Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters

Knobel, Meyer

doi:10.1007/s40618-015-0391-7

Cited by 77 publications

(74 citation statements)

References 90 publications

(123 reference statements)

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“…If a goitre is present or the history suggests a mass effect, check for tracheal deviation and percuss for subclavicular dullness, although these signs are not well validated. A predominantly intrathoracic goitre may be difficult to detect, even if large; the Pemberton manoeuvre should be performed to assess for thoracic inlet obstruction, which is often an indication for thyroidectomy 20 . Signs of hyperthyroidism and hypothyroidism should be evaluated.…”

Section: Approach To Thyroid Nodulesmentioning

confidence: 99%

Thyroid nodules: diagnosis and management

Wong

Farrell

Grossmann

2018

Medical Journal of Australia

132

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Thyroid nodules are common. Their importance lies in the need to assess thyroid function, degree of and future risk of mass effect, and exclude thyroid cancer, which occurs in 7-15% of thyroid nodules. There are four key components to thyroid nodule assessment: clinical history and examination, serum thyroid stimulating hormone (TSH) measurement, ultrasound and, if indicated, fine-needle aspiration (FNA). If the serum TSH is suppressed, a thyroid scan with Tc can distinguish between a solitary hot nodule, a toxic multinodular goitre or, less commonly, thyroiditis or Graves' disease within a coexisting nodular thyroid. Scintigraphically cold nodules are evaluated in the same way as in the setting of normal or elevated serum TSH levels. Thyroid ultrasonography should be performed only for palpable goitre and thyroid nodules and by specialists with expertise in thyroid sonography. Routine thyroid cancer screening is not recommended, except in high risk individuals, as the detection of early thyroid cancer has not been shown to improve survival. FNA may be performed for nodules ≥ 1.0 cm depending on clinical and sonographic risk factors for thyroid cancer. FNA specimens should be read by an experienced cytopathologist and be reported according to the Bethesda Classification System. Molecular analysis of indeterminate FNA samples has potential to better discriminate benign from malignant nodules and thus guide management. Surgery is indicated for FNA findings of malignancy or indeterminate cytology when there is a high risk clinical context. Surgery may also be indicated for suspicion of malignancy; larger nodules, especially with symptoms of mass effect; and in some patients with thyrotoxicosis.

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Section: Approach To Thyroid Nodulesmentioning

confidence: 99%

Thyroid nodules: diagnosis and management

Wong

Farrell

Grossmann

2018

Medical Journal of Australia

132

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“…Primary and secondary factors are involved in the etiology of nodular goiter (Studer et al, 1989). Today, although the important role of iodine deficiency and the growth-promoting contribution of TSH are still recognized, nodular goiter is now considered a consequence of an inherited propensity for the thyroid to develop nodules with age (Knobel, 2015).…”

Section: Discussionmentioning

confidence: 99%

Is the TSHR D727E polymorphism a genetic predisposition for multinodular goiter in the Turkish population?

Gozu

Özçelik²,

Aloğlu³

et al. 2016

Genet. Mol. Res.

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ABSTRACT. The D727E germline polymorphism in the thyroidstimulating hormone receptor gene (TSHR) may cause genetic susceptibility to the development of goiter. Therefore, in this study we investigated allele frequencies and genotype distributions of the TSHR D727E polymorphism, their association with clinical parameters, and the development of goiter in the Turkish population. We investigated the TSHR D727E polymorphism in 123 patients and 97 healthy subjects using the polymerase chain reaction-restriction fragment length polymorphism technique. Peripheral blood was used for DNA 2 H.I. Gözü et al. Genetics and Molecular Research 15 (3): gmr.15038504 extraction. Although no significant difference was found in TSHR D727E polymorphism frequencies between the patients with nodular goiters (26/123 patients, 21.1%) and the controls (12/97 patients, 12.4%) (P = 0.107), the frequency of the TSHR D727E polymorphism in the hyperthyroid+subclinical hyperthyroid patient groups (23%) was significantly higher than in the control subjects (12.4%) (P = 0.024). In this study, nodular goiter presented significantly earlier in GC genotype patients (mean age 35 years) than in CC genotype patients (mean age 42 years) in the hyperthyroid group (P = 0.009). More importantly, TSH levels in the GC variant controls were closely significant lower (1.26 ± 0.49) than in the CC variant controls (1.74 ± 0.84) (P = 0.053). The TSHR D727E polymorphism might be involved in the pathogenesis of toxic multinodular goiter (TMNG). Moreover, this polymorphism might be an indication of early-onset TMNG. However, development of MNG is multifactorial. Therefore, further case-control studies with larger populations are required to verify these observations.

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“…It can be associated with a number of thyroid diseases such as thyroid dysfunction (hyperthyroidism and hypothyroidism), autoimmune thyroid disease (Graves' disease and Hashimoto's thyroiditis) [2, 3], thyroiditis, and thyroid cancer [4, 5]. Regardless of varies clinical manifestation, the etiology of goiter is essentially the same: the thyroid attempting to adapt to circumstances of changes in the thyroid's ability to secrete adequate amounts of hormones [1], of which hypothyroidism is the most common in recent decade [6].…”

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy and Toxicity of Different Species of Sargassum in Haizao Yuhu Decoction in PTU-Induced Goiter Rats

Xiu

Zhong

Liu

et al. 2017

Evidence-Based Complementary and Alternative Medicine

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Background Haizao Yuhu Decoction has been widely used to treat thyroid-related diseases especially goiter with few side effects in traditional Chinese medicine (TCM), including herb pair Sargassum (HZ) and Glycyrrhizae Radix et Rhizoma (GC), as one of “eighteen antagonistic medicaments.” The two different species of Sargassum, Sargassum fusiforme (Sf) and Sargassum pallidum (Sp), are not clearly differentiated in clinical use, so that herb pair Sf-GC and Sp-GC could show different effect and toxicity. Methods We investigated the antigoitrous effect and toxicity and clarified the potential underlying mechanism of the two different species of Sargassum in HYD (HYDf and HYDp) in PTU-reduced goiter rats. Results The results demonstrated that both HYDf and HYDp could exhibit antigoitrous effect through alterations in hypothalamus-pituitary-thyroid (HPT) axis and inhibition of the TPO gene expression; there is no difference in the antigoitrous effects between the two different species of Sargassum application in HYD. Conclusion This study evaluated the safety and efficacy of herb pair HZ-GC applied in HYD in goiter rats at molecular, cellular, and whole level and compared the two species of Sargassum further. We provide a reliable way to clarify the possible mechanism of the antagonistic medicament herb pair HZ-GC for its application.

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Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters

Cited by 77 publications

References 90 publications

Thyroid nodules: diagnosis and management

Thyroid nodules: diagnosis and management

Is the TSHR D727E polymorphism a genetic predisposition for multinodular goiter in the Turkish population?

Comparative Efficacy and Toxicity of Different Species of Sargassum in Haizao Yuhu Decoction in PTU-Induced Goiter Rats

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