Assessment of Endemic Goiter of Children in Eastern Sudan (Kassala State) Using Ultrasonography and ELISA

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.

Pathological diagnosis and immunohistochemical analysis of giant retrosternal goiter in the elderly: A case report

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.

Lithium carbonate-induced giant goiter and subclinical hyperthyroidism in a patient with schizophrenia:A case report and review of literature

BACKGROUND Lithium carbonate is used to manage various mood disorders,but it can cause thyroid abnormalities,including goiter,hypothyroidism,and hyperthyroidism.In rare cases,it can lead to giant goiter and subclinical hyperthyroidism,which may require surgical intervention in severe cases.CASE SUMMARY This case represents a rare development of giant goiter and subclinical hyperthyroidism in a schizophrenia patient who was subjected to prolonged lithium carbonate treatment.The enlarged thyroid gland caused pressure on the airway and recurrent laryngeal nerve,which led to respiratory distress,hoarseness,and dysphagia.The immediate danger of suffocation required urgent surgical intervention.In this report,we describe the case of a 41-year-old Chinese woman.This sheds light on the etiology and challenges associated with managing a giant goiter.The patient underwent a subtotal thyroidectomy to relieve airway compression and facilitate airway expansion.Prior to the procedure,the patient was given iodine to prepare.Concurrently,changes were made to the psychiatric medication regimen.Following surgery,the patient's respiratory function and vocal cord functionality improved significantly,and her mental state remained stable.CONCLUSION It is essential to monitor thyroid function,test thyroid antibody levels,and perform thyroid ultrasounds consistently in all patients undergoing long-term lithium carbonate treatment.This vigilance helps prevent severe and potentially life-threatening thyroid enlargement.

Development of endemicity and conservation importance indices for tropical forests and the floral diversity assessment of Mt.Natoo in Benguet,Philippines

The scientific community faces the challenge of measuring progress toward biodiversity targets and indices have been traditionally used.However,recent inventories in secondary tropical mountain forests using traditional biodiversity indices have yielded results that are indistinct with primary ones.This shows the need to develop complementary indices that goes beyond species count but integrates the distribution and conservation status of the species.This study developed endemicity and conservation importance index for tropical forest that incorporated the distribution and conservation status of the species.These indices were applied to Mt.Natoo,a remnant primary mossy forest in Buguias,Benguet,Philippines,that resulted to endemicity index of 81.07 and conservation importance index of 42.90.Comparing these with secondary forest sites with comparable Shannon-Wiener,Simpson,Evenness and Margalef’s indices,our endemicity and conservation indices clearly differentiates primary forest(our study site)with higher values from secondary forests with much lower values.Thus,we are proposing these indices for a direct but scientifically-informed identification of specific sites for conservation and protection in tropical forests.Additionally,our study documented a total of 168 vascular plant species(79 endemic and 12 locally threatened species)in Mt.Nato-o.Majority are of tropical elements for both generic and species levels with some temperate elements that could be attributed to the site's high elevation and semi-temperate climate.These are important baseline information for conservation plans and monitoring of tropical mossy forests.

Assessment of plant diversity of endemic species of the Saharo-Arabian region in Egypt

Savanna, semi-deserts, and hot deserts characterize the Saharo-Arabian region, which includes Morocco, Mauretania, Algeria, Tunisia, Libya, Egypt, Palestine, Kuwait, Saudi Arabia, Qatar, Bahrain, the United Arab Emirates, Oman, Yemen, southern Jordan, Syria, Iraq, Iran, Afghanistan, Pakistan, and northern India. Its neighboring regions, the Sudano-Zambezian region belonging to the Paleotropical Kingdom and the Mediterranean and Irano-Turanian regions included in the Holarctic Kingdom, share a large portion of their flora with the Saharo-Arabian region. Despite the widespread acknowledgment of the region's global importance for plant diversity, an up to date list of the Saharo-Arabian endemics is still unavailable. The available data are frequently insufficient or out of date at both the whole global and the national scales. Therefore, the present study aims at screening and verifying the Saharo-Arabian endemic plants and determining the phytogeographical distribution of these taxa in the Egyptian flora. Hence, a preliminary list of 429 Saharo-Arabian endemic plants in Egypt was compiled from the available literature. Indeed, by excluding the species that were recorded in any countries or regions outside the Saharo-Arabian region based on different literature, database reviews, and websites, the present study has reduced this number to 126 taxa belonging to 87 genera and 37 families. Regarding the national geographic distribution, South Sinai is the richest region with 83 endemic species compared with other eight phytogeographic regions in Egypt, followed by the Isthmic Desert(the middle of Sinai Peninsula, 53 taxa). Sahara regional subzone(SS1) distributes all the 126 endemic species, Arabian regional subzone(SS2) owns 79 taxa, and Nubo-Sindian subzone(SS3) distributes only 14 endemics. Seven groups were recognized at the fourth level of classification as a result of the application of the two-way indicator species analysis(TWINSPAN) to the Saharo-Arabian endemic species in Egypt, i.e., Ⅰ Asphodelus refractus group, Ⅱ Agathophora alopecuroides var. papillosa group, Ⅲ Anvillea garcinii group, Ⅳ Reseda muricata group, V Agathophora alopecuroides var. alopecuroides group, Ⅵ Scrophularia deserti group, and Ⅶ Astragalus schimperi group. It's crucial to clearly define the Saharo-Arabian endemics and illustrate an updated verified database of these taxa for a given territory for providing future management plans that support the conservation and sustainable use of these valuable species under current thought-provoking devastating impacts of rapid anthropogenic and climate change in this region.

Low cervical incision combined with video-assisted thoracoscopy for resection of a goiter extending to the posterior mediastinum:A case report and literature review

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.

Advances in the Intervention of Prunella Spica Capsules on Postoperative Recurrence of Nodular Goiter

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.

Mechanism of Huatan Sanjie Fang in improving goiter in Graves'disease mice based on the Hippo signaling pathway

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.

Antibody seropositivity and endemicity of chikungunya and Zika viruses in Nigeria

Mosquito-borne infections are of global health concern because of their rapid spread and upsurge,which creates a risk for coinfections.chikungunya virus(CHIKV),an arbovirus disease transmitted by Aedes aegypti or A.albopictus,and malaria,a parasitic disease transmitted by Anopheles gambiae,are prevalent in Nigeria and neighbouring countries,but their burden and possible coinfections are poorly understood.In this study,we investigated the antibody seropositivity and endemicity of chikungunya and Zika viruses(ZIKV)in three regions of Nigeria.A cross-sectional serosurvey was conducted on 871 participants.Samples were collected from outpatients by simple random sampling.Analyses of the samples were performed using recomLine Tropical Fever for the presence of antibody serological marker IgG immunoblot with CHIKV VLP(virus like particle),ZIKV NS1 and ZIKV Equad according to manufacturers’instructions and malaria RDT for malaria parasite.There was a significantly higher antibody seropositivity against CHIKV in the central region than in the northern and southern regions(69.5%,291/419),while ZIKV-seropositivity(22.4%,34/152)and CHIKV-ZIKV co-circulating antibody seropositivity(17.8%,27/152)were notably higher in the southern region than in the central and northern regions.This investigation revealed an unexpectedly high antibody seropositivity and concealed endemicity of CHIKV and ZIKV in three Nigerian regions.The seropositivity of detectable antibodies differed among the three geographical locations.

Risk estimation of chronic kidney disease in a leptospirosis endemic area: A case-control study from south Andaman Islands of India

Objective:To estimate the risk of chronic kidney disease in patients with leptospirosis.Methods:All reported(41890)and later confirmed leptospirosis(1990)cases from 2010-2020 were traced by universal sampling.386 Laboratory-confirmed leptospirosis cases were enrolled and 413 age,gender,area,and occupation matched healthy persons were included as controls.Variables including socio-demographic characteristics,medical history,and health-related behaviours were compared between the two groups and association between these variables and reduced estimated glomerular filtration rate(eGFR)was analyzed with multiple linear regression.Results:The median of eGFR was 49.0(27.0,75.0)mL/min/1.73 m^(2) in the cases and 96.0(72.0,121.0)mL/min/1.73 m^(2) in the controls,showing significant differences(P<0.001).Bivariate analysis showed that leptospirosis seropositivitiy,repeat leptospirosis infection,diabetes,male gender,working in field(sun exposure),COVID-19 infection and smoking had statistically significant association with reduced eGFR.Leptospirosis seropositivity had negative effects on eGFR.Multiple linear regression confirmed that leptospirosis seropositivity had negative effects on eGFR(unstandardised β coefficients=−30.86,95%CI−49.7 to−11.9,P<0.001).Conclusions:Chronic kidney disease is a complex disease with multiple risk factors involved.Exposure to leptospirosis is one of the essential factors in accelerating its progression.

Thyroidectomy for Massive Goiter Weighing more than 500 Grams. Technical Difficulties, Complications and Management. Review

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.

Complete transthoracic resection of giant posterior mediastinal goiter: A case report and review of the surgical approaches

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.

Surveys in Areas of High Risk of Iodine Deficiency and Iodine Excess in China, 2012-2014： Current Status and Examination of the Relationship between Urinary Iodine Concentration and Goiter Prevalence in Children Aged 8-10 Years

Objective We aimed to evaluate goiter prevalence and iodine nutritional status in areas with high levels of water iodine; to monitor the prevalence of iodine deficiency disorders （IDD） in areas at high risk of IDD; and to compare the prevalence of goiter and urine iodine （UI） concentrations between children living in the two areas. Methods Based on surveillance from 2012-2014, we analyzed the concentration of UI and prevalence of goiter in 8-10-year-old children from 12 high-risk IDD provinces, and from 8 provinces and municipalities with excessive water iodine. We calculated goiter prevalence for each UI level according to World Health Organization （WHO） standards and constructed predictive prevalence curves. Results The goiter prevalence and median UI of children from areas with high water iodine were not optimal, being above the WHO standards （5% and 100-199 μg/L, respectively）, whereas those in high-risk areas fell within the standard. UI and goiter prevalence exhibited a U-shaped relationship in high-risk endemic areas and a parabolic relationship in areas of iodine excess. Conclusion Iodine surplus in high-iodine areas leads to high goiter prevalence and UI. However, in high-risk areas, UI was optimal and goiter prevalence met the national criteria for IDD elimination.

The Systematic Taxonomy of Chinese Endemic Genera in Hynobiidae

Hynobiids are exclusively in Asia. China is the main distribution of hynobiids,and has many rich species because of the diversity of habitat. In present paper,the introduction on the systematic taxonomy of Chinese endemic genera （Protohynobius,Batrachuperus,Liua,Pachyhynobius and Pseudohynobius） in Hynobiidae will improve the understanding on these genera.

Notes on the key role of stenochoric endemic plants in the floristic regionalization of Yunnan

With the accumulation and accessibility of information about plant species,it is time to re-evaluate and further divide a global biodiversity hotspot region,Yunnan,located in southwestern China.In this study,we combined data on the distribution of 1010 stenochoric endemic seed plants,vegetation constitution,geological history and climate change,and used these to propose a new system of floristic regions.We identified 11 distinct floristic subregions and 84 floristic provinces within Yunnan.Our work confirmed some views emphasized by Wu Zhengyi that the stenochoric endemic species play a key role in defining floristic provinces;that stenochoric endemic plants with long collection and publication histories are more valuable;that greater attention should be paid to woody plants;and that for Yunnan,a border region,some trans-border distributed elements should be treated cautiously.

Metastasis to the thyroid gland from primary breast cancer presenting as diffuse goiter:A case report and review of literature

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.

Studies on Human Dietary Requirements and Safe Range of Dietary Intakes of Selenium in China and Their Application in the Prevention of Related Endemic Diseases

The human dietary selenium requirement in China has been estimated by various methods. The minimum dietary selenium requircment for the prevention of Keshan disease (KD) was found to be around 17 μg/d. On the other hand, an intake of 40 μg/d is required to maintain the plasma glutathione peroxidase (GPx) activity at plateau. Hence 40 μg/d is considered as the adequate dietary selenium requirement. Studies conducted in a chronic selenosis area indicate thai the toxic dietary selenlum inlake (adverse effect level), which would maintain the characteristic fingernail changes, was approximately 1600 μg/d. The mean value of dietary selenium intakes, which enabled the five patients to recover from fingernail lesions, was found to be 819 ±126μg/d. At a 95% confidence limit, the lower limit is around 600μg/d. Therefore, 600 and 400μg/d were suggested as the individual daily maximum safe selenium intake and the safe dietary selenium intake, respectively,The results were used in the prevention of Se-related endemic KD and Kashin-Beck disease (KBD)

Iodization of Village Water Supply in the Control of Endemic Iodine Deficiency in Rural Sarawak, Malaysia

A simple water iodizing system, which incorporates the Venturi principle in combination with the controlled release mechanism of a silicone-sodium iodide elastomer, for the iodization of rural piped-water supply in the control of endemic iodine deficiency has been developed and its effectiveness evaluated in three Iban longhouse villages in the iodinedeficient district of Lubok Antu, Sarawak. Urines were collected for iodine assays from women aged 15-40 years before and at 6 and 12 months after the connection of the iodinating device; goiter assessment was performed on the women at the start and end of the 1-year study. Water samples were collected for iodine assays at 2-weekly intervals. In all three villages, significant and sustained increases in median urinary iodine excretions,reaching levels recommended for an iodine-suffcient population, were observed; goitre prevalences were reduced in all the villages (by 22.6% to 35.8%). The iodine levels in the water ranged from 34 μg/l to 212 μg/L. In the control village, median urinary iodine excretions remained essentially unchanged but a small increase in goiter prevalence was observed. The iodized water was well received by the villagers and no adverse effects of water iodization were observed. The system functioned unattended throughout the one year period. The cost of providing supplemental iodine via the iodizing device is approximately 60 cents (U.S.) per family per year which is affordable by either the Government or the villagers. It is concluded that the iodizing system offers a new cost-effective strategy for the control of endemic iodine deficiency in Sarawak and may have applications in other areas with similar water sources

The Relationship between Giant Goiter and Operative Complications: A Retrospective Study

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.

Voluminous Goiters in Surgery B of Chu of Point G: Diagnostic Aspects

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.