Single Lobe Disease in Cases of Advanced Endemic Goiter: A New Phenotype

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Abstract

Objectives: To report a new phenotype of advanced endemic goiter that affects only one lobe of the thyroid gland. Patients and Methods: This study included 60 patients from the west of Sudan with long-standing unilateral simple endemic goiter that required lobectomy, with emphasis on the gross appearance, measurements and cytological features of the contralateral lobe. Results: Out of 60 patients with unilateral goiter, 50 (83%) were found to have the disease on the ipsilateral lobe only (monolobar goiter). The contralateral lobe in these 50 patients showed no nodularity, and its volume was within the normal limits. All patients with monolobar disease had total lobectomy on the affected side, and postoperatively they continued to have normal blood levels of T<sub>3</sub>, T<sub>4</sub> and TSH. Conclusion: We report a new phenotype of advanced endemic goiter that affects only one lobe of the thyroid gland, and in the presence of a structurally and functionally normal contralateral lobe.

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Most cited references 41

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Thyroid development and its disorders: genetics and molecular mechanisms.

R Lauro, Mario De Rosa (2004)

Thyroid gland organogenesis results in an organ the shape, size, and position of which are largely conserved among adult individuals of the same species, thus suggesting that genetic factors must be involved in controlling these parameters. In humans, the organogenesis of the thyroid gland is often disturbed, leading to a variety of conditions, such as agenesis, ectopy, and hypoplasia, which are collectively called thyroid dysgenesis (TD). The molecular mechanisms leading to TD are largely unknown. Studies in murine models and in a few patients with dysgenesis revealed that mutations in regulatory genes expressed in the developing thyroid are responsible for this condition, thus showing that TD can be a genetic and inheritable disease. These studies open the way to a novel working hypothesis on the molecular and genetic basis of this frequent human condition and render the thyroid an important model in the understanding of molecular mechanisms regulating the size, shape, and position of organs.

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Thyroid incidentalomas. Prevalence by palpation and ultrasonography.

S. Ezzat (1994)

Thyroid nodules are commonly identified on autopsy examination. There are relatively few descriptions, however, of the frequency with which thyroid nodules are encountered incidentally during the course of other investigations. Prospective study to examine the prevalence of thyroid nodules in asymptomatic North American subjects, with palpation findings compared with findings on high-resolution ultrasonography. Palpable nodules were identified in 21 (21%) of 100 subjects, with nine solitary nodules (9%) and 12 multiple nodules (12%). In comparison, only 33 subjects were found to be free of any nodules by ultrasonography. Of the 67 subjects with abnormal ultrasound findings, 22 had solitary nodules (22%) and 45 had multiple nodules (45%). The prevalence of nodules was greater in women (72%) than in men (41%) (P < .02). A concordance rate of 49% was noted between ultrasound and findings by palpation. The data indicate that thyroid abnormalities are very common incidental findings, emphasizing the need for a conservative approach when such lesions are encountered incidentally.

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New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report.

Khairya Moosa, E Pretell, Luciano Molinari … (2004)

Goiter prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDDs) in a population. In areas of mild-to-moderate IDDs, measurement of thyroid volume (Tvol) by ultrasound is preferable to palpation for grading goiter, but interpretation requires reference criteria from iodine-sufficient children. The study aim was to establish international reference values for Tvol by ultrasound in 6-12-y-old children that could be used to define goiter in the context of IDD monitoring. Tvol was measured by ultrasound in 6-12-y-old children living in areas of long-term iodine sufficiency in North and South America, central Europe, the eastern Mediterranean, Africa, and the western Pacific. Measurements were made by 2 experienced examiners using validated techniques. Data were log transformed, used to calculate percentiles on the basis of the Gaussian distribution, and then transformed back to the linear scale. Age- and body surface area (BSA)-specific 97th percentiles for Tvol were calculated for boys and girls. The sample included 3529 children evenly divided between boys and girls at each year ( +/- SD age: 9.3 +/- 1.9 y). The range of median urinary iodine concentrations for the 6 study sites was 118-288 micro g/L. There were significant differences in age- and BSA-adjusted mean Tvols between sites, which suggests that population-specific references in countries with long-standing iodine sufficiency may be more accurate than is a single international reference. However, overall differences in age- and BSA-adjusted Tvols between sites were modest relative to the population and measurement variability, which supports the use of a single, site-independent set of references. These new international reference values for Tvol by ultrasound can be used for goiter screening in the context of IDD monitoring.

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Author and article information

Journal

Journal ID (publisher-id): ETJ

Journal ID (pmc): ETJ

Journal ID (doi): 10.1159/issn.2235-0640

Title: European Thyroid Journal

Publisher: S. Karger AG

ISSN (Print): 2235-0640

ISSN (Electronic): 2235-0802

Publication date Subscription-year: 2012

Publication date (Print): October 2012

Publication date (Electronic): 15 September 2012

Volume: 1

Issue: 3

Pages: 198-203

Affiliations

^aDepartment of Surgery, University Charity and Teaching Hospital and Khartoum Breast Care Center, and ^bDepartment of Pathology, University of Medical Sciences and Technology, Khartoum, Sudan

Author notes

*Omar Abdul Hameed Ali, Khartoum Breast Care Center, PO Box 276, Khartoum (Sudan), Tel. +249 91 215 3084, E-Mail omarhameed87@hotmail.com

Article

Publisher ID: 342361 Pmcid ID: PMC3821475 Other ID: Eur Thyroid J 2012;1:198–203

DOI: 10.1159/000342361

PMC ID: PMC3821475

PubMed ID: 24783020

SO-VID: 7329356c-b3fd-4707-abef-15dec696c7a4

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 14 May 2012

Date accepted : 01 August 2012

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Figures: 5, Pages: 6

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Single Lobe Disease in Cases of Advanced Endemic Goiter: A New Phenotype

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Karger: Endocrinology

Most cited references 41

Thyroid development and its disorders: genetics and molecular mechanisms.

Thyroid incidentalomas. Prevalence by palpation and ultrasonography.

New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report.

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