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

      research-article
      Author(s): a , * , b
      Publication date (Electronic):
      Journal: European Thyroid Journal
      Publisher: S. Karger AG
      Keywords: Endemic goiter, Unilateral goiter, Monolobar goiter

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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 obectomy, 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 3, T 4 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 references41

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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.
            Article 0 comments Cited 72 times – based on 0 reviews     Review now
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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 (nlm-ta): Eur Thyroid J
                Journal ID (iso-abbrev): Eur Thyroid J
                Journal ID (publisher-id): ETJ
                Title: European Thyroid Journal
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                ISSN (Print): 2235-0640
                ISSN (Electronic): 2235-0802
                Publication date (Print): October 2012
                Publication date (Electronic): 15 September 2012
                Publication date PMC-release: 1 April 2013
                Volume: 1
                Issue: 3
                Pages: 198-203
                Affiliations
                [1] aDepartment of Surgery, University Charity and Teaching Hospital and Khartoum Breast Care Center, Khartoum, Sudan
                [2] 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@ 123456hotmail.com
                Article
                Publisher ID: etj-0001-0198
                DOI: 10.1159/000342361
                PMC ID: 3821475
                PubMed ID: 24783020
                SO-VID: 7329356c-b3fd-4707-abef-15dec696c7a4
                Copyright © Copyright © 2012 European Thyroid Association Published by S. Karger AG, Basel
                History
                Date received : 14 May 2012
                Date revision received : 1 August 2012
                Page count
                Figures: 5, References: 40, Pages: 6
                Categories
                Subject: Clinical Thyroidology / Original Paper

                Keywords: endemic goiter,unilateral goiter,monolobar goiter
                Data availability:
                Keywords: endemic goiter, unilateral goiter, monolobar goiter

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