducing morbidity and mortality. However, few studies have used validated questionnaires to assess HRQoL prospectively in such patients. The purpose of this study was to assess the impact of hyperthyroidism and its treatment on HRQoL using validated disease-specific and generic questionnaires. Methods: This prospective cohort study enrolled 88 patients with Graves' hyperthyroidism and 68 with toxic Nodular Goiter from endocrine outpatient clinics at two Danish university hospitals. The patients were treated with antithyroid drugs, radioactive iodine, or surgery. Disease-specific and generic HRQoL were assessed using the thyroid-related patient-reported outcome (ThyPRO) and the Medical Outcomes Study 36-item Short Form (SF-36), respectively, evaluated at baseline and six-month follow-up. The scores were compared with those from two general population samples who completed ThyPRO (n = 739) and SF-3...
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serum thyroxine and age rather than thyroid volume and serum tsh are determinants of the thyroid radioiodine uptake in patients with Nodular Goiter
Journal of Endocrinological Investigation, 2011Co-Authors: Steen Joop Bonnema, Viveque Egsgaard Nielsen, Soren Fast, Henrik Boeljorgensen, Peter Grupe, Peter B Andersen, Laszlo HegedüsAbstract:Background: Radioiodine (131|) therapy is widely used for treatment of non-toxic Goiters. A limitation for this treatment is a low thyroid radioiodine uptake (RAIU), often encountered in these patients. Aim: To estimate the impact of various factors on the thyroid RAIU. Methods: We examined prospectively 170 patients (146 females; age range: 22–87 yrs) with Nodular Goiter (median 64 ml, range: 20–464 ml) selected for 131| therapy. Serum TSH was sub-normal in 42.4%. None were treated with anti-thyroid drugs. The thyroid RAIU was determined at 24h and 96h. The Goiter volume was measured by ultrasound (no.=127), or by magnetic resonance imaging (no.=43). Results: The 24h and the 96h RAIU were 34.2±9.8(SD)% (range: 11.4–66.0%) and 34.0±10.0% (range: 10.5–60.9%), respectively. Sixty-one patients had a 24h RAIU <30% and these individuals were older than patients with a 24h RAIU ≥30% (median 58 vs 51 yrs, p=0.02). These two subgroups did not differ significantly in other variables. Overall, the 24h RAIU was positively correlated to the serum (s) free T4-index (r=0.20, p=0.01), and negatively to age (r=−0.18, p=0.02), but not significantly related to serum TSH or thyroid volume. Age correlated positively with thyroid volume (r=0.31, p<0.001). In a regression analysis, s-free T4-index and age remained as the only determinants of the 24h and the 96h RAIU. Conclusions: In patients with a symptomatic Nodular Goiter, serum T4 and age are the major determinants of the thyroid RAIU. A sub-normal serum TSH is not a marker of a compromised thyroid RAIU but reflects that the iodine is confined to a few ‘hot spots’.
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recombinant human thyrotropin stimulated radioiodine therapy of Nodular Goiter allows major reduction of the radiation burden with retained efficacy
The Journal of Clinical Endocrinology and Metabolism, 2010Co-Authors: Soren Fast, Laszlo Hegedüs, Viveque Egsgaard Nielsen, Peter Grupe, Christa Bluhme, Lars Bastholt, Steen Joop BonnemaAbstract:Context and Objective: Stimulation with recombinant human TSH (rhTSH) before radioiodine (131I) therapy augments Goiter volume reduction (GVR). Observations indicate that rhTSH has a preconditioning effect beyond increasing thyroid 131I uptake. We test the hypothesis that an equivalent GVR might be obtained by an absorbed thyroid dose well below what has been used previously. Patients and Design: In a double-blinded setup, 90 patients (78 women; median age, 52 yr; range, 22–83) with a nontoxic Nodular Goiter (median size, 63 ml; range, 25–379 ml) were randomized to either 0.1 mg rhTSH (n = 60) followed by a thyroid dose of 50 Gy or placebo followed by 100 Gy (n = 30). Results: At 12 months, the mean relative GVR in the placebo and the rhTSH group was identical (35 ± 3%; P = 0.81). The median administered 131I-activity was 170 MBq (45–1269) in the rhTSH group and 559 MBq (245–3530) in the placebo group (70% reduction, P < 0.0001). According to the official radiation regulation, hospitalization was required...
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transient Goiter enlargement after administration of 0 3 mg of recombinant human thyrotropin in patients with benign nontoxic Nodular Goiter a randomized double blind crossover trial
The Journal of Clinical Endocrinology and Metabolism, 2006Co-Authors: Viveque Egsgaard Nielsen, Steen Joop Bonnema, Laszlo HegedüsAbstract:Background: Recombinant human (rh) TSH, in doses from 0.01 to 0.9 mg, has been used to augment the effect of radioiodine (131I) therapy in patients with a benign nontoxic Nodular Goiter. Transient thyroid enlargement and thyrotoxicosis may be seen following 131I therapy. Aim: The aim of the study was to investigate whether rhTSH per se causes Goiter enlargement, until now an issue evaluated only in healthy nongoitrous subjects. Methods: In random order, 10 patients with nontoxic Nodular Goiter [mean 39.8 ± 20.5 (sd) ml] received either 0.3 mg rhTSH or isotonic saline in a double-blinded crossover design. Thyroid volume (by ultrasound) and function were closely monitored during the following 28 d. Results: Saline injection did not affect thyroid function or size. After rhTSH, median serum TSH increased from baseline 0.97 mU/liter (range 0.39–1.56) to 37.0 mU/liter (range 18.5–55.0) at 24 h (P < 0.01), with a subsequent decline to subnormal levels at d 7. Mean free T4 and free T3 increased significantly fro...
M E Peterson - One of the best experts on this subject based on the ideXlab platform.
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animal models of disease feline hyperthyroidism an animal model for toxic Nodular Goiter
Journal of Endocrinology, 2014Co-Authors: M E PetersonAbstract:Since first discovered just 35 years ago, the incidence of spontaneous feline hyperthyroidism has increased dramatically to the extent that it is now one of the most common disorders seen in middle-aged to senior domestic cats. Hyperthyroid cat Goiters contain single or multiple autonomously (i.e. TSH-independent) functioning and growing thyroid nodules. Thus, hyperthyroidism in cats is clinically and histologically similar to toxic Nodular Goiter in humans. The disease in cats is mechanistically different from Graves’ disease, because neither the hyperfunction nor growth of these nodules depends on extrathyroidal circulating stimulators. The basic lesion appears to be an excessive intrinsic growth capacity of some thyroid cells, butiodinedeficiency,othernutritionalgoitrogens,orenvironmentaldisruptorsmayplayarole in the disease pathogenesis. Clinical features offeline toxic Nodular Goiter include one or more palpable thyroid nodules, together with signs of hyperthyroidism (e.g. weight loss despite an increased appetite). Diagnosis offeline hyperthyroidism is confirmed by finding the increased serum concentrations of thyroxine and triiodothyronine, undetectable serum TSH concentrations, or increased thyroid uptake of radioiodine. Thyroid scintigraphy demonstrates a heterogeneous pattern of increased radionuclide uptake, most commonly into both thyroid lobes. Treatment options for toxic Nodular Goiter in cats are similar to that used in humans and include surgical thyroidectomy, radioiodine, and antithyroid drugs. Most authorities agree that ablative therapy with radioiodine is the treatment of choice for
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comments regarding subclinical hyperthyroidism in cats a spontaneous model of subclinical toxic Nodular Goiter in humans
Thyroid, 2008Co-Authors: Duncan C. Ferguson, Margarethe Hoenig, Elaine M. Kaptein, M E PetersonAbstract:We would like to comment on some of the points made by Wakeling et al. in their manuscript entitled ‘‘Subclinical Hyperthyroidism in Cats: A Spontaneous Model of Subclinical Toxic Nodular Goiter in Humans?’’ (1). The authors state: ‘‘The purpose of this study was to determine whether a relationship exists between TSH concentration and thyroid histopathology in biochemically euthyroid cats (as assessed by tT4 [serum total T4 concentration] thereby providing further evidence for the existence of subclinical hyperthyroidism in cats.’’ We certainly support the idea that the histopathological changes associated with spontaneous feline hyperthyroidism provide a model of toxic Nodular Goiter (Plummer’s disease), and have contributed to the literature in this regard (2–4). Undoubtedly, there is a prodromal period for this disease associated with clinically and biochemically undetectable hyperthyroidism. However, the authors of this manuscript have chosen a ‘‘healthy’’ population dominated by cats with chronic renal disease which we propose confounds the interpretation of their data. The concern rises from the observation in human patients with chronic kidney disease, both before as well as following kidney transplantation, that there is an increased frequency of Goiter and thyroid adenomas (as well as hypothyroidism, probably due to increased serum iodine levels). In one study (5) of patients with chronic renal disease, the incidence of abnormal thyroid structures (nodules or abnormal echogenicity on ultrasound) in patients before or chronically after transplantation was 63=70% with 13=17% having Goiter. The control group with normal renal function had 29%=16%, respectively. Despite the increased tendency for nodules, the thyroid volume was not significantly altered in the chronic kidney disease patients. A second concern is the reliance on the heterologous canine TSH assay to characterize thyroid hyperfunction in these cats. The commercially available canine TSH assay does detect gross elevations of TSH in the cat, such as during methimazole therapy. The assay has a sensitivity limit of 0.03 ng=mL that translates to about 0.1 ng=mL (very close to 1 mU=L) when corrected for 36% crossreactivity to recombinant feline TSH (6,7). Therefore, as was true for firstgeneration human TSH assays, on a case-by-case basis, a normal concentration cannot be reliably distinguished from an undetectable value. The authors quote from ‘‘unpublished data’’ (now published in reference 8) from 90 cats that the reference range for healthy senior cats is 7 years of age had detectable TSH. The authors note: ‘‘However, it is likely that not all cats with TSH <0.03 ng=mL have subclinical hyperthyroidism, particularly cats with severe concurrent illness and young cats.’’ Of the 59 cats for which there was histopathological data, 41 had chronic kidney disease and 13 were young cats. Therefore, 54=59 or 91.5% of the cases fit the categorization over which they raise concern. The authors continue: ‘‘In particular, it is known that kidney disease suppresses thyroid hormone production in cats and that the degree of suppression of tT4 is related to the severity of the concurrent disease (25).’’ As one of us was an author on this study (9), we would state that while the depression of serum total T4 concentration was observed, no measurement of thyroid hormone production per se was undertaken. The authors state that because creatinine was similar in the normal TSH and high TSH groups, and body weight and liver enzymes were similar, there were no differences in the populations. Aside from the effects of a chronic illness, uremia per se will be a major contributor to altering thyroid hormone metabolism, in part through alteration of serum T4 binding. No free T4 measurements were provided in the current study to evaluate this possibility, but the subsequent publication by the authors (8) supports this hypothesis in cats: the median free T4 concentration in the group with chronic kidney disease was only slightly higher than that of normal euthyroid population while the median total T4 concentration
Christopher R Mchenry - One of the best experts on this subject based on the ideXlab platform.
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thyroid cancer in patients with toxic Nodular Goiter is the incidence increasing
American Journal of Surgery, 2015Co-Authors: Kevin C Choong, Christopher R MchenryAbstract:Abstract Background There has been a dramatic increase in the incidence of thyroid cancer, but it is unclear if this has occurred in patients with toxic Nodular Goiter (TNG). Methods TNG was defined as one or more thyroid nodules in combination with a low serum TSH level. Patients who underwent thyroidectomy for TNG were identified from a prospectively maintained database. The rates of incidental thyroid cancer were compared over the intervals 1990 to 1999, 2000 to 2009, and 2010 to 2014. Results There was no significant difference in cancer rate between the 3 time periods. Overall, 7 (4.7%) of the 148 patients had thyroid cancer; similarly, 1 (3.2%) of the 31 patients from 1990 to 1999, 3 (4.2%) of 72 patients from 2000 to 2009, and 3 (6.7%) of the 45 patients from 2010 to 2014 ( P > .05) had thyroid cancer. Conclusions No significant increase in the rate of carcinoma was observed in patients with TNG. As a result, the risk benefit analysis should not change when considering therapeutic options for TNG.
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an investigation of epidemiologic factors associated with large Nodular Goiter
Journal of Surgical Research, 2006Co-Authors: Roy Phitayakorn, D M Super, Christopher R MchenryAbstract:Background. Sporadic Nodular Goiter is a common problem in the United States and significant compressive symptoms may occur with progression to a critical size. Methods. Potential epidemiological variables associated with the development of large unilateral (≥50 g) and bilateral (≥100 g) Nodular Goiter were investigated including: age, gender, race, body mass index (BMI), family history of thyroid disease, pregnancy at time of diagnosis, insurance status, and tobacco or alcohol use. Data were obtained from an IRB-approved thyroid database and retrospective chart review of consecutive patients operated on for Nodular Goiter from 1990 through 2005. A univariate and multivariate analysis of epidemiological variables in patients with "large" versus "small" Nodular Goiter was completed. Results. Of the 488 patients operated on for Nodular Goiter, 113 (23%) were classified as "large," 43 with unilateral (mean 106 ± 72 g) and 70 with bilateral enlargement (mean 173 ± 92 g) and 375 (77%) were classified as "small," 179 with unilateral (18 ± 10 g) and 196 with bilateral (37 ± 24 g) enlargement. Based on univariate analysis, African-American race, age ≥40 years, BMI ≥30 kg/m 2 , and lack of insurance were associated with an increased risk of large Nodular Goiter (P ≤ 0.001), whereas alcohol use was protective (P = 0.002). A multivariate analysis revealed that African-American race [adjusted odds ratio (adj. OR) 3.3, 95% CI = 2.0-5.4], age ≥40 years (adj. OR 2.1, 95% CI = 1.2-3.8), and BMI ≥30 kg/m 2 (adj. OR 2.5, 95% CI = 1.5-4.0) were independently associated with large Nodular Goiter. No significant differences were observed in gender, family history of thyroid disease, pregnancy, or tobacco use (P > 0.1). Conclusions. African-American race, obesity, and increasing age are independent risk factors for the development of large Nodular Goiter. These results may be helpful in determining how best to monitor patients with Nodular Goiter, with earlier intervention to help prevent progressive enlargement and its sequelae.
Paolo Vitti - One of the best experts on this subject based on the ideXlab platform.
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the role of nuclear medicine in the clinical management of benign thyroid disorders part 2 Nodular Goiter hypothyroidism and subacute thyroiditis
The Journal of Nuclear Medicine, 2021Co-Authors: Giuliano Mariani, Paolo Vitti, E Fiore, Massimo Tonaccehra, M Grosso, Pierpaolo Falcetta, Lucia Montanelli, Brunella Bagattini, Harry StraussAbstract:Part 2 of this series of Continuing Education articles on benign thyroid disorders deals with Nodular Goiter, hypothyroidism, and subacute thyroiditis. Together with Part 1 (which dealt with various forms of hyperthyroidism), this article is intended to provide relevant information for specialists in nuclear medicine dealing with the clinical management of patients with benign thyroid disorders, the primary audience for this series. Goiter, an enlargement of the thyroid gland, is a common endocrine abnormality. Constitutional factors, genetic abnormalities, or dietary and environmental factors may contribute to the development of Nodular Goiter. Most patients with nontoxic Nodular Goiter are asymptomatic or have only mild mechanical symptoms (globus pharyngis). Work-up of these patients includes measurement of thyroid-stimulating hormone, free triiodothyronine, free thyroxine, thyroid autoantibodies, ultrasound imaging, thyroid scintigraphy, and fine-needle aspiration biopsy of nodules with certain ultrasound and scintigraphic features. Treatment for multiNodular Goiter includes dietary iodine supplementation, surgery, radioiodine therapy (to decrease thyroid size), and minimally invasive ablation techniques. Hypothyroidism ranges from rare cases of myxedema to more common mild forms (subclinical hypothyroidism). Primary hypothyroidism often has an autoimmune etiology. Clinical presentations differ in neonates, children, adults, and elderly patients. Work-up includes thyroid function tests and ultrasound imaging. Nuclear medicine is primarily used to locate ectopic thyroid tissue in congenital hypothyroidism or to detect defects in iodine organification with the perchlorate discharge test. Treatment consists of thyroid replacement therapy with l-thyroxine, adjusting the daily dose to the individual patient’s metabolic and hormonal requirements. Subacute thyroiditis is a self-limited inflammatory disorder of the thyroid gland, often associated with painless or painful swelling of the gland and somatic signs or symptoms. Inflammation disrupts thyroid follicles resulting in a rapid release of stored thyroxine and triiodothyronine causing an initial thyrotoxic phase, often followed by transient or permanent hypothyroidism. Although subacute thyroiditis is often related to a viral infection, no infective agent has been identified. Subacute thyroiditis may be caused by a viral infection in genetically predisposed individuals. Work-up includes lab tests, ultrasound imaging, and radionuclide imaging. Thyroid scintigraphy demonstrates different findings depending on the phase of the illness, ranging from very low or absent tracer uptake in the thyroid gland in the hyperthyroid phase to a normal appearance in the late recovery phase. Since subacute thyroiditis is self-limited, treatment is directed toward relief of pain. High-dose nonsteroidal antiinflammatory drugs are usually the first-line treatment. If severe pain persists, a course of corticosteroids may be necessary. Permanent hypothyroidism develops in up to 15% of patients with subacute thyroiditis, even more than 1 y after presentation.
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genetic interaction analysis of vegf a rs3025039 and vegfr 2 rs2071559 identifies a genetic profile at higher risk to develop Nodular Goiter
Journal of Endocrinological Investigation, 2020Co-Authors: Annette M Molinaro, Paola Orlandi, Filippo Niccolai, P Agretti, G De Marco, Eleonora Ferrarini, C Di Cosmo, Paolo Vitti, Paolo Piaggi, T Di DesideroAbstract:Nodular Goiter in patients from areas of iodine deficiency is due to the growth of follicular and endothelial cells, involving different vascular-related growth factors in its pathogenesis. The aim of our study was to examine the association of known single polymorphisms of vascular endothelial growth factor-A [VEGF-A], VEGF receptor-2 [VEGFR-2] and hypoxia-inducible factor-1α [HIF-1α] genes or their genetic interactions with the risk of Nodular Goiter development. 116 normal subjects, without any thyroid disease, and 108 subjects with Nodular Goiter [subjects with Goiter and at least one thyroid nodule of > 1 cm of maximum size and in absence of signs of autoimmunity] were selected from a homogeneous population living in a mild iodine deficiency geographic area. Analyses were performed on germline DNA obtained from blood samples and VEGF-A rs3025039, VEGFR-2 rs2071559, and HIF-1αrs11549465 SNPs were investigated by real-time PCR technique. The multifactor dimensionality reduction [MDR] methodology was applied to investigate the genetic interaction between SNPs. Hardy–Weinberg equilibrium was performed. None of the studied polymorphisms were individually associated with a higher risk to develop Nodular Goiter [P > 0.05]. The combination of the VEGF-A rs3025039 and VEGFR-2 rs2071559 polymorphisms had the highest accuracy of 0.58 [P = 0.018] and the interaction of some genotypes was significantly associated with the risk of Nodular Goiter development. Our results support a genetic interaction between the VEGF-A rs3025039 and VEGFR-2 rs2071559 polymorphisms as a predictor of the risk to develop Nodular Goiter in subjects coming from an area with mild iodine deficiency.
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radioiodine 131i treatment for large Nodular Goiter recombinant human thyrotropin allows the reduction of radioiodine 131i activity to be administered in patients with low uptake
Thyroid, 2011Co-Authors: Claudia Ceccarelli, L Antonangeli, Federica Brozzi, Francesca Bianchi, Massimo Tonacchera, P Santini, S Mazzeo, W Bencivelli, Aldo Pinchera, Paolo VittiAbstract:Background: 131I therapy is effective in reducing the volume of large Nodular Goiters (thyroid volume [TV]), mainly after stimulation with recombinant human thyrotropin (rhTSH). The amount of 131I to be administered inversely depends on thyroid radioactive iodine uptake (RAIU). In patients with low RAIU, we evaluated the efficacy of 131I treatment at lower doses with respect to those calculated on the basal RAIU, after rhTSH stimulation. Methods: Eighteen consecutive patients (17 women and 1 man, 49–83 years) with large Nodular Goiter were included in the study. At enrolment, 24th h RAIU, TSH, free thyroxine, free triiodothyronine, thyroglobulin antibodies, thyroid peroxidase antibodies, TSH receptors antibodies, urinary iodine, and TV were measured. RAIU was 40% in 7 (higher uptake group [HUG]). RAIU difference in the two groups was significant (p < 0.0001). LUG patients were treated with rhTSH (0.03 mg i.m.) and RAIU was measured again after 24 hours. ...