Search

Iodine is an essential component of hormones produced by the thyroid gland. Thyroid hormones, and therefore iodine, are essential for mammalian life. Optimal dietary iodine intakes for healthy adults are 150–250 µg day −1 . Iodine deficiency has multiple adverse effects in humans due to inadequate thyroid hormone production that are termed as iodine deficiency disorders. Assessment methods of iodine status include urinary iodine concentration, goiter, and blood thyroglobulin. Globally, it is estimated that 2 billion individuals have an insufficient iodine intake, in both industrialized and developing countries. In most countries, the best strategy to control iodine deficiency in populations is carefully monitored iodization of salt.

Background The purpose of the study was to analyze and discuss the demographic, clinical, radiological, therapeutic and postoperative findings of the Cervico-mediastinal goiters (CMG) treated through a cervical approach admitted in the ENT department of Ibn Rochd university hospital, Casablanca, Morocco between January 2014 and January 2020. Materiels and methods Over a period of 6 years, 116 patients underwent surgical treatment for CMG. It was defined as a goiter extending below the plane of superior thoracic aperture on CT scan. All our patients had clinical, biological and radiological assessment before surgery. A nasofibroscopy was carried out pre and postoperatively. All the CMG have been extracted trough a cervical approach by an experimented ENT surgeon. Results 84,48% of the CMG was diving into the anterior mediastinum and 15.52% into the posterior. The CMGs extended above, at, and below the level of the aortic arch respectively in 76.72%, 18.10% and 5.17% of the patients. All of 116 goiters were successfully removed through a cervical approach. No patient required a sternotomy. Postoperatively, vocal cord paralysis was transient in 3 patients (2.58%) and permanent in 2 patients (1.72%). Hypocalcemia was transient in 10 patients (8.62%) and permanent in 2 patients (1.72%). Final histology found 106 benign multinodular goiters (91.37%), 7 papillary carcinomas (6.03%) and 3 vesicular carcinomas (2.58%). No death was noted. Conclusions With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases with low morbidity rate and no mortality., Highlights • In the literature, there is no consensus on the definition of cervico-mediastinal goiters. • CMG is a challenging disease that needs proper clinical, biological and radiological assessment. • Malignancy in a CMG is not higher than that of the cervical goiters and most of the foci in CMG were in the intrathoracic region. • With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases.

Highlights • A two Kilograms Euthyroid Goiter. • Multinodular goiter (MNG) is a clinic pathological entity characterized by an increased volume of the thyroid gland with formation of nodules. • Awareness on the operation of such huge multinodular goiter is the sincere aim of this work due to the fact that these are rare findings in today’s surgical clinics., Introduction Multinodular goiter (MNG) is a clinic pathological entity characterized by an increased volume of the thyroid gland with formation of nodules. Goiter is defined as a thyroid gland weighing over 20–25 g or with a volume of over 19 ml in women and 25 ml in men. In developed countries where iodination of food is common and health services are available and accessible, hardly will you see a goiter of up to 0.2 kg while in areas where poverty is high and health services not available, there identification of goiter of up to 4 kg. Therefore each member of theatre team must be competent and experienced to anticipate any complications which may occur during thyroidectomy of such huge goiter. Awareness on the operation of such huge multinodular goiter is the sincere aim of this work due to the fact that these are rare findings in today’s surgical clinics. Presentation of case A 35 M.O.S years old female presented with complain of swelling of the anterior neck for 10 years. Laboratory and radiological investigations reveals nontoxic multinodular goiter with no suspicion of malignance. After successful thyroidectomy, a 2 kg multinodular goiter was removed and taken for histological diagnosis. Post-operative care was uneventful and patient discharged day five post-operative. No complication observed during follow up. Discussion The case report presented a patient with huge goiter of 2 kg, which was not compressing the trachea. After physical examination, radiological imaging and laboratory investigation of thyroid hormones confirm as nontoxic goiter. The subtotal thyroidectomy was successful and after follow up of 60 days there was no complication reported. Conclusions Currently, hardly will you find goiter weighing a kg and thus skills for thyroidectomy in such case is hardly available. Special complications like trachealmalacia and difficult intubation which need one to be aware of fiber optic intubation and be prepared for tracheostomy require experienced operating team.

Resistance to thyroid hormone (RTH) is a rare congenital disorder characterized by impaired sensitivity of target tissues to thyroid hormone. The disease is mostly caused by heterozygous mutations of thyroid hormone receptor β (THRB) gene. We present a ten-year-old Taiwanese boy with goiter, mood disturbances and attention deficit hyperactivity disorder (ADHD). Blood tests showed elevated serum thyroxine (T4) and triiodothyronine (T3) levels with nonsuppressed thyrotropin (TSH) levels. Sella MRI failed to detect any pituitary adenoma. Initial treatment with anti-thyroid drugs resulted in increased TSH levels and goiter size. His medication was discontinued after his visit to our hospital for a second opinion. A thyrotropin-releasing hormone (TRH) stimulation test showed a normal TSH response to TRH stimulation. Molecular analysis identified a novel heterozygous THRB p.Val349Ala mutation. The patient attained normal growth and a paucity of symptoms without any medication during the follow-up period. We hope that the presentation of this case can make the early diagnosis of RTH possible so that inappropriate management of these patients can be avoided in the future.

Introduction Amyloid goiter is a rare presentation of thyroid swelling, which occurs with either primary or secondary amyloidosis. This condition must be differentiated from other types of goiters or malignancies. Even though the thyroid is extensively involved by amyloid, patients are usually euthyroid, but many different presentations and overlaps have been reported. Currently the treatment is surgical resection of the thyroid gland Case presentation We report a case of a 53-year-old previously healthy male who presented with a 2 year history of a progressively enlarging painless neck swelling. The patient was euthyroid and denied any associated symptoms. The patient subsequently underwent an uneventful total thyroidectomy along with an unremarkable follow up and was diagnosed with primary amyloidosis involving only the thyroid gland confirmed by histopathology. Discussion and conclusion Amyloid goiter is a rare entity; a high index of suspicion is required in patients with an enlarging thyroid gland and a concomitant history of chronic inflammatory processes or plasma cell dyscrasia. FNA biopsy should be performed to exclude the top differential of primary thyroid malignancy. Thyroidectomy is necessary for definitive diagnosis and symptom relief. Every effort should be made to delineate the extent of the disease, and in those previously healthy plasma cell dyscrasia should be excluded, Highlights • We present a rare case of amyloid goiter, detailing our work up, results and management. • The majority of patients are euthyroid at presentation. • Thyroid malignancy must be ruled out as a differential. • Thyroidectomy is necessary to reach a definitive diagnosis and/or for symptom relief. • Systemic workup required; delineating extent of disease.

Background/purpose: Few studies exist investigating the effectiveness of radioiodine (RAI) therapy for hyperthyroidism patients in Asia. We herein investigated the real-world efficacy of single-dose RAI therapy in Taiwanese patients with Graves’ disease (GD). Methods: This is a retrospective study of 243 patients with GD recorded between 1989 and 2016 in a tertiary referral hospital. Eu- or hypothyroid after RAI therapy were defined as the successful group. Kaplan–Meier curve and cox-regression model were used for analysis of prognostic factors. Results: Of the 243 patients, 187 were females, with mean age of 46.9 ± 13.6 years. Most patients (63.8%) did not choose RAI as the first-line therapy. The median dose was 7 mCi, with a mean follow-up period of 107.1 ± 82.8 months. The overall success rate was 70.9%. Univariate analysis revealed calculated- or fixed-dose (P = 0.015), goiter size (P

Highlights • Papillary thyroid carcinoma is the most widely recognized pediatric carcinoma. • Thyroid paraganglioma is rare, arises from inferior laryngeal paraganglioma. • It’s hard to separate from thyroid carcinomas as it arises from thyroid capsule. • The only way to differentiate the two diseases is through immunohistochemistry., Background Papillary thyroid carcinoma is a common neoplasm arising from follicular cells of the thyroid. Differentiating the neck mass between thyroid paraganglioma and papillary thyroid carcinoma is often difficult. Case report We report a 16-year-old girl with painless neck mass. Physiological goiter was suspected initially but we found papillary thyroid carcinoma. Results CT neck revealed hyper vascular lesions in bilateral lobes of thyroid. DSA imaging was done for further evaluation which showed high flow fistulous type of lesion supplying from superior thyroidal artery raising suspicion of paraganglioma. Postoperative biopsy ultimately revealed papillary carcinoma of thyroid in the background of hashimotos’ thyroiditis with metastatic deposits in neck lymph nodes. Conclusion Thyroid paraganglioma is a rare type of tumor, it arises from inferior laryngeal paraganglioma within thyroid capsule and is as thus difficult to distinguish from thyroid carcinomas. A biopsy is the best diagnostic choice but immunohistochemistry is the only investigation which is considered as the gold standard for distinguishing between these two diseases.

Introduction and importance This case series describe the efficacy of hemi-thyroidectomy to relieve the compressive symptoms of cases having large multi-nodular goiter with preservation of the thyroid gland function. It's considered as an education tool for surgeons to perform safe hemi thyroidectomy to patients indicated for total removal of the gland. Compressive symptoms like mild/severe dysphagia or dyspnea associated with both benign and malignant thyroid disease. Although total thyroidectomy is currently considered the standard of care, hemi thyroidectomy is another surgical option with more benefits. Case presentation This case series was performed in a tertiary university hospital in Riyadh, Saudi Arabia. It included 35 females and 3 males above the age of 18 (mean age 42 years). All the operations were elective hemi-thyroidectomies performed by one surgeon, during 2019. Patients were complaining of; Voice Change, Neck Swelling, Dysphagia, Chocking, SOB, and Orthopnea. 20 of them were medically free and 18 patients had multiple associated comorbidities. Clinical findings and investigations Demographic data, baseline co-morbidities, TSH levels prior to surgery, thyroid gland size, FNA results and pre-operative symptoms were recorded. In addition, compressive symptomatology outcomes from two weeks to two years were recorded. Thirty-two of them (84%) had their symptoms resolve completely and did not need a completion surgery. Out of the 6 who had persistent symptoms, only two needed a completion surgery. Furthermore, only 34.2% required thyroid hormone replacement, 31.6% were euthyroid and 2.6% were hypothyroid preoperatively. Interventions and outcome Hemi thyroidectomy was chosen to avoid the risk of hormone replacement, and hypocalcemia. Our results revealed that compressive symptoms were effectively relieved in the majority of our patients. Only 2 patients had to undergo completion thyroidectomy due to compressive symptoms with no perioperative or postoperative complications. Relevance and impact We would recommend hemi thyroidectomy for cases of large multi nodular goiter due to its positive implication on patient outcome particularly if the patient refuse hormonal replacement., Highlights • Compressive symptoms were effectively relieved in the majority of our patients. • Only 2 patients had to undergo completion thyroidectomy due to compressive symptoms. • No perioperative or postoperative complications were witnessed during the primary or completion surgery. • The main drawback with hemithyroidectomy is recurrence. • Nevertheless, most recurrences post thyroid surgery are asymptomatic and are diagnosed on ultrasonography.

Surgery for thyroid goiter presents a unique set of challenges to the surgeon based on goiter size and extent, associated distortion of complex neck base anatomy, and goiter vascularity. Specific goiter characteristics influence the risk of potential upper airway compromise as well as the intraoperative risk of injury to the parathyroid glands and recurrent laryngeal nerves. In this chapter, cervical and substernal goiter definition and clinical presentation are reviewed in addition to typical goiter workup and management options. Special consideration is given to airway assessment in the goiter patient, including a discussion of the potential for airway compromise and specific intubation concerns. Surgical technique for goiter resection is outlined with particular emphasis on strategies to reduce the risk of injury to important anatomic structures that may be distorted, such as the case of a retrotracheal or posterior mediastinal goiter and the associated ventral recurrent laryngeal nerve. In the special case of substernal goiter, specific circumstances that may necessitate the rare need for sternotomy are outlined. Finally, potential postoperative complications are discussed, including recurrent laryngeal nerve paralysis, hypoparathyroidism, and the more controversial rate of tracheomalacia.

The prevalence of thyroid nodules increases with age and of those 5%–10% are malignant. Management is aimed to exclude thyroid cancer. Clinical history is not sensitive or specific to diagnose thyroid cancer. Serum TSH, ultrasound (US), and thyroid fine-needle aspiration (FNA) determine the management of thyroid nodules. FNA can be avoided in any autonomous thyroid nodule that presents with low serum TSH. The suspicious US characteristics of malignancy and the risk history are the same for young and old adults. Indication-selection of thyroid nodules for FNA is made according to most recent clinical guidelines by personal risk factors, suspicious US features, and sonographic patterns of malignancy risk. The Bethesda thyroid cytological reporting system allows to categorize cytological lesions by malignancy risk and to make therapeutic recommendations. The use of molecular markers in FNA material for the differential diagnosis of the benign and malignant thyroid nodule can avoid surgeries. Simple Goiter (SG) is asymptomatic in most patients, although hyperthyroidism risk increases in the elderly. Symptoms also depend on the type of goiter (nodular or diffuse), size, and speed of growth. Obstructive symptoms may occur in long-evolving, large-sized multinodular goiters of elderly patients. Measurement of serum TSH and US performance—and FNA if indicated—to measure thyroid size, nodules, and evolution, are required. When clinical suspicion of compressive or substernal goiter exists, chest X-ray and/or cervical-thoracic CT are useful to evaluate suspected tracheal compression. Most patients do not require treatment but just monitoring of thyroid function and size. There is no consensus on the ideal treatment of the nontoxic goiter. TSH suppression therapy with L-T4 is controversial in elderly patients because of the adverse effects. Long-term studies comparing surgery with radioiodine in elderly patients are lacking. Therapeutic decisions should be individualized mainly based on patient characteristics (associated comorbidities). Radioiodine treatment is safe and effective to reduce the thyroid size. Surgery is indicated in suspected malignant or compressive goiters (usually > 80 g).

Benign goiter remains a major public health issue around the globe. Bilateral subtotal thyroidectomy for management of goiter is associated with a high recurrence rate. Total thyroidectomy has now become the preferred surgical approach for treatment of symptomatic goiter. Reoperative thyroid surgery for recurrent symptomatic goiter requires careful preparation and should incorporate neuromonitoring to help preserve vocal cord function.

Iodine is an essential mineral nutrient and an integral component of thyroid hormones. Iodine deficiency is typically associated with goiter, but can have more serious health implications. Adequate iodine status is important for normal brain development. Iodine deficiency in utero or in early life can cause severe neurological and cognitive impairment. Over the last three decades, global efforts have reduced the prevalence of iodine deficiency disorders (IDD) in many areas of the world with implementation of nutrition policies and programs such as "salt" iodization. However, in a number of areas iodine deficiency is still widespread. Iodine deficiency in remote regions with high poverty will be more difficult to eradicate. Efforts to eliminate IDD in affected areas and sustaining successful iodine programs will be a priority given the substantial public health and economic benefits. A key component will be periodic monitoring of population iodine status to ensure sufficient intakes and the absence of excessive intakes. Median urinary iodine concentration (UIC), a validated biomarker for assessing population iodine status, will facilitate monitoring. Research validating "usual" UIC for use in combination with the Estimated Average Requirement cut-point method will expand its utility and allow accurate determination of the prevalence of inadequate intakes in populations. Further research on the development of biomarkers for assessment of individual iodine status for routine patient care will be important.

Thyroid tumor and thyroid goiter are prevalent disease around the world. In this case-control study, we investigated the association between exposure to a total of twelve mineral elements and thyroid disease as well as thyroid functions. Participants with thyroid tumor or goiter (N = 197) were matched with a healthy population (N = 197) by age (± 2 years old) and same sex. Questionnaires were used to collect data about the demographic characteristics and information of subjects. Serum and urine samples were collected simultaneously for each of the subjects. Mineral elements, iodine level of urine and levels of the total seven thyroid function indexes in serum were detected respectively. Conditional logistic regression was applied to estimate the associations between mineral elements and the risk of thyroid tumor and goiter through single-element models and multiple-element models. Multiple linear regression was used to evaluate relationships between mineral elements and percentage changes of thyroid functions. Higher concentrations of mineral elements in the recruited population were found in this study than other comparable studies, and the levels of chromium (Cr), manganese (Mn), nickel (Ni), arsenic (As), cadmium (Cd), selenium (Se), antimony (Sb), thallium (Tl) and lead (Pb) in the case group were lower than the control group. According to the single-element models, Cr, Mn, Ni, Sb and Tl showed significant negative associations with the risk of thyroid tumor and goiter, and, Cd showed nonmonotonic dose response. Cd and mercury (Hg) showed a nonmonotonic percentage change with T4, while Tl was associated with the increased FT4 in the control group. Therefore, Cd, Hg and Tl may disturb the balance of thyroid function to some extent, and Cr, Mn, Ni, Cd, Sb, and Tl may become potential influencing factors for the risk of thyroid tumor and goiter.

The thyroid axis is a prime example of the physiologic interactions between the mother, the fetus, and their environment. Congenital hypothyroidism is one of the most common preventable causes of mental retardation. The discovery of the crucial role of maternal iodine intake for the normal development of the fetus also led to the first successful intervention in preventive medicine. The use of iodized salt at the population level resulted in a marked decrease in the prevalence of goiter in children and the disappearance of “endemic cretinism” in the industrialized world. The newborn screening program for congenital hypothyroidism is hailed as an unqualified success. At present, most severe cases of congenital hypothyroidism are caused by developmental defects of the thyroid and, albeit much less frequently, to defective pituitary control of thyroid function and these are the focus of this chapter.

Background Non-thyroid malignancies that metastasize to the thyroid gland are relatively rare. At one end of the spectrum they may only be identified at the time of autopsy. At the other extreme, they may be identified during the evaluation of a progressive malignancy. Most patients who are identified as having metastases to their thyroid gland are euthyroid, but some patients may have associated hypothyroidism or hyperthyroidism. This review examines cases of hyperthyroidism associated with metastases affecting the thyroid gland. Results Twenty four articles describing 26 cases of malignancy-associated hyperthyroidism were identified, with the cases presenting with features suggestive of a thyroiditis and with goiter. The solid malignancies (19 cases) were mostly breast and lung cancer. Hematologic malignancies (7 cases) were also reported with a similar thyroiditis-like presentation. Patients underwent the traditional work-up for a thyroiditis, but frequently underwent other radiographic studies, in addition to radioactive iodine imaging, and frequently also underwent thyroid biopsy. The course in most patients (22/26 cases) was progression from hyperthyroidism to hypothyroidism, as the underlying malignancy progressed or thyroidectomy was performed, or the patient succumbed to their malignancy. Some patients (4 cases) became euthyroid with successful treatment of their malignancy. A subset of patients (5 cases) initially presented with severe thyrotoxicosis. Many affected patients succumbed to their underlying malignancy. Conclusion Malignancy-associated hyperthyroidism has a similar underlying mechanism to subacute thyroiditis, in so much as there is damage or destruction of thyroid tissue. In cases of subacute thyroiditis this damage is self-limited, and there is recovery of thyroid function. In some cases of thyroiditis associated with malignancy there may be thyroid gland recovery as the underlying malignancy is treated and controlled. However, if the malignancy progresses, eventual hypothyroidism is likely to ensue.

Summary Iodine is an essential component of hormones produced by the thyroid gland. Thyroid hormones, and therefore iodine, are essential for mammalian life. Optimal dietary iodine intakes for healthy adults are 150–250 μg/d. In regions where iodine in soils and drinking water is low, humans and animals may become iodine deficient. Iodine deficiency has multiple adverse effects in humans due to inadequate thyroid hormone production that are termed the iodine deficiency disorders. Iodine deficiency during pregnancy and infancy may impair growth and neurodevelopment of the offspring and increase infant mortality. Deficiency during childhood reduces somatic growth and cognitive and motor function. Assessment methods include urinary iodine concentration, presence of goiter, newborn serum thyroid-stimulating hormone concentration, and serum thyroglobulin concentration. In most countries, the best strategy to control iodine deficiency in populations is carefully monitored iodization of salt.

Edited by: Charis M. Galanakis., Glucosinolates (GSLs) are a group of sulfur- and nitrogen-containing glycosides found in abundance in Cruciferous plants, including many important vegetable species of the Brassica genus such as broccoli, cabbage, and cauliflower. They are considered as highly bioactive secondary metabolites with significant effects against various types of cancer and carcinogenesis, either in intact form or after their enzymatic or nonenzymatic transformation in isothiocyanates and indolic compounds. There are more than 120 types of GSLs in Cruciferous plants which depending on their content and chemical structure may exhibit toxic, antinutritional, or beneficial effects to human health. Therefore, although GSLs in general are considered as “good” metabolites, there are cases where they are associated with toxicity effects, mainly regarding the hypertrophy of thyroid gland and the induction of goiter. In this chapter, an overview of the beneficial effects of GSLs is presented, while special focus is given on those cases where adverse effects and toxicities have been reported. Moreover, the means by which plant content in GSLs could be regulated to increase nutritional value of plant products and minimize toxicities risk are presented.

Publisher Summary This chapter discusses several types of autoimmune thyroiditis (AT). Goitrous or Hashimoto's thyroiditis and atrophic thyroiditis or primary myxedema, result in hypothyroidism, and it is likely these represent two ends of a spectrum of thyroid destruction. The goiter in Hashimoto's thyroiditis is usually firm and painless, with an irregular surface. Patients are often euthyroid at presentation but serum thyroid-stimulating hormone (TSH) levels can be elevated even if thyroxine (T4) levels are within the reference range, representing subclinical thyroid failure. Primary myxedema is identified only when hypothyroidism is apparent clinically and biochemically. Furthermore, Graves' disease shares many features with AT and what determines the type of disorder is a critical issue. So far genetic susceptibility factors have proven nonspecific but more detailed analysis may reveal specific genotypes for Graves' disease. Future studies can clarify the relative importance of stress, iodine intake, infection, and hormonal alterations. It is particularly important to study mechanisms at the earliest possible stage of disease so that an initiating rather than an enhancing role for these factors can be assessed.

Highlights • Carotid body tumors (CBT) are rare neoplasms with malignant potential. • The concomitant presentation of a CBT with goiter has been only reported in one case in 1950. • The extended Kocher incision for resection of both tumors was performed succesfully., Introduction Carotid body tumors (CBT) are rare neoplasms with relatively; due to their malignant potential, the indicated treatment is surgical resection. There have been described some associations of carotid body tumors with other neoplasms, however, the concomitant presentation of CBT with multinodular goiter is rarely encountered. Presentation of case We herein present the case of a 43-year old woman with the aforementioned association. As a part of the diagnostic evaluation, an ultrasound was performed, revealing both conditions simultaneously. The surgery took place with the aim of resecting both lesions during the same intervention. The patient was discharged without complications. Discussion The concomitant presentation of goiter and carotid body tumor is rarely reported but an extended Kocher incision could be enough to an adequate exposure and same surgical procedure resection. Conclusion This case reinforce the concomitant assessment in two different pathologies. Although there is one case reported before, this case lead to improvement in the treatment of these patients.

Background Medullary Thyroid Carcinoma (MTC) is a malignancy that primarily arises from the C-cells of the thyroid gland with a tendency to regional and distant metastases. Methods We report a case of a 34-year-old female with MTC where there was no evidence of primary foci of the disease within the thyroid gland, while there was a widespread metastasis in the cervical lymph nodes, lungs, abdomen, and vertebrae. Results The patient was diagnosed with metastatic sporadic MTC based on the pre-operative work up. She underwent completion thyroidectomy with bilateral neck dissection levels II-VI. The post-operative histopathology report confirmed the diagnosis. Conclusion The case report shows an unusual presentation of MTC. It demonstrates that there is an entity of metastatic sporadic MTC, confirmed by an abnormal calcitonin level, with unknown primary.

Objective: Clinically apparent thyroid enlargement due to massive amounts of amyloid deposition, known as amyloid goiter, is rare. Endocrinologists should become familiar with this manifestation of systemic amyloidosis, which may be diagnosed by Congo red staining of the specimen obtained by fine-needle aspiration. Methods: We describe a 70-year-old man who presented with a slowly enlarging goiter. It was asymptomatic, predominantly left-sided, nontoxic, and multinodular with atypia of undetermined significance (Bethesda System category III) by cytology. The goiter tested negative using the ThyraMIR miRNA Gene Expression Classifier kit (eviCore Healthcare, Bluffton, SC). Results: Left thyroid lobectomy produced a 220-g specimen with nodular hyperplasia and prominent amyloid deposition confirmed by Congo red staining. Liquid chromatography tandem mass spectrometry detected a peptide profile consistent with light chain amyloid deposition of the lambda type, formerly called primary amyloidosis. In retrospect, he had been diagnosed with restrictive cardiomyopathy, cardiac conduction system disease, coronary artery disease, non-nephrotic range proteinuria, and chronic kidney disease, which had been attributed to his longstanding type 2 diabetes mellitus. Extensive workup subsequently demonstrated cardiac amyloidosis and monoclonal gammopathy of unknown significance, consistent with light chain amyloidosis. Conclusion: Amyloid goiter should be included in the differential diagnosis of enlarging goiters with Bethesda System category III cytology in patients with monoclonal gammopathy of uncertain significance, clinical manifestations of systemic amyloidosis, or known diagnosis of monoclonal cell dyscrasia.

Water is life, so essential to human life. Trace elements in drinking water may have an impact on human health, and iodine and fluorine are important substances in the growth and development of the human body, the damage caused by either low or high levels of both has (raised global concerns) been increasing global attention. Of late (Up to now), there are many people residing in areas with iodine deficiency or high levels of iodine and fluorine in drinking water. Iodine deficiency has many adverse effects on growth and development such as simple goiter or endemic cretinism. Meanwhile, ingesting higher than recommended levels of iodine can cause health problems include hyperthyroidism, hypothyroidism, and goiter. Excessive fluorine intake over a long period of time may result in fluorosis, which is characterized by dental mottling and skeletal manifestations such as crippling deformities, osteoporosis, and osteosclerosis. Furthermore, excessive iodine and fluorine coexist in the groundwater in many regions, causing a potential risk to the human thyroid. Therefore, ongoing monitoring and prevention programs need to be enhanced to the exposed population.

Fetal goiter is defined as an enlargement of the thyroid gland that can be secondary to thyroid dysfunction, generally hypothyroidism. It can be originated by the passage of drugs such as propylthiouracil or methimazole administered to the mother to treat hyperthyroidism. It can also be the result of the transplacental passage of stimulating immunoglobulins or antibodies against the thyroid-stimulating hormone (TSH) receptor. The enlarged thyroid gland can potentially obstruct the fetal airway and/or esophagus and so polyhydramnios can be associated. In a case where there is a suspicion of an obstruction of the fetal upper airway, an ex utero intrapartum treatment (EXIT) should be considered for the moment of delivery. Other signs associated with fetal thyroid dysfunction can be observed such as fetal tachycardia, cardiac dysfunction, or abnormalities in skeletal ossification. In cases of fetal hypothyroidism, there is a higher risk for developmental delays. Fetal growth can also be impaired when there is fetal thyroid dysfunction. Fetal ultrasound (US) is the standard for its diagnosis, but magnetic resonance imaging (MRI) could be helpful to assess the extension of the enlarged gland. Both fetal hyperthyroidism and hypothyroidism can be treated prenatally, the former by administering antihyperthyroid drugs to the mother and the latter by administering levothyroxine intraamniotically.

Thyroid disorders are among the most prevalent of medical conditions and their manifestations vary considerably and are determined principally by the availability of iodine in the diet. The most common cause of thyroid disorders worldwide is iodine deficiency, leading to goiter formation and hypothyroidism. In iodine-replete areas, most persons with thyroid disorders have autoimmune disease, ranging from hypothyroidism to hyperthyroidism. The problems encountered in epidemiological studies of thyroid disorders are those of definition (e.g., overt hypothyroidism and subclinical hypothyroidism), the selection criteria used, the influence of age, gender, environmental factors, and the different techniques used for the measurement of thyroid hormones.

Iodine deficiency causes multiple adverse effects through the life cycle. These are collectively termed the iodine deficiency disorders (IDDs). Although there has been substantial progress in many countries to control IDD, it remains a common cause of goiter and preventable mental impairment worldwide. In nearly all iodine-deficient countries, the best strategy to control IDD is salt iodization. Iodized salt programs have been successfully and sustainably implemented in many countries worldwide and have shown consistent high efficacy against IDD. However, introduction of iodized salt to iodine-deficient populations may transiently increase the incidence of several thyroid disorders, and iodine programs should include monitoring for both iodine deficiency and excess. Overall, the relatively small risks of iodine excess are far outweighed by the substantial risks of iodine deficiency.

Thyroid dyshormonogenesis due to thyroglobulin (TG) gene mutations have an estimated incidence of approximately 1 in 100,000 newborns. The clinical spectrum ranges from euthyroid to mild or severe hypothyroidism. Up to now, one hundred seventeen deleterious mutations in the TG gene have been identified and characterized. The purpose of the present study was to identify and characterize new mutations in the TG gene. We report eight patients from seven unrelated families with goiter, hypothyroidism and low levels of serum TG. All patients underwent clinical, biochemical and image evaluation. Sequencing of DNA, genotyping, as well as bioinformatics analysis were performed. Molecular analyses revealed three novel inactivating TG mutations: c.5560G>T [p.E1835*], c.7084G>C [p.A2343P] and c.7093T>C [p.W2346R], and four previously reported mutations: c.378C>A [p.Y107*], c.886C>T [p.R277*], c.1351C>T [p.R432*] and c.7007G>A [p.R2317Q]. Two patients carried homozygous mutations (p.R277*/p.R277*, p.W2346R/p.W2346R), four were compound heterozygous mutations (p.Y107*/p.R277* (two unrelated patients), p.R432*/p.A2343P, p.Y107*/p.R2317Q) and two siblings from another family had a single p.E1835* mutated allele. Additionally, we include the analysis of 48 patients from 31 unrelated families with TG mutations identified in our present and previous studies. Our observation shows that mutations in both TG alleles were found in 27 families (9 as homozygote and 18 as heterozygote compound), whereas in the remaining four families only one mutated allele was detected. The majority of the detected mutations occur in exons 4, 7, 38 and 40. 28 different mutations were identified, 33 of the 96 TG alleles encoded the change p.R277*. In conclusion, our results confirm the genetic heterogeneity of TG defects and the pathophysiological importance of the predicted TG misfolding and therefore thyroid hormone formation as a consequence of truncated TG proteins and/or missense mutations located within its ACHE-like domain., This study was funded by grants from the FONCyT-ANPCyT-MINCyT (PICT 2014-1193 to CMR, PICT 2012-1090 and PICT 2015–1811 to HMT), CONICET (PIP 2015-11220150100499 to CMR) and Universidad de Buenos Aires (UBACyT 2016-20020150100099BA to CMR).

Iodine is an element essential for human growth and development with serious consequences when deficient in human nutrition. Iodine is found in nature universally in soil and water but in highly varying amounts depending on the terrain, with less in many mountainous and plains areas. Iodine deficiency can seriously affect normal fetal development, newborns, and other age groups as a thyroid abnormality. The discovery that iodine supplements prevents thyroid gland enlargement (goiter) in children and adults and prevents serious deficiency in newborns has made a major contribution to public and population health. Successful implementation of a pioneering salt iodization program occurred in France and Switzerland in the 19 th century but amid controversy. High rates of goiter were found among US army draftees in 1917. David Marine conducted a large field trial of providing iodine to school children in Akron, Ohio demonstrating effective preventive and curative effects for reducing goiter. Iodized table salt was introduced in Switzerland in 1922 and in the United States in 1924 with widespread use greatly improving the iodine nutritional status of populations. Iodization of salt has been a global health issue promoted by the World Health Organization since the 1970s. In recent decades, iodization of salt on a mandatory basis in China and Nigeria has successfully reduced iodine deficiency dramatically. However, an estimated 38 million newborns in developing countries are vulnerable and unprotected from the lifelong consequences of brain damage associated with iodine deficiency disorders. Even in high-income countries such as in much of Europe iodine insufficiency is far from eliminated. Iodine deficiency control remains a global health challenge.

Iodine (atomic weight 126.9 g/mol) is an important micronutrient that is required for the synthesis of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). The diet is the primary method of achieving adequate iodine nutrition, with dairy products, some breads, seaweed and other seafood, and iodized salt as the most common iodine-containing foods. Adolescents and adults require iodine in amounts of 150 μg/day, with higher amounts required during pregnancy and lactation. After digestion and absorption, the released iodine enters the plasma iodine pool and can be taken up again by the thyroid gland or excreted by the kidney. Iodine deficiency is the main cause of endemic goiter, but exposure to environmental pollutants and ingestion of certain dietary substances (goitrogens) can additionally interfere with iodine uptake into the thyroid to aggravate this effect. Finally, iodine ingestion greater than the recommended upper tolerable intake limit (1100 μg/day) increases the risk of iodine-induced thyroid dysfunction.

The potential toxicity of Moringa stenopetala drug/food preparations is scrutinized both from available toxicology data in the literature for the crude extracts and pharmacologically active principles identified from the plant so far. Among the compounds of interest are glucosinolates and their derivatives that could be implicated in thyroid dysfunction through goitrogenic effects. The potential of these compounds in modulating plant–animal interactions including herbivore deterrent activities as well as direct toxicity at cellular and organismal levels is discussed.