Non-recurrent laryngeal nerve in thyroid surgery.
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A case of non-recurrent laryngeal nerve is reported. The non-recurrent laryngeal nerve was found on the right side and was not associated with any vascular abnormalities. The anatomy and surgical implication of this rare condition is discussed (+info)
Association of anion gap with thyroid dysfunction and nodular goiter in CAPD patients.
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OBJECTIVE: To investigate the association of clinical parameters and serum anion gap with thyroid dysfunction and nodular goiter in continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: Cross-sectional study. SETTING: Single dialysis unit and outpatient clinic. PATIENTS: This study Included 89 uremic patients on CAPD. Gender ratio was 50 males to 39 females (M/F = 1.28); mean age was 54.8 years. MAIN OUTCOME MEASURES: We investigated the prevalence of nodular goiter and thyroid dysfunction with a 10-MHz high-frequency ultrasound scanner and immunoassay kits. RESULTS: Nodular goiter was detected in 52.8% (47/89) of the CAPD patients. Patients with nodular goiter were older than those without goiter (57.7 vs 51.5 years, p < 0.05). Nodular goiter was found more frequently in females than in males (66.7% vs 44.0%, p < 0.05). Patients with nodular goiter had longer duration of CAPD than patients without goiter (51.6 +/- 42.9 vs 31.0 +/- 28.1 months, p < 0.02). In addition, CAPD patients with goiter had a higher serum anion gap (AG) (16.8 +/- 3.3 vs 14.0 +/- 4.5 mEq/L, p < 0.02) and a lower weekly creatinine clearance (55.9 +/- 12.6 vs 64.6 +/- 21.1 L/week/1.73 m2, p < 0.05) than patients without goiter. As serum AG gradually Increased, significant alteration of thyroid parameters developed In the following sequence: (1) reduction of total T3 level at an AG level of 15, (2) elevation of thyrotropin (TSH) and Increased prevalence of goiter at an AG of 18, and (3) reduction of free T4 and total T4 levels and elevation of TSH, with further increased frequency of goiter at an AG of 20 mEq/L. CONCLUSION: According to this study, age, gender, dialysis duration, serum AG, and weekly creatinine clearance are correlated with prevalence of goiter in CAPD patients. Sequential alteration of thyroid function and Increasing frequency of nodular goiter correlated with higher serum AG. There are two explanations for this correlation: the level of serum AG may be an indirect index of the level of serum goitrogens, and higher serum AG and Increased frequency of nodular goiters might be a reflection of loss of residual renal function. Therefore, thyroid function screening and goiter detection using ultrasound should be considered when examining CAPD patients with progressively elevating serum anion gap. (+info)
Isolation and characterization of human thyroid endothelial cells.
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From collagenase digests of human thyroid, endothelial cells were separated from follicular cells by their greater adherence to gelatin-coated plates. Endothelial cells were further purified using fluorescence-activated cell sorting, selecting for cells expressing factor VIII-related antigen. Isolated cells were negative for thyroglobulin and calcitonin when examined by immunostaining. The receptor for the angiopoietins, Tie-2, was expressed by the cells, and expression was increased by agents that elevate cAMP. Nitric oxide synthase (NOS) 3, the endothelial form of NOS, was expressed by the cells and similarly regulated. Cells responded strongly to the mitogen fibroblast growth factor (FGF)-2 in growth assays but only weakly to vascular endothelial growth factor (VEGF). VEGF was, however, able to stimulate nitric oxide release from the cells consistent with their endothelial origin. The FGF receptor (FGFR1) was full length (120 kDa) and immunolocalized to the cytosol and nucleus. Thyrotropin (TSH) did not regulate FGFR1, but its expression was increased by VEGF. Thrombospondin, a product of follicular cells, was a growth inhibitor, but neither TSH nor 3,5,3'-triiodothyronine had direct mitogenic effects. Thyroid follicular cell conditioned medium contained plasminogen activator activity and stimulated the growth of the endothelial cells, but when treated with plasminogen to produce the endothelial-specific inhibitor, angiostatin, growth was inhibited. Human thyroid endothelial cell cultures will be invaluable in determining the cross talk between endothelial and follicular cells during goitrogenesis. (+info)
Diagnostic relevance of fine needle aspiration cytology for follicular lesions of the thyroid: retrospective study.
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AIM: To determine diagnostic relevance of cytologic subclassification of follicular lesions of the thyroid and its role in the therapeutic approach. METHODS: We performed a retrospective analysis of the data of patients who underwent thyroid surgery at the Sisters of Mercy University Hospital, Zagreb, between March 1995 and February 2001, and had a report of preoperative fine needle aspiration (FNA) biopsy of thyroid follicular lesion, which comprises cellular follicular lesion, suspicious for follicular neoplasm, or follicular neoplasm. RESULTS: Out of 110 patients with preoperative FNA biopsy diagnosis of follicular lesion, 86 (78%) had a lesion corresponding histologically to a neoplasm. However, a malignant tumor was found in only 6% of the patients. In the diagnostic categories of cellular follicular lesion and lesion suspicious for follicular neoplasm, the rate of malignancy was even lower, 3% and 4%, respectively. We found significant difference between FNA and histologic findings in distinguishing non-neoplastic from neoplastic thyroid lesions in the category of cellular follicular lesion and follicular neoplasm. CONCLUSION: Due to the low malignancy rate in patients with FNA biopsy diagnoses of cellular follicular lesion or lesion suspicious for follicular neoplasm of the thyroid, we suggest close clinical follow-up of such patients, rather than immediate surgical intervention. (+info)
Differentiation between malignant and benign solitary thyroid nodules by fluorescent scanning.
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A quantitative fluorescent technique has been developed for making in vivo iodine content determinations of the total thyroid gland or of selected parts. In solitary thyroid nodules "cold" to radionuclide studies, the ratio of iodine content in the nodule to that in a corresponding area of the contralateral lobe has proven to be a good indicator of malignancy. In a preliminary study of 42 surgical patients, an iodine content ratio (ICR) below 0.60 (chosen a posteriori) proved to be an excellent indication of malignancy with a sensitivity of 100%, a specificity (predictive value) of 79%, and an overall accuracy of 90%. Further definitive studies are needed to verify these preliminary observations. (+info)
Extensive squamous metaplasia in nodular goiter--a diagnostic dilemma in the fine needle aspiration (FNA) cytology--a case report.
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Metaplastic changes are commonly found at widespread locations occurring in both reactive and neoplastic conditions. They can simulate tumors histologically. Squamous metaplasia is rarely seen in areas of fibrosis and inflammation secondary to hemorrhage in nodular goiters. If it is extensive with associated degenerative changes and present clinically in the form of a nodule, cytopathologist must take care to differentiate this from primary or metastatic squamous cell carcinoma or even anaplastic carcinoma. (+info)
Role and regulation of the fibroblast growth factor axis in human thyroid follicular cells.
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Thyroidal levels of fibroblast growth factor-2 (FGF-2) and fibroblast growth factor receptor 1 (FGFR1) are elevated in human thyroid hyperplasia. To understand the significance of this, effects of FGFR1 activation on normal human thyrocyte growth and function in vitro and the regulation of FGF-2 and FGFR1 expression have been examined. FGF-2 stimulated cell growth, as measured by cell counting, and inhibited thyroid function as measured by 125I uptake. Sensitivity to FGF-2 disappeared after 7 days, although FGFR1 expression was maintained. Thyroid-stimulating hormone (TSH, 300 mU/l) increased FGFR1 mRNA expression within 4 h and protein expression by 8 h. Exogenous FGF-2 decreased FGFR1 protein. Endogenous FGF-2 levels were low (approximately 1-2 pg/microg protein), and TSH treatment decreased these by 50%. Protein kinase C (PKC) activation increased FGF-2 mRNA and FGF-2 secretion within 2 h. This effect was enhanced (4.4-fold) when cells were cultured in TSH. We conclude that TSH stimulates FGFR1 but not FGF-2 expression. PKC activation stimulates FGF-2 synthesis and secretion, and TSH synergizes with PKC activators. Increases in FGFR1 or FGF-2 or in both may contribute to goitrogenesis. (+info)
Evaluation of dominant thyroid masses.
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Controversy exists concerning the management of solitary thryoid nodules because of conflicting information converning the high clinical incidence of thyroid nodules, the varying incidence of cancer reported in those surgically excised and the infrequency of death from thyroid cancer. During the past several years, a plan for evaluating patients with dominant thyroid masses has evolved. The objective is to avoid unnecessary operations by identifying patients with a high risk of cancer. The criteria which are used are the age and sex of the patient, the duration of the mass, 125I or 99mTc scans, 75Selenomethionine scans, B-mode ultrasonography and the response of the mass to suppressive therapy. This is a report of the findings in 222 patients who have been studied employing this approach. Thirty per cent of the patients were operated upon. Forty per cent had neoplasms (well differentiated cancer--28.8%, adenoma--12.1%), 47.0%--nodular goiter, 6.1% cysts, and 6.1% chronic thyroiditis. The incidence of cancer in the 222 patients was 8.6% and adenoma 3.6%. Patients at greatest risk of having cancer are those with solid nonfunctioning nodules which fail to regress with suppressive therapy. This study indicates that the approach described above is effective in selecting for surgical excision those individuals at greatest risk of having thyroid cancer. (+info)