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The term «nodular» or «adenomatous» goiter is used concerning thyroid gland diseases of a various morphological structure. The disease is extremely widespread among the population especially in the regions with iodine deficiency. Fine-needle aspiration puncture biopsy under USD control with the cytological examination of punctate is a «gold» standard to diagnose thyroid nodes before surgery. Though this method differs from that of histological one, it enables us to give an idea concerning thyroid pathology occurring in a certain patient. Of course, postsurgical histological examination is the most accurate method of studying the thyroid tissue, but diagnostics of the pathology before surgery is more important for the choice of an adequate surgery with the purpose to minimize the risk of recurrence.The objective of the study was to determine nucleocytoplasmic correlation in the thyrocytes in the case of nodular types of goiter with recurrent and non-recurrent course and to compare findings obtained from histological and cytological specimens.Material and Methods. The histopathological method was used to examine the samples of postoperative recurrent nodular goiter, primary nodular goiter with a quick growth of nodes confirmed by ultrasonography findings, and primary nodular goiter with a slow growth of thyroid nodes diagnosed by means of USD, and thyroid tissue without pathology.Results. The area of nuclei in thyrocytes in the mean trends didn’t differ between study groups in any variant of pairwise comparison. The nucleocytoplasmic correlation was found to be statistically lower in all the main groups than that in with normal thyroid tissue in both histopathological preparations and in smears from thyroid punctures. Thus, in the group with relapse of nodular goiter it was 1,36 times as less, nodular goiter with quick growth - 1.28 and 1.22 times, respectively, and in the group with nodular goiter with slow growth - 1.46 and 1,05 times, respectively, compared with healthy thyroid tissue.Conclusions. The investigation determined that similar regularity occurs both in histological specimens and punctate smears from the thyroid gland – nucleocytoplasmic correlation in the thyroid cells decreases gradually in a line – the tissue of the normal thyroid gland, nodular/adenomatous goiter with slow growth, nodular/adenomatous goiter with quick growth, and relapse of nodular/adenomatous goiter. Though, quantitative data between histological and cytopathological specimens differ, the changes are of a constant character and enable to recommend histological and cytopathlogical examinations as quite equal.

Objective: To determine the clinical presentation and histopathological evaluation of patients undergoing thyroidectomies at tertiary care Hospital. Methodology: This cross-sectional study was done at department of general surgery of LUMHS/Jamshoro. Duration of the study was 1 year from October 2017 to September 2018. All the cases with a diagnosis of thyroid disorder and underwent thyroidectomy were selected and above 25 years of the age were included. All the surgeries were carried out by senior surgeons along with the cooperation of the ENT surgeons. After surgeries specimens of all the cases were sent to the diagnostic laboratory for the histological assessment. Data was collected via self-made proforma. Results: Of 58 patients majority i.e. 43.10% were found with age group of 35-44 years. Females found in the majority 63.80%. The swelling was noted among all of the cases, followed by pain, difficulty in swallowing, difficulty in breathing and others 8.62%, 10.34%, 20.68% and 25.68% respectively. Adenomatous goiter was the most common histopathological finding in 82.75% cases, papillary carcinoma was found 8.62%, follicular carcinoma was only in one case and anaplastic carcinoma was also in 1 case. Conclusion: Swelling, difficulty in swallowing and difficulty in breathing were the most common clinical features. Adenomatous goiter was the most common histological finding and papillary carcinoma was the commonest malignancy.

Original Article, Introduction: On the basis of the self-similarity of the human body, fractal dimensions can be calculated mathematically. Fractal analysis can also quantitatively express the density and complexity of a structure as a fractal dimension. We hypothesize that the fractal dimensions of ultrasonographic findings would change in thyroid disease. In this study, we explore the possibility of applying fractal analysis to the quantitative evaluation of ultrasonographic findings in thyroid tissue. Methods: This retrospective study used data on 1205 patients who newly received thyroid ultrasonography between April 2004 and March 2016. Patients who were included had one or more of the following: normal thyroid, Graves' disease, Hashimoto's thyroiditis, subacute thyroiditis, adenomatous goiter, or papillary carcinoma. Furthermore, the fractal dimension of thyroid ultrasonography was calculated in sagittal pictures. The region of interest was set along the contour of the thyroid gland, excluding a film. Fractal analysis was performed using box-counting methods. Results: For the normal thyroid gland, there was a significant decrease in the fractal dimensions of both contour and concentration structures, with significant differences compared with the disease groups. Among the thyroid disease groups, papillary carcinoma had the highest fractal dimension. The fractal dimension of the thyroid gland increased with age in the normal group. There were no differences in fractal dimensions by gender. Conclusion: Fractal analysis makes it possible to objectively determine the presence of chronic inflammation in thyroid tissue, but it is difficult to distinguish papillary carcinoma from benign goiter.

We encountered a 70-year-old Japanese woman with neurofibromatosis type 1 (NF1) who had a history of pheochromocytoma and concurrently developed adenomatous goiter, primary hyperparathyroidism, and acromegaly. The patient had a somatotroph adenoma of the adenohypophysis that predisposed her to multinodular goiter. Three parathyroid tumors were detected by cervical ultrasonography and cervicothoracic computed tomography. Genetic analyses did not reveal genetic alterations (e.g. loss-of-function mutation) in the causative genes of endocrine tumors, including MEN1, RET, VHL, CDKN1B, and CDKN2C. The NF1 gene could not be analyzed genetically due to the patient's refusal. The pathophysiologic mechanisms of endocrinopathy concurrence in NF1 remain to be elucidated.

Objective – to study the state of lipid peroxide oxidation (LPO) processes and anti-oxidant system (AOS) in neonates born to mothers with adenomatous goiter, to examine the effect of oxidative stress on the condition of the fetus and neonate.Material and methods. An analysis of the state of 20 fetuses from healthy women (control group) and 54 fetuses from women with nodular goiter (main group) was made. Of these, 30 fetuses are from women with nodular goiter of the 1st degree (group I) and 24 from women with nodular goiter of the second degree (group II). The state of the intrauterine fetus was assessed by the findings of cardiotocography (CTG), fetus biophysical type (FBT), and Dopplerometry. Certain parameters of LPO and AOS were studied in order to evaluate stress-realizing and stress-limiting body systems. The content of LPO products was evaluated by the level of lipid hydroperoxides and malone dialdehyde. The AOS state was examined by the content of glutathione in the erythrocytes and glutathione peroxidase activity. The blood was taken from the umbilical vein of fetuses after birth.Results. Glutathione level in neonates from I group was found to increase considerably in response to the accumulation of LPO products (35,5±1,0 mcmol/ ml of erythrocytes against 31,5±1,1 mcmol/ml of erythrocytes in neonates of the control group, р0,05), which is indicative of antioxidant insufficiency and disorders of the compensatory-adaptive mechanisms. The findings of CTG, FBT and Dopplerometry are indicative of deterioration of the fetus state in women with adenomatous goiter. The more pronounced the signs of adenomatous goiter are, the lower point assessment of the fetus is (р, Цель работы - изучить состояние процессов пероксидации липидов (ПОЛ) и антиоксидантной системы (АОС) у новорожденных от матерей с узловым зобом, влияние окислительного стресса на состояние плода и новорожденного.Материал и методы. Проведен анализ состояния 20 плодов от здоровых женщин (контрольная группа) и 54 плодов от женщин с узловым зобом (основная группа). Из них 30 плодов от женщин с узловым зобом I степени (I группа) и 24 - от женщин с узловым зобом II степени (II группа). О состоянии внутриутробного плода судили по данным кардиотокографии (КТГ), биофизического профиля плода (БПП), результатов допплерометрии. Для оценки стрес-реализирующих и стрес-лимитирующих систем организма изучали некоторые показатели ПОЛ и АОС. Содержимое продуктов ПОЛ оценивали по уровню гидроперекисей липидов и малонового альдегида. Состояние АОС изучали по содержанию глутатиона в эритроцитах и активности фермента глутатион-пероксидазы. Забор крови у плодов проводили из вены пуповины после рождения.Результаты. Установлено, что у новорожденных І группы в ответ на накопление продуктов ПОЛ значительно повышался уровень глутатиона (35,5±1,0 мкмоль/мл эр. против 31,5±1,1 мкмоль/мл эр. в новорожденных контрольной группы, р0,05), что свидетельствует о антиоксидантной недостаточности и нарушении компенсаторно- приспособительных механизмов. Данные КТГ, БПП и допплерометрии свидетельствуют об ухудшении состояния плода у женщин с узловым зобом. Выяснено, что чем больше выражена степень проявления узлового зоба, тем ниже бальная оценка плода (р, Мета роботи – вивчити стан процесів пероксидації ліпідів (ПОЛ) і антиоксидантної системи (АОС) у новонароджених від матерів із вузловим зобом, вплив окисного стресу на стан плода і новонародженого.Матеріал і методи. Проведено аналіз стану 20 плодів від здорових жінок (контрольна група) і 54 плодів від жінок із вузловим зобом (основна група). З них 30 плодів від жінок із вузловим зобом І ступеня (І група) і 24 – від жінок із вузловим зобом ІІ ступеня (ІІ група). Про стан внутрішньоутробного плода судили за даними кардіотокографії (КТГ), біофізичного профілю плода (БПП), результатів доплерометрії. Для оцінки стрес-реалізуючих і стрес-лімітувальних систем організму вивчали деякі показники ПОЛ і АОС. Вміст продуктів ПОЛ оцінювали за рівнем гідроперекисів ліпідів і малонового альдегіду. Стан АОС вивчали за вмістом глутатіону в еритроцитах і активності ферменту глутатіон-пероксидази. Забір крові у плодів проводили з вени пуповини після народження.Результати. З’ясовано, що в новонароджених І групи у відповідь на накопичення продуктів ПОЛ значно зростав вміст глутатіону (35,5±1,0 мкмоль/мл ер. проти 31,5±1,1 мкмоль/мл ер. у новонароджених контрольної групи, р0,05), що свідчить про антиоксидантну недостатність і порушення компенсаторно-пристосувальних механізмів. Дані КТГ, БПП і доплерометрії свідчать про погіршення стану плода у жінок із вузловим зобом. З’ясовано, що чим більше виражена ступінь прояву вузлового зоба, тим нижча бальна оцінка плода (р

Non-recurrent inferior laryngeal nerve (NRILN) is rare but one of the important anatomical variations in thyroid and parathyroid surgery. Almost all cases were observed on the right side with aberrant right subclavian artery and left NRILN have been reported in only five cases so far. Here, we reported a 38 year-old Japanese male with left NRILN accompanying adenomatous goiter. He was referred to our hospital for the surgical treatment of left thyroid goiter. Preoperative computed tomography revealed right-sided aortic arch and aberrant left subclavian artery with no signs of complete situs inversus viscerum, suggesting possible left NRLN. Left hemithyroidectomy was performed using nerve monitoring system. Intraoperatively, left recurrent laryngeal nerve was not identified along tracheoesophageal groove, but directly originated from vagal nerve and was running horizontally to larynx. Mobility of vocal cords were not impaired and postoperative course was uneventful. During thyroid surgery for the patients with right-sided aortic arch, meticulous care should be taken using nerve monitoring system to avoid nerve injury.

Thyroid nodules have been observed in childhood cancer survivors (CCS) treated with chemotherapy and radiotherapy. We report four patients with thyroid nodules identified during the long-term follow-up of children who underwent hematopoietic stem cell transplantation (HSCT). The thyroid nodules were diagnosed as adenomatous goiter in all four patients. The interval between the primary cancer diagnosis and the occurrence of the thyroid nodules was more than 10 yr. Furthermore, all four patients underwent HSCT in conditioning with total body irradiation (TBI) before the age of 10 yr. Two of four patients commenced treatment with levothyroxine due to elevated TSH levels. Only two patients showed elevated thyroglobulin levels (> 70 µg/L). In conclusion, we suggest that CCS who have undergone HSCT in conditioning with TBI more than 10 yr previously should be followed up carefully for thyroid nodules using ultrasound.

Most substernal goiters can be managed through the transcervical approach, but a sternotomy is required in some cases. This report is about a large substernal goiter, which was resected via a transcervical and full sternotomy approach. The patient was a 57-year-old female, who visited our hospital for surgical treatment for a large substernal goiter. Computed tomography of the neck and chest revealed that the substernal goiter extended to both sides of the thorax and had compressed the trachea. We performed total thyroidectomy safely via a transcervical and full sternotomy approach. No postoperative complications occurred, except transient hypocalcemia. A histopathological examination did not reveal any malignancy, and the lesion was diagnosed as an adenomatous goiter. Most substernal goiters can be managed through the transcervical approach, but a full sternotomy is required when a substernal goiter extends to both sides of the thorax and/or has a larger diameter than the thoracic inlet or airway constriction is revealed. A full sternotomy provides excellent exposure and can help reduce the risk of complications, such as recurrent laryngeal nerve palsy and injuries to major blood vessels.

Benign nodular goiter is a common disease. Although large goiters with obstructive symptoms including shortness of breath and dyspnea are a clear indication for surgery, acute upper airway obstruction, particularly in benign cervical goiter cases, is rare. We herein report the case of 46-year-old female with acute upper airway obstruction due to benign nodular goiter. The patient had a large and elastic goiter which was more pronounced on the left side of her neck, and surgery was scheduled for within a few months. Three months after the initial presentation, while still waiting for surgery, the patient was brought to the emergency room due to loss of consciousness and breathing difficulty and was immediately intubated. A computed tomography (CT) scan revealed that the trachea was markedly compressed by a nodular lesion in the left lobe, and bilateral pneumonia was also evident. Total thyroidectomy was immediately performed via the supraclavicular approach. The patient had an uneventful postoperative course and recovered well. The resected specimen included a well-encapsulated solid and cystic mass. Histopathological examination mainly revealed adenomatous goiter. The present case suggests that benign asymptomatic nodular goiter mostly located in the neck may cause acute airway obstruction, even if the nodules are not large. Early surgery should be performed when tracheal deviation and stenosis due to a large goiter is prominent by CT scan.

目的 : 甲状腺穿刺吸引細胞診で, 良悪性鑑別困難とした症例の精度管理を行った. 濾胞性腫瘍と診断した症例の細胞像を検討し, 悪性の可能性の乏しい腺腫様甲状腺腫を推定する群を抽出した.方法 : 良悪性鑑別困難の細胞診断の下, 手術された 14 例の細胞所見を再検討し, 組織診断と比較した. 対比症例として濾胞腺腫, 濾胞癌微小浸潤型と比較した.成績 : 細胞診鑑別困難の手術例 14 例の, 術後の病理診断は, 悪性リンパ腫 5 例, 乳頭癌 1 例, 腺腫様甲状腺腫 6 例, 濾胞腺腫 2 例 (好酸性細胞腺腫 1 例, 異型腺腫 1 例) であった. つまり, 鑑別困難濾胞性腫瘍と診断した 8 例中 6 例 (75%) が腺腫様甲状腺腫 (腺腫結節) であった. これら 8 例の細胞所見の特徴は背景に泡沫細胞や多量のコロイドを認めるなどの嚢胞変性やコロイド嚢胞の特徴がなく, 細胞量も多く腫瘍性と診断したが, さらに(1)濾胞上皮細胞集塊は小型で, N/C 比も比較的大きい (核密度が高い) 群と, (2)細胞集塊は小型で, 細胞の N/C 比も小さい群と, (3)N/C 比が小で, 大型の濾胞細胞集塊が多数みられる 3 群に細分類が可能であった.結論 : 濾胞性腫瘍と細胞診断した例は 3 群に分割が可能であった. N/C 比の小さい症例で, 細胞量が多くとも, 大型から中型の濾胞上皮集塊のときは, 腺腫様甲状腺腫の可能性が高く, 以降良性と診断することに変更した. 一方, 小型の濾胞細胞集塊が中心の症例では, 悪性の含まれる可能性がある, 真の良悪性鑑別困難であり, N/C 比の小のものは, 良悪性鑑別困難の (A) と診断し, N/C 比が大の (核密度が高い) 症例は, 悪性の含まれる可能性が高い良悪性鑑別困難の (B) と診断する.

頸部伸展・頸部襟状切開にて摘出できた縦隔内甲状腺腫の切除例を報告する。【症例1】75歳女性。胸部異常陰影にて紹介。気管は右側に圧排され，甲状腺左葉下極から中縦隔に進展する7 cm大の充実性腫瘤を認めた。腫瘤の下縁は大動脈弓の高さであった。頸部襟状切開にて摘出手術を行った。腫瘍と甲状腺との連続は認めなかった。腫瘍は周囲組織から容易に剥離可能で頸部からのアプローチのみで切除できた。【症例2】48歳男性。胸部異常陰影にて紹介。右上縦隔に異常陰影を認め，気管を左側に圧排。甲状腺右葉下極から中縦隔に進展する9 cm大の充実性腫瘤を認めた。腫瘤は左腕頭静脈の背側を通過して縦隔内に進展し，下縁は奇静脈の高さであった。同様に頸部襟状切開にて摘出手術を行った。鈍的剥離によって容易に頸部に脱転され，頸部からのアプローチのみで甲状腺右葉と腫瘍を切除できた。2例とも術後経過は良好であり，病理検査でどちらも腺腫様甲状腺腫と診断された。

腺腫様甲状腺腫の穿刺吸引細胞診後にび慢性甲状腺腫大をきたした症例を経験した．その臨床経過と若干の文献的考察をした．患者は38歳，女性．他院にて，結節性甲状腺腫と診断され，その後増大するため当院紹介となった．既往歴，内服歴特になし．患側の左葉を22G注射針にて穿刺吸引細胞診を施行したところ，2～3分後から頸部圧迫感と疼痛を訴えた．エコーにて健側右葉が1cmから4cmに腫脹し，内部血流の増加を認めた．1時間頸部を氷片で冷却するも改善しないため，ステロイドを投与したところ急速に症状は改善した．9日間内服でステロイドを漸減しエコーを行ったところ，腫脹は改善していた．経時的にエコーで経過を追うことができた．術前後にステロイド投与を行ったところ，手術を完墜し合併症なく退院となった．穿刺吸引細胞診で偶然に甲状腺内の神経を刺激したため，血管拡張，血管透過性亢進物質が放出されて，び慢性の腫脹を引き起こしたものと推測された．

Henry S. Plummer (1874–1936), son of a Minnesota general practitioner, was one of the early physicians to join the Mayo brothers, after which he played a formidable role in developing the infrastructure known as Mayo Clinic. He foresaw the value of an integrated group practice and need for specialization. He designed the clinic buildings, modernized the clinical laboratory, introduced x-rays to the practice, and created the modern medical record.

Primary malignant lymphoma of the thyroid gland is not a rare disease that we come across in our hospital. Here we report a rare case of adenomatous goiter infiltrated by malignant lymphoma. A 42-year-old woman was admitted to our hospital because of slow-growing anterior neck tumor and rapid-growing axillary tumor. The right anterior neck tumor was 12 cm in diameter and the right axillary tumor was 7 cm in diameter. Fine needle aspiration cytology revealed that these two tumors were class V and malignant lymphoma was suspected. We performed an open biopsy of the neck tumor and histopathological examination revealed that diffuse large B-cell lymphoma co-existed with adenomatous goiter. Eight courses of CHOP were conducted for the patient and CR was ob-tained in her axillary tumor but her neck tumor was NC. We performed surgical resection of the neck tumor and histopathological examination revealed the pathological CR of malignant lymphoma.

A case of mediastinal goiter in a 51-year-old female is reported. She demonstrated an abnormal shadow on chest X-ray but there were no clinical symptoms. Tumors were recognized in the isthmus of the thyroid and mediastinum on CT scan and MRI. These two tumors were resected via standard neck skin incision and sternotomy. At surgery, we found no communication between the two tumors. Following Rives’ classification, the mediastinal tumor in this case was diagnosed as aberrant mediastinal goiter. Pathological diagnoses of both tumors were adenomatous goiter.

For the period 1998–2002, in the framework of the Ukraine–USA Thyroid Project, medical screening examinations have been conducted to subjects who were aged 0 to 18 years at the time of the Chernobyl accident. These were residents of eight districts, from Kyiv, Chernihiv, and Zhytomyr regions of the Ukraine, having been most affected following the Chernobyl accident, and having received within several weeks after the accident direct measurements of thyroid doses of gamma radiation. For the period 1998–2000, 13227 cohort subjects have undergone screening, and in 2001–2002, a repeat screening was performed. As a result of screening, 64 cases of thyroid carcinoma have been identified, including 43 cases after the first screening and 21 cases after the second screening. The distribution of patients by thyroid exposure dose pointed out a predominance of cancer cases in the high-dose group (exposure dose exceeding 1.0 Gy). In addition, 27 cases of benign surgical thyroid pathology have been identified at the first screening, among which were diagnosed 18 cases of follicular adenoma, two cases of multinodular adenomatous goiter, four cases of nodular solitary goiter, one case of fibrous nodule with degenerative changes, one case of diffuse toxic goiter (Graves' disease), and one case of diffuse euthyroid goiter.

The patient was a 44-year-old woman who exhibited a diffuse goiter during health screening. Her medical history did not include any significant medication-based treatment. An echographic examination detected a solid cystic tumor, which measured 21 × 14 × 10 mm, in her right thyroid lobe; however, she displayed normal thyroid function. After fine-needle aspiration cytology had been performed with a 22 G injection needle, the patient immediately complained of compression and pain extending from the front of her neck to her lower chin, which was not accompanied by dyspnea. A second echographic examination revealed diffuse and edematous enlargement and increased internal blood flow in the bilateral thyroid lobes as well as a thyroid nodule. We immediately iced the patient’s neck and administered 125 mg methylprednisolone via an intravenous infusion. Within one hour, her symptoms had markedly improved, but acute pain remained. Thus, we continued the steroid (prednisone) treatment, but the dose was gradually reduced from 10 mg/day to 5 mg/day at 1 week after the patient’s symptoms disappeared. The mechanism responsible for the patient’s condition remains unclear.