BACKGROUND Elderly giant retrosternal thyroid goiter is a rare yet significant medical condition,often presenting clinical symptoms that can be confused with other diseases,posing diagnostic and therapeutic challenges...BACKGROUND Elderly giant retrosternal thyroid goiter is a rare yet significant medical condition,often presenting clinical symptoms that can be confused with other diseases,posing diagnostic and therapeutic challenges.This study aims to delve into the characteristics and potential mechanisms of this ailment through pathological diagnosis and immunohistochemical analysis,providing clinicians with more precise diagnostic and treatment strategies.A 77-year-old male,was admitted to hospital with the chief complaint of finding a goiter in the semilunar month during physical examination,accompanied by dyspnea.Locally protruding into the superior mediastinum,the adjacent structure was compressed,the trachea was compressed to the right,and the local lumen was slightly narrowed.The patient was diagnosed with giant retrosternal goiter.Considering dyspnea caused by trachea compression,our department planned to perform giant retrosternal thyroidectomy.Immunohistochemical results:Tg(+),TTF-1(+),Calcitonin(CT)(I),Ki-67(+,about 20%),CD34(-).Retrosternal goiter means that more than 50%of the volume of the thyroid gland is below the upper margin of the sternum.As retrosternal goiter disease is a relatively rare disease,once the disease is diagnosed,it should be timely surgical treatment,and the treatment is more difficult,the need for professional medical team for comprehensive treatment.CONCLUSION The imaging manifestations of giant retrosternal goiter are atypical,histomorphology and immunohistochemistry can assist in its diagnosis.This article reviews the relevant literature of giant retrosternal goiter immunohisto-chemistry and shows that giant retrosternal goiter is positive for Tg,TTF-1,and Ki-67.展开更多
Objective:To explore the mechanism of Huatan Sanjie Fang(HTSJ)in regulating goiter in Graves'disease(GD)mice by detecting key factors of the Hippo signaling pathway.Methods:A mouse model of GD was established by i...Objective:To explore the mechanism of Huatan Sanjie Fang(HTSJ)in regulating goiter in Graves'disease(GD)mice by detecting key factors of the Hippo signaling pathway.Methods:A mouse model of GD was established by injecting Ad-TSHR289 adenovirus into the bilateral quadriceps femoris of female mice.Successful mouse models were then randomly divided into a model group,methimazole(MMI)group,and HTSJ group,and fed with deionized water,MMI(4.5 mg/kg per day),and HTSJ(35.10 g/kg per day),respectively,for 10 weeks.Histopathological changes of the thyroid gland were subsequently observed by hematoxylin-eosin staining.Radioimmunoassay was used to detect serum total thyroxine(T4)and thyrotrophin-receptor antibody(TRAb)levels.The relative expression of mRNA of Mst1,YAP,and TAZ were detected by quantitative real-time polymerase chain reaction,while the protein expression of Mst1,YAP,TAZ,pMst1,and pYAP were detected by western blot.Results:After 10 weeks of drug intervention,goiter and other pathological changes in the HTSJ group significantly improved compared with the model group,and the levels of serum T4 and TRAb significantly decreased(P=.002,P<.001,respectively).Decreased mRNA expression of Mst1,YAP,and TAZ,the key factors of the Hippo signaling transduction pathway,was also observed(P=.002,P=.022,P<.001,respectively).In contrast,protein expression of Mst1(P=.046),pMst1(P=.026),and p YAP(P=.004)increased,while protein expression of YAP and TAZ decreased(P=.041,P<.001,respectively).Conclusion:HTSJ can effectively improve goiter in GD mice through the Hippo signaling pathway.展开更多
Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires tho...Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires thoracotomy.In recent years,there have been several reports of resection of substernal goiters by minimally invasive surgery.Here,we present a 75-year-old female with a giant substernal goiter who successfully underwent resection of the goiter extending to the posterior mediastinum using low cervical incision combined with video-assisted thoracoscopy.展开更多
As important drugs for the treatment of nodular goiter(NG),Prunella Spica preparations are widely used clinically,and have a significant effect on NG.Various active ingredients in the preparations intervene in the for...As important drugs for the treatment of nodular goiter(NG),Prunella Spica preparations are widely used clinically,and have a significant effect on NG.Various active ingredients in the preparations intervene in the formation of NG by inhibiting the proliferation of thyroid follicular cells,promoting cell apoptosis,regulating immunity,improving the microcirculation of thyroid tissue and other mechanisms,and can reduce the postoperative recurrence of NG.展开更多
Background: Multinodular goiter is a relatively common thyroid disorder with a marked female preponderance. Most of these goiters weigh less than 100 grams with those weighing more than 500 grams being exceptional. Th...Background: Multinodular goiter is a relatively common thyroid disorder with a marked female preponderance. Most of these goiters weigh less than 100 grams with those weighing more than 500 grams being exceptional. The massively expanding goiter due to the strategic anatomic location of thyroid gland, in addition to being cosmetically disfiguring can seriously compromise the patency of the trachea and oesophagus. Thyroidectomy for such goiters is a surgical challenge due to the possible association of tracheomalacia, retrosternal extension, skin involvement and the difficulty in intubation and dissection of the thyroid gland due to distorted and displaced anatomy. Material and methods: While presenting 2 patients who underwent thyroidectomy for glands weighing more than 500 grams, the literature is reviewed to analyze the technical difficulties and approach in such patients and the frequently encountered complications in them and their management. Results: A review of the literature revealed an additional 7 cases of patients who had undergone thyroidectomy for glands weighing more than 500 grams. Massively enlarged goiter was often associated with tracheomalacia, tracheal stenosis and retrosternal extension. Difficulty during surgery was most often encountered in establishing the airway and in exposure of the gland particularly when the skin was involved. The predominant postoperative complications were related to respiratory distress as a consequence of tracheomalacia and tracheal stenosis. Conclusion: In spite of the technical challenge related to the airway, and thyroidectomy, surgery continues to be the best option in experienced hands due to its distinct advantage of its immediate effect and complete resolution of compressive symptoms.展开更多
Intrathoracic goiter(IG) is commonly located in the anterior mediastinum. Here, we report the case of a 54-year-old Chinese woman with successful removal of an intrathoracic goiter and improvement of dyspnea by a righ...Intrathoracic goiter(IG) is commonly located in the anterior mediastinum. Here, we report the case of a 54-year-old Chinese woman with successful removal of an intrathoracic goiter and improvement of dyspnea by a right posterolateral thoracotomy approach. Conclusion: Posterior mediastinal thyroid goiter with mediastinal compressive symptoms is an indication for surgery.展开更多
Background: Thyroidectomy for giant goiter is a surgical challenge due to distorted and displaced anatomy. The aim of this study is to evaluate the relationship between giant goiter and its operative complications. Ma...Background: Thyroidectomy for giant goiter is a surgical challenge due to distorted and displaced anatomy. The aim of this study is to evaluate the relationship between giant goiter and its operative complications. Material and Methods: A retrospective multicenter study of consecutive patients who had thyroid surgery was conducted, including 639 patients who undergone thyroidectomy in State hospital at Van and Corlu city—Turkey. Seven cases had giant goiter in the patients. Total thyroidectomy was performed all patients. Results: All patients were women. The mean weight of glands removed was 689 gr in giant goiter’s patients. Two operative complications had happened;right site injury of the external branch of the superior laryngeal nerve had happened to one patient;hypocalcemia was happened to another one patient. In those two patients previously were operated partial thyroidectomy. Conclusions: Thyroidectomy for a massively enlarged goiter is technically challenging. The predominant operative complications were related to previously operate and the thyroid gland due to distorted and displaced anatomy. The surgical approach to such cases requires carefully preoperative evaluation and planning. Especially, using of intraoperative nerve monitoring is to be useful in these difficult cases which previously had undergone surgery.展开更多
Purpose: To describe the aspects of the positive diagnosis of large goiters. Patients and Methods: We conducted a retrospective and prospective study including 115 patients from January, 2009 till December, 2014 (6 ye...Purpose: To describe the aspects of the positive diagnosis of large goiters. Patients and Methods: We conducted a retrospective and prospective study including 115 patients from January, 2009 till December, 2014 (6 years) in Central Hospital of University of Point G in Bamako (Mali). The diagnosis of large goiters was based on the measurements of the anterior neck swelling. Thus large goiter was defined as any goiter including the height or width was greater than or equal to 10 cm (centimeters). Results: We operated 115 cases of large goiters on 760 goiters operated either 15.1%. The average age of patients was 44, 43 years ±14, 3 with extremes of 9 and 80 years. There was 101 women (87.8%) and 14 men (12.2%) with a sex ratio of 7.2 in favor of women. The signs of compression were dyspnea in 40% of cases (46/115), dysphonia in 13.0% (15/115), and dysphagia in 8.6% (10/115). The average height of goiter was 12.1 cm ± 3.5 cm with extremes of 10 and 29 cm and the average width was 14.4 cm ± 5.4 cm with extremes of 10 and 32 cm. Thyroid ultrasound found large goiters multinodular in 100%. Cervical radiography found the tracheal deviation in 48.2% (42/87), tracheal compression in 20.6% (18/87), plunging goiters in 11.5% (10/87). Cytology found a benign goiter in 97.4% of cases (112/115), malignant (thyroid cancer) in 2.6% of cases (3/115). Conclusion: Diagnosis of large goiters was based on the measurement of the swelling in our context. The signs of compression are the severity of this condition.展开更多
Background: Schwannoma is a benign tumor derived from Schwann cells. The most common location was cerebellopontine angle (CPA). Neurilemmoma originated from the thyroid gland is very rare. Purpose: To discuss the diag...Background: Schwannoma is a benign tumor derived from Schwann cells. The most common location was cerebellopontine angle (CPA). Neurilemmoma originated from the thyroid gland is very rare. Purpose: To discuss the diagnosis and treatment of cervical vagal schwannoma and the causes of misdiagnosis and preventive measures. Case Presentation: A case of cervical vagal schwannoma misdiagnosed as nodular goiter by ultrasonography was analyzed retrospectively. This patient was found to have pain in the neck for 1 month and then went to our hospital for treatment. After admission, a 5 cm × 4 cm mass was found on the left side of the neck, with a medium texture and clear margin. It could move with swallowing. Initially ultrasound showed a well circumscribed hypoechoic mass in the left thyroid lobe, which is suggestive of hemorrhage of thyroid nodule. Biopsy of thyroid nodules after ultrasound guided biopsy revealed Schwannoma. Surgical treatment and postoperative pathological examination confirmed cervical vagal schwannoma. The patient recovered well and was discharged 9 days after operation. Conclusion: The location of thyroid schwannoma is rare, the relationship between thyroid schwannoma and surrounding tissues is unclear, and there is no typical ultrasonic manifestation. Moreover, if doctors are not aware of their knowledge, it is easy to cause misdiagnosis. Radiologists should raise awareness of the disease and carefully analyze the results of ultrasonography in combination with the clinical manifestations of the patients so as to reduce or avoid misdiagnosis of cervical schwannoma.展开更多
BACKGROUND Metastasis to the thyroid gland(TM)from primary breast cancer is uncommon and usually presents as thyroid nodules;however,diffuse goiter without thyroid nodules is the first sign of TM in rare cases.Skip me...BACKGROUND Metastasis to the thyroid gland(TM)from primary breast cancer is uncommon and usually presents as thyroid nodules;however,diffuse goiter without thyroid nodules is the first sign of TM in rare cases.Skip metastases(SMs)to the lymph nodes in breast cancer,defined as discontiguous higher-level metastases in the absence of lower levels of contiguous metastases,have been reported in the contralateral cervical area of the primary tumor site in rare cases.CASE SUMMARY A 49-year-old previously healthy Chinese woman was diagnosed with right lateral invasive ductal carcinoma and underwent neoadjuvant chemotherapy treatment and bilateral mastectomy with axillary lymph node dissection.No malignancy of the left breast or axillary or distant metastases were identified preoperatively.However,enlarged left cervical lymph nodes were detected 36 mo after surgery,and rapidly enlarging thyroid glands without nodules were detected 42 mo after surgery.Fine-needle aspiration cytology was performed on the left cervical lymph nodes and left lobe of the thyroid,which were both revealed to contain metastases from the primary breast cancer.Additionally,the immunostaining profiles changed in the process of metastases.The patient was discharged with the NP(vinorelbine and cisplatin)regimen for subsequent treatment,and stable disease was determined when the curative effect was evaluated.CONCLUSION Diffuse goiter may be the first sign of TM,and enlarged lymph nodes in the contralateral cervical area may be SMs of primary breast cancer.展开更多
Introduction: Total thyroidectomy is an operation that involves the surgical removal of the whole thyroid gland, with the preservation of the parathyroid glands. The aim of the present study was to assess the complica...Introduction: Total thyroidectomy is an operation that involves the surgical removal of the whole thyroid gland, with the preservation of the parathyroid glands. The aim of the present study was to assess the complication rates of total thyroidectomy on benign indication and first-time thyroid surgery and investigate the early outcome after opotherapy. Materials and Methods: In this retrospective study, patients who underwent total thyroidectomy for benign multinodular goiter in the department of thoracic surgery in our Hospital from January 2012 to December 2014 were included. In postoperative time, we evaluated surgical complication, histopathological examination and opotherapy. Results: A total 53 patients underwent total thyroidectomy for multmodular goiter;they were 49 (92.45%) bilateral and 4 (7.55%) unilateral (recurrence). The mean age was 47 years and mean diameter of goiter was 10.75 cm. Among the patients 88.68% were females and 11.32% were male. Preoperative hormonal statuses were (70%) in euthyroid and (30%) hyperthyroid following surgery complications like transient laryngeal nerve palsy (3.77%), transient hypocalcemia (7.55%), hematoma (1.9%) and wound infection (1.9%). On histopathological examination of the surgical specimen, 5.7% were reported to be malignant. Six month following surgery 92.45% of patients was a good hormonal balance. Conclusion: Total thyroidectomy for multinodular goiter has a low morbidity and mortality;this procedure olves both the problem of recurrence of disease and reintervention. The opotherapy is doable with a good hormonal balance.展开更多
Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Dep...Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Department of Obstetrics and Gynecology at Microcitemico Pediatric Hospital, Cagliari, for suspected fetal goiter at 32 gestational weeks. The case was monitored regularly by ultrasound and treated successfully with intra-amniotic levothyroxine (L-T4) administration. Fetal goiter was observed to decrease after this treatment and the thyroid ultrasound findings were also normal both at birth and in subsequent follow-ups. Our case report confirms the feasibility of conservative treatment with L-T4, which can effectively prevent complications related to fetal goiter.展开更多
Pregnant women sometimes have thyroid disease, and thus goiter;however, it does not become so large to the extent that the goiter obstructs the air way, causing respiratory symptoms. Here, we report such a case. A 27-...Pregnant women sometimes have thyroid disease, and thus goiter;however, it does not become so large to the extent that the goiter obstructs the air way, causing respiratory symptoms. Here, we report such a case. A 27-year-old woman with large goiter presented with life threatening stridor at 37 weeks. <span style="font-family:Verdana;">After a multidisciplinary-team discussion, we performed caesarean section</span><span style="font-family:Verdana;"> plus thyroidectomy, which resulted in good outcomes. Histological examination revealed hyperplasia and not malignancy. The postoperative course was uneventful. The mother and infant were healthy.</span>展开更多
Thyroid gland is one of most important endocrine glands in the body. It plays vital role in growth control and its measurements tends to change in respect to age, sex, weight and ethnic group of the individual. This s...Thyroid gland is one of most important endocrine glands in the body. It plays vital role in growth control and its measurements tends to change in respect to age, sex, weight and ethnic group of the individual. This study aimed to assess endemic goiter and to estimate the measurement of normal thyroid gland dimensions and thyroid hormones level in school-aged children using Ultrasonography and ELISA Technique in Eastern Sudan (Kassala state). A total of 100 subjects is 6 - 18 years (43 males, 57 females), and mean of age (9.73 ± 2.54 years). This study was done in the period from April 2016 to February 2017. All the subject undergone thyroid ultrasound and thyroid hormone level test. Subjects with history of goiter were excluded from the study, by thyroid dimension (length, height and diameter). Thyroid volume was estimated using ellipsoid formula and thyroid hormones (TSH, T3 and T4) using Toso full automation. The study revealed that 12 subjects of the study (12%) with goiter, 7 female (7%) and 5 males (5%) with age ranged 6 - 11 years with increase in TSH and T3 and decrease in T4 level. The mean of thyroid volumes for normal subject and subject of goiter are 4.93 ± 0.63, 5.4 ± 1.4 mL, respectively, and TSH, T3, T4 (1.8 ± 0.97, 2.4 ± 0.86 UIu/nL), (3.61 ± 0.32, 3.8 ± 0.55 Pg/Nl), (1.35 ± 1.23 ng/DI level respectively). It concluded that there was positive correlations between the age and the thyroid volume (p = 0.65). It increases with increase of the age. The Rt lobe is larger than the Lt lobe;the thyroid volume is higher in male than female, and this study found the TSH and T3 decreased with ages while T4 increased with ages in normal subject;TSH and T3 level increased and T4 level decreased in goiter children.展开更多
AIM: To compare our ten year results for thyroidectomy for cervico-mediastinal goiters with the best surgical treatment reported in the literature.METHODS: From January 2000 to December 2009, of 1530 patients who unde...AIM: To compare our ten year results for thyroidectomy for cervico-mediastinal goiters with the best surgical treatment reported in the literature.METHODS: From January 2000 to December 2009, of 1530 patients who underwent thyroidectomy in our department, we selected 105 cases of cervico-mediastinal goiter. In the majority of cases, the cervical approach is the standard procedure and only occasionally sternotomy or thoracotomy is necessary. The indications for surgery are generally related to a progressive increase of the thyroid mass into the anterior mediastinum with compression and dislocation of the trachea or esophagus and the possibility of an unknown malignancy.RESULTS: In 98(93.3%) of our 105 patients, the standard surgical approach was anterior cervicotomy followed by total thyroidectomy. In three cases, total sternotomy was performed and in the remaining four patients, a partial split sternotomy was effective to remove the intrathoracic mass. Post-operative complications included transient recurrent laryngeal nerve palsyin 6 patients(5.7%) which only became permanent in 2 patients(1.9%). The transient hypoparathyroidism rate was 22% but 2 mo after surgery permanent hypoparathyroidism was confirmed in only 2% of our selected group. No patients required temporary tracheostomy following surgery related to a possible bilateral nerve palsy. Patients received a single prophylactic antibiotic dose preoperatively and wound infections were not significant. There was no mortality in our selected group and most patients showed a significant improvement of dyspnea and other correlated symptoms postoperatively.CONCLUSION: The majority of cervico mediastinal goiters can be completely removed through a cervical incision. In selected cases, generally malignancies with local infiltration of mediastinal soft tissues and adhesions to large vessels, split sternotomy may be a safer approach to not increase morbidity.展开更多
Amyloid goiter (AG) is a rare but well-established disease entity that may occur in a number of conditions. In the following article, we will report two cases of AG. Both patients were young males: 28 & 24 years o...Amyloid goiter (AG) is a rare but well-established disease entity that may occur in a number of conditions. In the following article, we will report two cases of AG. Both patients were young males: 28 & 24 years old, presented with rapidly enlarging thyroid gland manifested with pressure effects (dyspnea and hoarseness of voice). Provisional clinical diagnosis was malignant thyroid neoplasm. One of the patients was markedly hypothyroid while the other was euthyroid. Histopathological evaluation revealed extracellular deposition of deep pink homogenous material that was confirmed as amyloid with congo red. Patient in case 1 was primary localized AG while patient in case 2 was systemic amyloidosis secondary to interstitial pulmonary fibrosis (IPF) that was first manifested by AG. The main aims of the article were to describe histopathological features of amyloidosis of the thyroid gland and to raise awareness of AG to be included in the differential diagnosis in patients presented with rapidly enlarging goiter with mass effects.展开更多
Introduction: Goiter often poses aesthetic disgrace problem. The psychosocial impacts of goiter, in particular in woman may be significant. Objective: studying the psychological and social impacts of the disease in go...Introduction: Goiter often poses aesthetic disgrace problem. The psychosocial impacts of goiter, in particular in woman may be significant. Objective: studying the psychological and social impacts of the disease in goiter patients within the African context and their consequences on the treatment. Methods: It was a transversal study that took place from May 1to July 31, 2011 in the Collines and Donga departments situated in the center and the north of Benin. The study consisted of a survey conducted through an individual discussion based on questionnaire submitted to goiter patients who accepted to provide their answers. Results: This survey involved 86 patients of which 83 women and 3 men. Their average age was 43.7 ± 13.41. Goiter was noticeable in the totality of the patients. 68.6% of patients declared that they experienced on daily basis the shame caused by the disease. 66% thought that it was a natural disease;however, 27.9% believed that it was caused by bewitchment or sorcery. 46.5% and 37.2% resorted to modern and indigenous medicine respectively;16.3% made no therapeutic move. Despite the psychosocial impacts of the disease, 50% of the patients rejected surgical intervention possibility. The core motives they raised were lack of financial means (34.8%), disease recurrence fright (23.3%), anesthesia fright (16.3%), and surgical fright (14%). Conclusion: Despite the psychological impacts of the disease, strong resistance exists probably more on cultural aspect than the motives mentioned by thyroidectomy patients.展开更多
Aims: To describe the diagnostic aspects, surgical indications and post-operative complications of thyroidectomies performed in our department. Materials and method: A descriptive retrospective study that took place i...Aims: To describe the diagnostic aspects, surgical indications and post-operative complications of thyroidectomies performed in our department. Materials and method: A descriptive retrospective study that took place in the ENT Department and Cervicofacial Surgery of Gabriel TOURE University Hospital of Bamako. We did a comprehensive sampling of all goiter cases from January 2013 to December 2018. Were included in the study, the records of patients of all ages and genders, admitted into the ward and scheduled for thyroidectomy (partial or total). The exclusion criteria were incomplete hospitalization records. There were a total of 139 files were retained. Results: In 60 months, 139 cases were collected out of 1720 patients hospitalized for surgery, representing a hospital prevalence of 8.08%. The average age was 46.89 years. (123 women and 16 men). The socio-professional categories were dominated by housewives (68.34%). The reported functional signs were tachycardia, asthenia and other signs of dysthyroidism in 59% as well as signs of compression in 24.46%. In 72 cases or 51.80%, the patients consulted between 2 and 10 years of disease progression. Twenty patients or 14.39% had a history of familial goiter and 2 patients had a history of thyroid surgery. On physical examination the swelling was antero-cervical in 56.83% of cases. In 96 cases or 69.06% the glandular diameter was between 5 and 9 cm. In 2 cases or 1.43% we noted cervical adenopathy in the jugulo-carotid chain. Ultrasound, TSHus and fT4 were performed first-line and systematically in all our patients. Ultrasound objectified an appearance of multinodular goiter in 106 cases or 76.26%. In 60.43% of cases the patients were TI classes RADS 3, they were TI RADS 4A in 16 cases or 11.51%. CT scans were performed in 3 patients or 2.15% to specify the loco-regional extension, to look for possible lymph node invasion, and to compress or dipping the goiter. Surgical indication was placed in front of a multinodular goiter (GMN) in 106 cases or 76.26%, a single goiter in 11 cases or 7.9%, a single nodule greater than 3 cm in 17 cases or 12.23%, Basedow disease in 4 cases or 2.88% and a recurrence in one case 0.72%. We performed a lobo-isthmectomy in 56.11%, a total thyroidectomy in 20.14% of cases, subtotal in 20.86% of cases and total thyroidectomy with mediation-recurrent lymph node curage and bilateral jugulo-carotidien in 4 cases or 2.87%. Recurrent nerves were systematically searched and seen in all cases. Replacement therapy was indicated in all patients who underwent a total thyroidectomy. Complications recovered were 1 case of compressive hematoma, 6 cases of transient dysphonies and cough, 4 cases of definitive hypocalcemia. 1 case of recurrence, but no deaths were observed. Histopathology performed in all of our patients was dominated by vesicular and colloid adenoma. Conclusion: Thyroid surgery is a common surgery but not devoid of complications, the most dangerous of which remain recurrent impairment and definitive hypoparathyroidism. The experience of all surgical teams in the vasculo-nervous anatomy of the neck is the best guarantor to reduce and prevent complications.展开更多
Thyroid heterotopia is an abnormal localization of normal thyroid tissue coexisting with a normal organ and of normal localization. It is distinguished from ectopic thyroid and thyroid cancer metastasis. Lingual or su...Thyroid heterotopia is an abnormal localization of normal thyroid tissue coexisting with a normal organ and of normal localization. It is distinguished from ectopic thyroid and thyroid cancer metastasis. Lingual or sublingual thyroid is defined as the presence of thyroid tissue in the midline at the base of the tongue anywhere between the circumvallate papillae and the epiglottis. The prevalence of lingual thyroid is 1 in 100,000, and it is more common in women, with a female to male ratio ranging from 3:1 to 7:1. Embryologically, the thyroid originates at the foramen cecum, which is located at the junction of the anterior two thirds with the posterior one-third of the tongue, report a case of a goiter on a heterotopic basilingual thyroid tissue causing dysphagia in a 58-year-old woman operated in the ENT department of the CHN in Nouakchott, Mauritania, the thyroid origin of the mass was confirmed by histology.展开更多
Background: Retrosternal goiters (RG) are those lesions extending to occupy the thoracic cavity. They carry a surgical risk due to distorted anatomy, the minimal access, and the potential for great vessels or pleural ...Background: Retrosternal goiters (RG) are those lesions extending to occupy the thoracic cavity. They carry a surgical risk due to distorted anatomy, the minimal access, and the potential for great vessels or pleural injury. No other effective therapeutic alternative to surgery exists. Cervicotomy is still the surgical approach of choice, although a form of sternotomy may always be necessary for field extension and safe gland delivery. Materials and Methods: This is a single institution combined retrospective & prospective study including retrospective analysis of all cases presenting to the NCI, Cairo University with RG candidate for surgery between Jan. 2008 until the end of Dec. 2012, and a prospective study of all cases with the same presentation presenting to the NCI between Jan. 2013 until the end of Dec. 2015. Data was collected from archive of patients at the statistical department. Aims: To study the clinico-pathological characteristics, the presentation, work-up, surgical approaches and postoperative complications of RG. Results: 42 patients were included & were divided into benign (34 patients, 80.9%) and malignant groups (8 cases, 19.1%). All patients (100%) were adults ranging (19 to 73 years) with mean 53.1 years. There was a female predominance (36 female, 85.7%) versus (6 males, 14.3%). Median duration of symptomatology was 23 months ranging (6 - 53 months). 23 patients (54.7%) were symptomatic while 19 cases (45.3%) accidently discovered. Mean tumor size was 9.97 cm in the benign group and 11.1 cm in the malignant group. 31 patients (73.8%) were euthyroid, 9 (21.4%) were thyrotoxic and 2 (4.7%) were hypothyroid. All patients (100%) underwent total thyroidectomy. The commonest approach was cervicotomy (33 cases, 78.6%), while a type of sternotomy was done in 9 cases (21.4%). 2 cases (4.7%) received postoperative radiation therapy & 4 cases (9.5%) received postoperative radioactive iodine. No perioperative mortality occurred & the overall morbidity was 6 cases (14.2%) in the benign group and 2 cases (4.7%) in the malignant group (4.7%). The median follow up period was 17.5 months. The median overall survival (OS) was 39.4 months and the median disease free survival (DFS) was 9.8 months for the malignant group. Conclusion: Cervicotomy is a safe favorable approach to remove a RG. Intraoperative field extension up to a form of sternotomy may be necessary for gland delivery with increasing operating time, hospital stay and morbidity. Postoperative morbidity is mainly due to the respiratory, recurrent laryngeal nerve palsy and hypoparathyroidism which is mainly increased when sternotomy is performed.展开更多
基金Supported by the Scientific Research Foundation of Peking University Shenzhen Hospital,No.KYQD202100Xthe National Natural Science Foundation of China,No.81972829and Precision Medicine Research Program of Tsinghua University,No.2022ZLA006。
文摘BACKGROUND Elderly giant retrosternal thyroid goiter is a rare yet significant medical condition,often presenting clinical symptoms that can be confused with other diseases,posing diagnostic and therapeutic challenges.This study aims to delve into the characteristics and potential mechanisms of this ailment through pathological diagnosis and immunohistochemical analysis,providing clinicians with more precise diagnostic and treatment strategies.A 77-year-old male,was admitted to hospital with the chief complaint of finding a goiter in the semilunar month during physical examination,accompanied by dyspnea.Locally protruding into the superior mediastinum,the adjacent structure was compressed,the trachea was compressed to the right,and the local lumen was slightly narrowed.The patient was diagnosed with giant retrosternal goiter.Considering dyspnea caused by trachea compression,our department planned to perform giant retrosternal thyroidectomy.Immunohistochemical results:Tg(+),TTF-1(+),Calcitonin(CT)(I),Ki-67(+,about 20%),CD34(-).Retrosternal goiter means that more than 50%of the volume of the thyroid gland is below the upper margin of the sternum.As retrosternal goiter disease is a relatively rare disease,once the disease is diagnosed,it should be timely surgical treatment,and the treatment is more difficult,the need for professional medical team for comprehensive treatment.CONCLUSION The imaging manifestations of giant retrosternal goiter are atypical,histomorphology and immunohistochemistry can assist in its diagnosis.This article reviews the relevant literature of giant retrosternal goiter immunohisto-chemistry and shows that giant retrosternal goiter is positive for Tg,TTF-1,and Ki-67.
基金supported by the National Natural Science Fund(82004337)the Beijing University of Chinese Medicine new teacher launch fund(2020-JYB-XJSJJ-002)。
文摘Objective:To explore the mechanism of Huatan Sanjie Fang(HTSJ)in regulating goiter in Graves'disease(GD)mice by detecting key factors of the Hippo signaling pathway.Methods:A mouse model of GD was established by injecting Ad-TSHR289 adenovirus into the bilateral quadriceps femoris of female mice.Successful mouse models were then randomly divided into a model group,methimazole(MMI)group,and HTSJ group,and fed with deionized water,MMI(4.5 mg/kg per day),and HTSJ(35.10 g/kg per day),respectively,for 10 weeks.Histopathological changes of the thyroid gland were subsequently observed by hematoxylin-eosin staining.Radioimmunoassay was used to detect serum total thyroxine(T4)and thyrotrophin-receptor antibody(TRAb)levels.The relative expression of mRNA of Mst1,YAP,and TAZ were detected by quantitative real-time polymerase chain reaction,while the protein expression of Mst1,YAP,TAZ,pMst1,and pYAP were detected by western blot.Results:After 10 weeks of drug intervention,goiter and other pathological changes in the HTSJ group significantly improved compared with the model group,and the levels of serum T4 and TRAb significantly decreased(P=.002,P<.001,respectively).Decreased mRNA expression of Mst1,YAP,and TAZ,the key factors of the Hippo signaling transduction pathway,was also observed(P=.002,P=.022,P<.001,respectively).In contrast,protein expression of Mst1(P=.046),pMst1(P=.026),and p YAP(P=.004)increased,while protein expression of YAP and TAZ decreased(P=.041,P<.001,respectively).Conclusion:HTSJ can effectively improve goiter in GD mice through the Hippo signaling pathway.
基金supported by the Fundamental Research Funds for the Central Universities(2021FZZX005-21).
文摘Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires thoracotomy.In recent years,there have been several reports of resection of substernal goiters by minimally invasive surgery.Here,we present a 75-year-old female with a giant substernal goiter who successfully underwent resection of the goiter extending to the posterior mediastinum using low cervical incision combined with video-assisted thoracoscopy.
基金Supported by the Key Project of Teaching Reform Research of Taishan Vocational College of Nursing(202307).
文摘As important drugs for the treatment of nodular goiter(NG),Prunella Spica preparations are widely used clinically,and have a significant effect on NG.Various active ingredients in the preparations intervene in the formation of NG by inhibiting the proliferation of thyroid follicular cells,promoting cell apoptosis,regulating immunity,improving the microcirculation of thyroid tissue and other mechanisms,and can reduce the postoperative recurrence of NG.
文摘Background: Multinodular goiter is a relatively common thyroid disorder with a marked female preponderance. Most of these goiters weigh less than 100 grams with those weighing more than 500 grams being exceptional. The massively expanding goiter due to the strategic anatomic location of thyroid gland, in addition to being cosmetically disfiguring can seriously compromise the patency of the trachea and oesophagus. Thyroidectomy for such goiters is a surgical challenge due to the possible association of tracheomalacia, retrosternal extension, skin involvement and the difficulty in intubation and dissection of the thyroid gland due to distorted and displaced anatomy. Material and methods: While presenting 2 patients who underwent thyroidectomy for glands weighing more than 500 grams, the literature is reviewed to analyze the technical difficulties and approach in such patients and the frequently encountered complications in them and their management. Results: A review of the literature revealed an additional 7 cases of patients who had undergone thyroidectomy for glands weighing more than 500 grams. Massively enlarged goiter was often associated with tracheomalacia, tracheal stenosis and retrosternal extension. Difficulty during surgery was most often encountered in establishing the airway and in exposure of the gland particularly when the skin was involved. The predominant postoperative complications were related to respiratory distress as a consequence of tracheomalacia and tracheal stenosis. Conclusion: In spite of the technical challenge related to the airway, and thyroidectomy, surgery continues to be the best option in experienced hands due to its distinct advantage of its immediate effect and complete resolution of compressive symptoms.
文摘Intrathoracic goiter(IG) is commonly located in the anterior mediastinum. Here, we report the case of a 54-year-old Chinese woman with successful removal of an intrathoracic goiter and improvement of dyspnea by a right posterolateral thoracotomy approach. Conclusion: Posterior mediastinal thyroid goiter with mediastinal compressive symptoms is an indication for surgery.
文摘Background: Thyroidectomy for giant goiter is a surgical challenge due to distorted and displaced anatomy. The aim of this study is to evaluate the relationship between giant goiter and its operative complications. Material and Methods: A retrospective multicenter study of consecutive patients who had thyroid surgery was conducted, including 639 patients who undergone thyroidectomy in State hospital at Van and Corlu city—Turkey. Seven cases had giant goiter in the patients. Total thyroidectomy was performed all patients. Results: All patients were women. The mean weight of glands removed was 689 gr in giant goiter’s patients. Two operative complications had happened;right site injury of the external branch of the superior laryngeal nerve had happened to one patient;hypocalcemia was happened to another one patient. In those two patients previously were operated partial thyroidectomy. Conclusions: Thyroidectomy for a massively enlarged goiter is technically challenging. The predominant operative complications were related to previously operate and the thyroid gland due to distorted and displaced anatomy. The surgical approach to such cases requires carefully preoperative evaluation and planning. Especially, using of intraoperative nerve monitoring is to be useful in these difficult cases which previously had undergone surgery.
文摘Purpose: To describe the aspects of the positive diagnosis of large goiters. Patients and Methods: We conducted a retrospective and prospective study including 115 patients from January, 2009 till December, 2014 (6 years) in Central Hospital of University of Point G in Bamako (Mali). The diagnosis of large goiters was based on the measurements of the anterior neck swelling. Thus large goiter was defined as any goiter including the height or width was greater than or equal to 10 cm (centimeters). Results: We operated 115 cases of large goiters on 760 goiters operated either 15.1%. The average age of patients was 44, 43 years ±14, 3 with extremes of 9 and 80 years. There was 101 women (87.8%) and 14 men (12.2%) with a sex ratio of 7.2 in favor of women. The signs of compression were dyspnea in 40% of cases (46/115), dysphonia in 13.0% (15/115), and dysphagia in 8.6% (10/115). The average height of goiter was 12.1 cm ± 3.5 cm with extremes of 10 and 29 cm and the average width was 14.4 cm ± 5.4 cm with extremes of 10 and 32 cm. Thyroid ultrasound found large goiters multinodular in 100%. Cervical radiography found the tracheal deviation in 48.2% (42/87), tracheal compression in 20.6% (18/87), plunging goiters in 11.5% (10/87). Cytology found a benign goiter in 97.4% of cases (112/115), malignant (thyroid cancer) in 2.6% of cases (3/115). Conclusion: Diagnosis of large goiters was based on the measurement of the swelling in our context. The signs of compression are the severity of this condition.
文摘Background: Schwannoma is a benign tumor derived from Schwann cells. The most common location was cerebellopontine angle (CPA). Neurilemmoma originated from the thyroid gland is very rare. Purpose: To discuss the diagnosis and treatment of cervical vagal schwannoma and the causes of misdiagnosis and preventive measures. Case Presentation: A case of cervical vagal schwannoma misdiagnosed as nodular goiter by ultrasonography was analyzed retrospectively. This patient was found to have pain in the neck for 1 month and then went to our hospital for treatment. After admission, a 5 cm × 4 cm mass was found on the left side of the neck, with a medium texture and clear margin. It could move with swallowing. Initially ultrasound showed a well circumscribed hypoechoic mass in the left thyroid lobe, which is suggestive of hemorrhage of thyroid nodule. Biopsy of thyroid nodules after ultrasound guided biopsy revealed Schwannoma. Surgical treatment and postoperative pathological examination confirmed cervical vagal schwannoma. The patient recovered well and was discharged 9 days after operation. Conclusion: The location of thyroid schwannoma is rare, the relationship between thyroid schwannoma and surrounding tissues is unclear, and there is no typical ultrasonic manifestation. Moreover, if doctors are not aware of their knowledge, it is easy to cause misdiagnosis. Radiologists should raise awareness of the disease and carefully analyze the results of ultrasonography in combination with the clinical manifestations of the patients so as to reduce or avoid misdiagnosis of cervical schwannoma.
基金Supported by National Natural Science Foundation of China(General Program),No.81571694(to Peng YL).
文摘BACKGROUND Metastasis to the thyroid gland(TM)from primary breast cancer is uncommon and usually presents as thyroid nodules;however,diffuse goiter without thyroid nodules is the first sign of TM in rare cases.Skip metastases(SMs)to the lymph nodes in breast cancer,defined as discontiguous higher-level metastases in the absence of lower levels of contiguous metastases,have been reported in the contralateral cervical area of the primary tumor site in rare cases.CASE SUMMARY A 49-year-old previously healthy Chinese woman was diagnosed with right lateral invasive ductal carcinoma and underwent neoadjuvant chemotherapy treatment and bilateral mastectomy with axillary lymph node dissection.No malignancy of the left breast or axillary or distant metastases were identified preoperatively.However,enlarged left cervical lymph nodes were detected 36 mo after surgery,and rapidly enlarging thyroid glands without nodules were detected 42 mo after surgery.Fine-needle aspiration cytology was performed on the left cervical lymph nodes and left lobe of the thyroid,which were both revealed to contain metastases from the primary breast cancer.Additionally,the immunostaining profiles changed in the process of metastases.The patient was discharged with the NP(vinorelbine and cisplatin)regimen for subsequent treatment,and stable disease was determined when the curative effect was evaluated.CONCLUSION Diffuse goiter may be the first sign of TM,and enlarged lymph nodes in the contralateral cervical area may be SMs of primary breast cancer.
文摘Introduction: Total thyroidectomy is an operation that involves the surgical removal of the whole thyroid gland, with the preservation of the parathyroid glands. The aim of the present study was to assess the complication rates of total thyroidectomy on benign indication and first-time thyroid surgery and investigate the early outcome after opotherapy. Materials and Methods: In this retrospective study, patients who underwent total thyroidectomy for benign multinodular goiter in the department of thoracic surgery in our Hospital from January 2012 to December 2014 were included. In postoperative time, we evaluated surgical complication, histopathological examination and opotherapy. Results: A total 53 patients underwent total thyroidectomy for multmodular goiter;they were 49 (92.45%) bilateral and 4 (7.55%) unilateral (recurrence). The mean age was 47 years and mean diameter of goiter was 10.75 cm. Among the patients 88.68% were females and 11.32% were male. Preoperative hormonal statuses were (70%) in euthyroid and (30%) hyperthyroid following surgery complications like transient laryngeal nerve palsy (3.77%), transient hypocalcemia (7.55%), hematoma (1.9%) and wound infection (1.9%). On histopathological examination of the surgical specimen, 5.7% were reported to be malignant. Six month following surgery 92.45% of patients was a good hormonal balance. Conclusion: Total thyroidectomy for multinodular goiter has a low morbidity and mortality;this procedure olves both the problem of recurrence of disease and reintervention. The opotherapy is doable with a good hormonal balance.
文摘Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Department of Obstetrics and Gynecology at Microcitemico Pediatric Hospital, Cagliari, for suspected fetal goiter at 32 gestational weeks. The case was monitored regularly by ultrasound and treated successfully with intra-amniotic levothyroxine (L-T4) administration. Fetal goiter was observed to decrease after this treatment and the thyroid ultrasound findings were also normal both at birth and in subsequent follow-ups. Our case report confirms the feasibility of conservative treatment with L-T4, which can effectively prevent complications related to fetal goiter.
文摘Pregnant women sometimes have thyroid disease, and thus goiter;however, it does not become so large to the extent that the goiter obstructs the air way, causing respiratory symptoms. Here, we report such a case. A 27-year-old woman with large goiter presented with life threatening stridor at 37 weeks. <span style="font-family:Verdana;">After a multidisciplinary-team discussion, we performed caesarean section</span><span style="font-family:Verdana;"> plus thyroidectomy, which resulted in good outcomes. Histological examination revealed hyperplasia and not malignancy. The postoperative course was uneventful. The mother and infant were healthy.</span>
文摘Thyroid gland is one of most important endocrine glands in the body. It plays vital role in growth control and its measurements tends to change in respect to age, sex, weight and ethnic group of the individual. This study aimed to assess endemic goiter and to estimate the measurement of normal thyroid gland dimensions and thyroid hormones level in school-aged children using Ultrasonography and ELISA Technique in Eastern Sudan (Kassala state). A total of 100 subjects is 6 - 18 years (43 males, 57 females), and mean of age (9.73 ± 2.54 years). This study was done in the period from April 2016 to February 2017. All the subject undergone thyroid ultrasound and thyroid hormone level test. Subjects with history of goiter were excluded from the study, by thyroid dimension (length, height and diameter). Thyroid volume was estimated using ellipsoid formula and thyroid hormones (TSH, T3 and T4) using Toso full automation. The study revealed that 12 subjects of the study (12%) with goiter, 7 female (7%) and 5 males (5%) with age ranged 6 - 11 years with increase in TSH and T3 and decrease in T4 level. The mean of thyroid volumes for normal subject and subject of goiter are 4.93 ± 0.63, 5.4 ± 1.4 mL, respectively, and TSH, T3, T4 (1.8 ± 0.97, 2.4 ± 0.86 UIu/nL), (3.61 ± 0.32, 3.8 ± 0.55 Pg/Nl), (1.35 ± 1.23 ng/DI level respectively). It concluded that there was positive correlations between the age and the thyroid volume (p = 0.65). It increases with increase of the age. The Rt lobe is larger than the Lt lobe;the thyroid volume is higher in male than female, and this study found the TSH and T3 decreased with ages while T4 increased with ages in normal subject;TSH and T3 level increased and T4 level decreased in goiter children.
文摘AIM: To compare our ten year results for thyroidectomy for cervico-mediastinal goiters with the best surgical treatment reported in the literature.METHODS: From January 2000 to December 2009, of 1530 patients who underwent thyroidectomy in our department, we selected 105 cases of cervico-mediastinal goiter. In the majority of cases, the cervical approach is the standard procedure and only occasionally sternotomy or thoracotomy is necessary. The indications for surgery are generally related to a progressive increase of the thyroid mass into the anterior mediastinum with compression and dislocation of the trachea or esophagus and the possibility of an unknown malignancy.RESULTS: In 98(93.3%) of our 105 patients, the standard surgical approach was anterior cervicotomy followed by total thyroidectomy. In three cases, total sternotomy was performed and in the remaining four patients, a partial split sternotomy was effective to remove the intrathoracic mass. Post-operative complications included transient recurrent laryngeal nerve palsyin 6 patients(5.7%) which only became permanent in 2 patients(1.9%). The transient hypoparathyroidism rate was 22% but 2 mo after surgery permanent hypoparathyroidism was confirmed in only 2% of our selected group. No patients required temporary tracheostomy following surgery related to a possible bilateral nerve palsy. Patients received a single prophylactic antibiotic dose preoperatively and wound infections were not significant. There was no mortality in our selected group and most patients showed a significant improvement of dyspnea and other correlated symptoms postoperatively.CONCLUSION: The majority of cervico mediastinal goiters can be completely removed through a cervical incision. In selected cases, generally malignancies with local infiltration of mediastinal soft tissues and adhesions to large vessels, split sternotomy may be a safer approach to not increase morbidity.
文摘Amyloid goiter (AG) is a rare but well-established disease entity that may occur in a number of conditions. In the following article, we will report two cases of AG. Both patients were young males: 28 & 24 years old, presented with rapidly enlarging thyroid gland manifested with pressure effects (dyspnea and hoarseness of voice). Provisional clinical diagnosis was malignant thyroid neoplasm. One of the patients was markedly hypothyroid while the other was euthyroid. Histopathological evaluation revealed extracellular deposition of deep pink homogenous material that was confirmed as amyloid with congo red. Patient in case 1 was primary localized AG while patient in case 2 was systemic amyloidosis secondary to interstitial pulmonary fibrosis (IPF) that was first manifested by AG. The main aims of the article were to describe histopathological features of amyloidosis of the thyroid gland and to raise awareness of AG to be included in the differential diagnosis in patients presented with rapidly enlarging goiter with mass effects.
文摘Introduction: Goiter often poses aesthetic disgrace problem. The psychosocial impacts of goiter, in particular in woman may be significant. Objective: studying the psychological and social impacts of the disease in goiter patients within the African context and their consequences on the treatment. Methods: It was a transversal study that took place from May 1to July 31, 2011 in the Collines and Donga departments situated in the center and the north of Benin. The study consisted of a survey conducted through an individual discussion based on questionnaire submitted to goiter patients who accepted to provide their answers. Results: This survey involved 86 patients of which 83 women and 3 men. Their average age was 43.7 ± 13.41. Goiter was noticeable in the totality of the patients. 68.6% of patients declared that they experienced on daily basis the shame caused by the disease. 66% thought that it was a natural disease;however, 27.9% believed that it was caused by bewitchment or sorcery. 46.5% and 37.2% resorted to modern and indigenous medicine respectively;16.3% made no therapeutic move. Despite the psychosocial impacts of the disease, 50% of the patients rejected surgical intervention possibility. The core motives they raised were lack of financial means (34.8%), disease recurrence fright (23.3%), anesthesia fright (16.3%), and surgical fright (14%). Conclusion: Despite the psychological impacts of the disease, strong resistance exists probably more on cultural aspect than the motives mentioned by thyroidectomy patients.
文摘Aims: To describe the diagnostic aspects, surgical indications and post-operative complications of thyroidectomies performed in our department. Materials and method: A descriptive retrospective study that took place in the ENT Department and Cervicofacial Surgery of Gabriel TOURE University Hospital of Bamako. We did a comprehensive sampling of all goiter cases from January 2013 to December 2018. Were included in the study, the records of patients of all ages and genders, admitted into the ward and scheduled for thyroidectomy (partial or total). The exclusion criteria were incomplete hospitalization records. There were a total of 139 files were retained. Results: In 60 months, 139 cases were collected out of 1720 patients hospitalized for surgery, representing a hospital prevalence of 8.08%. The average age was 46.89 years. (123 women and 16 men). The socio-professional categories were dominated by housewives (68.34%). The reported functional signs were tachycardia, asthenia and other signs of dysthyroidism in 59% as well as signs of compression in 24.46%. In 72 cases or 51.80%, the patients consulted between 2 and 10 years of disease progression. Twenty patients or 14.39% had a history of familial goiter and 2 patients had a history of thyroid surgery. On physical examination the swelling was antero-cervical in 56.83% of cases. In 96 cases or 69.06% the glandular diameter was between 5 and 9 cm. In 2 cases or 1.43% we noted cervical adenopathy in the jugulo-carotid chain. Ultrasound, TSHus and fT4 were performed first-line and systematically in all our patients. Ultrasound objectified an appearance of multinodular goiter in 106 cases or 76.26%. In 60.43% of cases the patients were TI classes RADS 3, they were TI RADS 4A in 16 cases or 11.51%. CT scans were performed in 3 patients or 2.15% to specify the loco-regional extension, to look for possible lymph node invasion, and to compress or dipping the goiter. Surgical indication was placed in front of a multinodular goiter (GMN) in 106 cases or 76.26%, a single goiter in 11 cases or 7.9%, a single nodule greater than 3 cm in 17 cases or 12.23%, Basedow disease in 4 cases or 2.88% and a recurrence in one case 0.72%. We performed a lobo-isthmectomy in 56.11%, a total thyroidectomy in 20.14% of cases, subtotal in 20.86% of cases and total thyroidectomy with mediation-recurrent lymph node curage and bilateral jugulo-carotidien in 4 cases or 2.87%. Recurrent nerves were systematically searched and seen in all cases. Replacement therapy was indicated in all patients who underwent a total thyroidectomy. Complications recovered were 1 case of compressive hematoma, 6 cases of transient dysphonies and cough, 4 cases of definitive hypocalcemia. 1 case of recurrence, but no deaths were observed. Histopathology performed in all of our patients was dominated by vesicular and colloid adenoma. Conclusion: Thyroid surgery is a common surgery but not devoid of complications, the most dangerous of which remain recurrent impairment and definitive hypoparathyroidism. The experience of all surgical teams in the vasculo-nervous anatomy of the neck is the best guarantor to reduce and prevent complications.
文摘Thyroid heterotopia is an abnormal localization of normal thyroid tissue coexisting with a normal organ and of normal localization. It is distinguished from ectopic thyroid and thyroid cancer metastasis. Lingual or sublingual thyroid is defined as the presence of thyroid tissue in the midline at the base of the tongue anywhere between the circumvallate papillae and the epiglottis. The prevalence of lingual thyroid is 1 in 100,000, and it is more common in women, with a female to male ratio ranging from 3:1 to 7:1. Embryologically, the thyroid originates at the foramen cecum, which is located at the junction of the anterior two thirds with the posterior one-third of the tongue, report a case of a goiter on a heterotopic basilingual thyroid tissue causing dysphagia in a 58-year-old woman operated in the ENT department of the CHN in Nouakchott, Mauritania, the thyroid origin of the mass was confirmed by histology.
文摘Background: Retrosternal goiters (RG) are those lesions extending to occupy the thoracic cavity. They carry a surgical risk due to distorted anatomy, the minimal access, and the potential for great vessels or pleural injury. No other effective therapeutic alternative to surgery exists. Cervicotomy is still the surgical approach of choice, although a form of sternotomy may always be necessary for field extension and safe gland delivery. Materials and Methods: This is a single institution combined retrospective & prospective study including retrospective analysis of all cases presenting to the NCI, Cairo University with RG candidate for surgery between Jan. 2008 until the end of Dec. 2012, and a prospective study of all cases with the same presentation presenting to the NCI between Jan. 2013 until the end of Dec. 2015. Data was collected from archive of patients at the statistical department. Aims: To study the clinico-pathological characteristics, the presentation, work-up, surgical approaches and postoperative complications of RG. Results: 42 patients were included & were divided into benign (34 patients, 80.9%) and malignant groups (8 cases, 19.1%). All patients (100%) were adults ranging (19 to 73 years) with mean 53.1 years. There was a female predominance (36 female, 85.7%) versus (6 males, 14.3%). Median duration of symptomatology was 23 months ranging (6 - 53 months). 23 patients (54.7%) were symptomatic while 19 cases (45.3%) accidently discovered. Mean tumor size was 9.97 cm in the benign group and 11.1 cm in the malignant group. 31 patients (73.8%) were euthyroid, 9 (21.4%) were thyrotoxic and 2 (4.7%) were hypothyroid. All patients (100%) underwent total thyroidectomy. The commonest approach was cervicotomy (33 cases, 78.6%), while a type of sternotomy was done in 9 cases (21.4%). 2 cases (4.7%) received postoperative radiation therapy & 4 cases (9.5%) received postoperative radioactive iodine. No perioperative mortality occurred & the overall morbidity was 6 cases (14.2%) in the benign group and 2 cases (4.7%) in the malignant group (4.7%). The median follow up period was 17.5 months. The median overall survival (OS) was 39.4 months and the median disease free survival (DFS) was 9.8 months for the malignant group. Conclusion: Cervicotomy is a safe favorable approach to remove a RG. Intraoperative field extension up to a form of sternotomy may be necessary for gland delivery with increasing operating time, hospital stay and morbidity. Postoperative morbidity is mainly due to the respiratory, recurrent laryngeal nerve palsy and hypoparathyroidism which is mainly increased when sternotomy is performed.
