Acute Presentation of Massive Retrosternal Thyrotoxic Goitres

Approximately 5% of goitres extend below the thoracic inlet and can potentially become life threatening due to compression of the airway and major vessels. Approximately 7% of these goitres which require surgical resection will need an additional sternotomy to deliver the intra-thoracic component. Massive retrosternal toxic goitres presenting acutely are rare and are described infrequently in literature. We hereby present two cases of massive retrosternal thyrotoxic goitres presenting with acute respiratory failure, requiring non-invasive ventilation, as well as significant head and neck venous compression. Surgery on the thyrotoxic patient with a goitre, even if not significantly enlarged, is associated with a high peri-operative mortality due to cardiac instability and hemorrhage. We discuss the challenges of surgical intervention in these patients with particular emphasis on the timing of surgery to relieve compressive symptoms and the time needed to achieve a euthyroid state. We also emphasize the need for meticulous hemostasis, use of a cell-saver, transfusion protocols, adjuncts to hemostasis, as well as careful monitoring and continuous adjustments to the coagulation profile.

Toxic Multinodular Goitre (Thyrotoxicosis with Hyperthyroidism) Induced Cardiomyopathy: A Case Report

Introduction: Toxic multinodular goitre, first described by H.S. Plummer in 1913, is unremitting and often develops slowly, with more subtle symptoms than Graves’ disease. Cardiac symptoms such as tachycardia, heart failure, or arrhythmia and atrial fibrillation are most frequent. Here we describe a case who presented with symptoms of thyroid enlargement and heart failure. Case report: A 48-year old female presented to us with complaints of dysphagia, hoarseness of voice, breathlessness on exertion and palpitations since one month ago. Furthermore, the patient gave history of swelling of the neck which was initially pea sized and gradually increased to the current size over a period of two months. On examining the swelling of the neck, thyroid gland appears enlarged, firm with multiple nodules. Two-dimensional echocardiography revealed a dilated left ventricle with generalized hypokinesia. Computed Tomography of the neck suggested enlarged thyroid gland (12.1 cm × 6.5 cm) with heterogenous architecture, and thyroid gland encircling the trachea for approximately 270 degree with mass effect. Thyroid scan showed multinodular goitre with multiple hyperfunctioning nodules of both lobes and warm nodules only in left lobe. The patient was diagnosed as multinodular goitre with cardiomyopathy. The patient was treated medically with methimazole, propranolol, aspirin, ramipril, sustained release urodeoxycholic acid, rosuvastatin, pantoprazole and multivitamin. The patient underwent near total thyroidectomy with radioactive iodine ablation, as and when required. Conclusion: Patients with toxic multinodular goitre very frequently present with cardiovascular symptoms, which when identified and treated early can reduce the morbidity significantly.

The Diagnosis of Diffuse Goitre by Ultrasound Imaging in Children

In order to find an easy and accurate procedure for diagnosis of diffuse goitre in children, we examined 50 patients with diffuse goitre using fine needle aspiration biopsy cytology, thyroid antibody detection, thyroid hormone analysis and ultrasound imaging. In the meantime, 109 healthy children (control) were examined by ultrasound imaging. The results showed that thyroid imaging in health children was a smooth echo pattern with stronger homogenous echogram than surrounding muscle tissues. The patients with diffuse goitre showed an normally enlarged thyroid volume. In 22 (84. 6 %) of 26 children With chronic lymphocytic thyroiditis, a varied patch hypoechogenicity was found, of whom 18 (81. 8 % ) had positive results of antibody testing. On the contrary, echo-pattern was normal in 17 (70. 8 %) of 24 patients with diffuse thyroid proliferation and only the remainder (7/24, 29. 1% ) had abnormal echo-pattern as well as elevated auto-antibody titers, of whom 2 were confirmed as chronic lymphocytic thyroiditis by a repeat fine needle aspiration biopsy 1 year later. By using combined ultrasound imaging and antibody determination, 92 % of the cases with chronic lymphocytic thyroiditis could be diagnosed. Our study suggests that ultrasonic imaging is an easy, non-invasive, reproducible and effective procedure in the differen,tial diagnosis of chronic lymphocytic thyroiditis in children.

Audiological Evaluation in Goitrous Hypotyhroidism

Objective: To determine the incidence of deafness in patients suffering from goiterous hypothyroidism exclusively and to evaluate the role of L-thyroxine therapy in improving the hearing in this group of patients. Study Design: A prospective cohort study. Materials and Methods: Hearing status was evaluated in a sample size of 100 consecutive patients reporting to the ENT/Endocrinology department of Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP with the diagnosis of goitrous hypothyroidism. The study group included patients in the age group of 5 to 65 years belonging to either sex. Patients with detected hearing loss were categorized into group A, and all other patients were designated group B. L-Thyroxine treatment for goitrous hypothyroidism was initiated in all the cases. At the end of 6 months, a repeat audiogram was done in all the patients in order to evaluate the efficacy of the said treatment protocol on the hearing in these patients. The data were tabulated and statistically analysed using Paired Students “t” test. Results: An overall 39% hearing loss was observed in patients with goitrous hypothyroidism. 15% cases had sensorineural hearing loss, 13% had mixed hearing loss and 8% had a conductive hearing loss. A statistically significant hearing improvement was recorded in this study by L-thyroxine treatment in group-A, and no deterioration of hearing was recorded in group-B. Conclusions: The incidence of sensorineural hearing is less in patients with goitrous hypothyroidism (15%) as compared with the overall incidence of sensorineural hearing loss reported for hypothyroidism (30%-40%). Further, there is a definitive improvement in hearing with the use of L-thyroxine treatment of goitrous hypothyroidism.

Benin Goitre in the General Surgery Department at Teaching Hospital Gabriel Touré

Introduction: Goitre is an increase in the volume of the thyroid gland. Goiters may be congenital or acquired, diffuse or nodular, functional or non-functional, benign or malignant. Purpose: The objectives of this work were to study and determine the frequency of benign goitre in the general surgery department of CHU Gabriel Touré, and to study epidemiological, clinical and therapeutic aspects. Patients and Method: This was a retrospective and prospective study conducted in the general surgery department of CHU Gabriel Touré, from January 1999 to December 2019. Included in the study were all patients with benign goiter confirmed in histology, hospitalized and treated in the service. Patients with thyroid malignant tumours, strumite, thyroid tract cyst, cervical abscess and neck trauma were not retained. Socio-demographic, clinical, para-clinical, therapeutic and post-operative aspects were the study parameters. Word processing and tables were done with Microsoft Word and Excel 2016 software. Data analysis was performed with Epi info7 software, the statistical test used was the Khi2 test and a value of P < 0.05 was considered statistically significant. Results: A total of 253 patient files were collected. Thyroidectomy represented 5.02% (253/5036) of surgical procedures. The average age was 42.5 years with a standard deviation of 15.6 and extremes of 13.9 and 76 years. The sex ratio was 8.7 in favour of the female sex. Anterior cervical swelling was the most common reason for consultation with 90.0% (230/253). There were 118/253 cases of euthyroid goiter (46.6%), 132/253 cases of hyperthyroid goiter (52.2%) and 3/253 cases of Basedow’s disease (1.2%). Histology revealed (178/253) cases of micro and macro follicular colloid adenoma (70.3%), (27/253) cases of micro and macro follicular vesicular adenoma (10.7%) and (48/253) cases of micro and macro vesicular hyperplasia. The most performed surgical techniques were subtotal thyroidectomy with a rate of 138/253 (54.5%) isthmo-lobectomy with a rate of 102/253 (40.3%), lobectomy with a rate of 11/253 (4.3%) and isthmectomy 1/253 (0.4%). One-month follow-up was marked by 4 cases of surgical site infection (1.6%), 2 cases of transient hypocalcemia (0.8%). One-year follow-up was simple in 98.4% of cases, we noted 4 cases of keloid. The average length of hospitalization was 3.31 ± 0.1 days. Conclusion: Goiter surgery is relatively common in the general surgery department of CHU Gabriel Touré. Good preparation and better post-operative monitoring could help minimize post-operative complications.

Primary Amyloid Goitre

Goitre is defined as the presence of amyloid within the thyroid gland in such quantities as to produce a clinically apparent enlargement. We report a case on a fifty-two-year-old female patient who presented with a rapidly growing thyroid swelling. Thyroid function tests were normal. This case was diagnosed as amyloid goitre and was discussed in detail along with review of literature.

王志刚教授从肝论治甲状腺功能亢进症经验整理

甲状腺功能亢进症(简称甲亢)临床以心悸、汗出、饮食增多、行大便次数明细增多以及体质量减轻为主要症状,多数还伴有眼突、水肿、视力减退症状。中医诊断初期可见肝郁气滞,中期可见肝火旺盛,久病则可见气阴两虚,甚则脾肾阳虚和阴阳两虚。其发病的原因有内外两种因素,内因主要为情志不畅、肝气郁滞从而内伤积聚以致肝脾气逆,脏腑功能失和。外因主要与生活环境、水质、饮水或食物中含碘不足、家族遗传史等有关。主要病理机制为甲状腺分泌激素过多导致机体兴奋增高和代谢亢进,属中医学中“瘿病”范畴。临床症状为患者颈部肿大、肿块,此病曾经在中国早期偏远地区发病较多,俗称“大脖子病”。随着生活水平提高,社会压力加大,环境变化等影响,甲亢症患病率有所增加。甘肃中医药大学王志刚教授致力于临床研究甲亢症30余年,并根据多年临床经验总结出“从肝论治”的相关治疗思路。通过疏肝理气、清肝降火、柔肝养阴的方法治疗,取得较好临床疗效。文章通过对王志刚教授从肝论治甲亢症的诊疗经验进行简要整理,旨在为临床治疗甲亢症提供新思路。

2019—2022年平潭综合实验区重点人群碘缺乏病监测结果分析

目的为了解福建省平潭综合实验区重点人群碘营养状况,为推进因地制宜、分类指导和科学补碘的防控策略提供科学依据。方法根据《福建省碘缺乏病监测实施方案》,将平潭按东、西、南、北、中划分5个片区,每个片区各随机抽取1个乡镇(街道),每个乡镇(街道)随机抽取1所小学,每所小学抽取40名8~10岁非寄宿学生(年龄均衡、男女各半),采集尿样和家庭食用盐样。同时每乡抽取20名孕妇(早、中、晚孕期均衡),采集孕妇尿样和家庭食用盐;检测食用盐和尿样中碘含量。结果2019—2022年共检测重点人群家庭食用盐1259份,碘盐中位数24.3 mg/kg,碘盐覆盖率为30.42%,合格碘盐食用率为27.16%;监测儿童尿样832份,尿碘中位数为137.3μg/L;监测孕妇尿样427份,尿碘中位数为113.5μg/L;共检测儿童甲状腺832人,甲状腺肿大率2.16%。结论平潭综合实验区碘盐覆盖率和合格碘盐食用率低,8~10岁儿童的碘营养状况总体保持适宜水平,孕妇存在较严重碘营养不足。

新疆鹅喉羚的种群结构

１９９２年８～９月和１９９３年９月，作者在新疆北部鹅喉羚北疆亚种（ＧａｚｅｌｌａｓｕｂｇｕｔｔｒｏｓａＳａｉｒｅｎｓｉｓ）分布区（天山以北）设置１９条样带，总长８１８ｋｍ，观测点至动物的平均垂直距离２４８．３ｍ，面积４０５．８ｋｍ２的调查统计，见鹅喉羚６２群次，共２２１只。样带中动物的平均密度为０．７１±０．１７只／ｋｍ２。对能判别性别和成幼的１６条样带中的３７群次１１３只统计，雌：雄＝１：１．０５，成：幼＝２．４：１。对８条样带中的１６群次５０只统计，母：仔＝１：１．４。１９９３年２月和１０月，我们还在新疆南部鹅喉羚南疆亚种（Ｇ．ｓ．ｙａｒｋａｎｄｅｎｓｉｓ）分布区（天山以南），设置８条样带，长２３０ｋｍ，平均垂直距离２９９ｍ，面积１１６ｋｍ２的调查统计，见鹅喉羚１７群次５１只，平均密度０．５７±０．２６只／ｋｍ２。

山东省碘缺乏病防治现状及存在问题与对策

目的 通过调查 ,对山东省碘缺乏病防治现状进行评价 ,指出存在的问题 ,并提出相应的防治对策。方法 用人口容量比例概率 (PPS)抽样法在全省抽取 30个县市区为调查点 ,对 8～ 10岁儿童的甲状腺肿大率、尿碘、居民户盐碘合格率、新生儿脐带血 TSH、学生及家庭主妇健康教育答卷等调查。并对相关指标进行了分析。结果 甲状腺肿大率、尿碘中位数、盐碘合格率三项主要指标基本达到或接近国家消除碘缺乏病标准。但不同地区之间新生儿 TSH值相差较大。结论 山东省碘缺乏病防治工作成绩较大 ,但存在问题仍然不少 。

卡拉麦里山有蹄类自然保护区蒙古野驴和鹅喉羚种群密度和数量

2006年9月至2007年12月,在卡拉麦里山有蹄类自然保护区采用截线取样法调查了蒙古野驴(Equus hemionus)和鹅喉羚(Gazella subgutturosa sairensis)的种群密度。蒙古野驴野外调查样线总长6,696.4km,发现7,758匹蒙古野驴;鹅喉羚样线总长8,428.84km,发现8,586头鹅喉羚。采用Distance5.0估算了蒙古野驴和鹅喉羚的密度和遇见率。从春季到秋季,蒙古野驴遇见率在0.058-0.092匹/km之间变化,而鹅喉羚遇见率则在0.096-0.342头/km之间变化。春季蒙古野驴种群密度为0.55±0.20匹/km2(平均数±标准差,下同),夏季为0.60±0.13匹/km2,秋季为0.78±0.19匹/km2和冬季为0.54±0.14匹/km2。蒙古野驴适宜栖息面积5,800km2。春季到冬季,蒙古野驴种群数量在3,379到5,318匹之间变化。鹅喉羚春季、夏季、秋季和冬季种群密度分别为1.14±0.18头/km2,0.95±0.12头/km2,1.08±0.18头/km2和1.54±0.31头/km2。该保护区的鹅喉羚冬季和春季适宜栖息面积均为10,000km2,夏季为12,000km2,秋季为15,000km2。估算该区域春季鹅喉羚数量为14,286头,夏季为6,628头,秋季为8,337头,冬季为19,677头。本研究的结果将为卡拉麦里山有蹄类自然保护区蒙古野驴和鹅喉羚长期监测提供基础数据。

季节、性别和群体大小对鹅喉羚警戒行为的影响

动物通过集群降低个体警戒时间,从而增加采食等行为时间,这种现象被称为"群体效应"。除群体大小外,社会及环境因子如季节与性别也可能影响个体警戒水平。本文于2007年至2009年在新疆卡拉麦里山有蹄类野生动物保护区采用焦点动物取样法,通过测定鹅喉羚警戒行为比例、平均每次警戒持续时间及10min内警戒频率,研究了季节、性别及群体大小对鹅喉羚个体警戒水平的影响,并验证群体效应。结果表明:由于季节更替而产生的生物量的变化对鹅喉羚个体警戒水平无显著影响;在秋冬季除雄性外,鹅喉羚个体警戒水平均有随群体增大而降低的趋势,但这种趋势并不十分明显。性别则显著影响其警戒水平,夏季由于雌性羚羊处于哺乳期,因而其警戒水平显著高于雄性(P<0.05);受繁殖行为影响,冬季雄性比雌性警觉性更高(P>0.05);春秋季两性间警戒水平没有差异(P>0.05)。不同生理周期是导致鹅喉羚育幼期雌性及繁殖期雄性个体警戒水平发生显著变化的重要因子。

结节性甲状腺肿的CT与病理对照分析

目的探讨螺旋CT对结节性甲状腺肿的诊断与鉴别诊断价值。资料与方法回顾性分析52例结节性甲状腺肿的CT表现,并与病理对照分析。根据CT表现将结节性甲状腺肿结节分为囊性、囊实性和实性结节。结果52例结节性甲状腺肿CT发现93个结节性病灶,其中囊性病灶28个;囊实性病灶54个;实性病灶11个。结论螺旋CT对结节性甲状腺肿的诊断与鉴别诊断是一种有价值的检查方法,但对单个实性结节与腺瘤的鉴别诊断仍存在困难。

卡拉麦里山有蹄类自然保护区鹅喉羚生境适宜性评价

在卡拉麦里山保护区内选取具有代表性的研究样区约1447km2作为评价区,基于2005年以来对卡拉麦里山有蹄类自然保护区鹅喉羚野外调查和样方采集,利用模糊赋值法建立生境评价模型,结合GIS技术的空间分析功能,以植被类型、坡度、坡向和人类干扰活动为评价因子进行生境适宜性研究。结果表明:春、夏、秋、冬四季实际生境面积分别为1146.9km2、1137.1km2、991.6km2和499.8km2,分别占研究区域总面积的79.3%、78.6%、68.5%和34.5%;其中适宜生境面积分别为304.1km2、599.4km2、303.6km2和56.2km2,分别占研究区域总面积的21.0%、41.4%、21.0%和3.9%。人类活动影响下,一些潜在生境转变为不适宜生境,春、夏、秋、冬四季生境分别丧失4.0%、3.1%、4.3%和48.5%。在各种人类活动中,居民点、国道、采矿点对鹅喉羚生境具有一定的干扰作用,使其质量有所降低,但未造成严重影响;而冬季牧民的放牧行为,导致鹅喉羚的适宜生境被家畜占据,鹅喉羚生境质量大面积下降。本文基于评价结果提出了保护措施。

新疆准噶尔盆地东部鹅喉羚采食地的特征

2001～2003年5月和9月,通过野外直接观察采样的方法,我们对新疆准噶尔盆地东部木垒地区鹅喉羚的采食地进行了研究.在研究区南部,分布着以盐生假木贼和蒿为主的低矮小半灌木,其间散布有木本猪毛菜和驼绒藜为优势种的条块状高灌丛.鹅喉羚多在灌丛块中采食.Mann-Whitney U检验表明,采食地内的植物种数、植被盖度和植被高度都显著高于对照地中相应成分.主成分分析表明,影响鹅喉羚采食地选择的主要环境因子是植物种数和植被盖度.在研究区北部,分布着以沙生针茅和木地肤为主的植被,其间散布有固定和半固定沙丘.沙丘上各种灌木发育较好,鹅喉羚多在沙丘上觅食.Mann-Whitney U检验表明,采食地内的植物种数、植被盖度、植被高度,以及蛇麻黄、木地肤和驼绒藜的盖度都显著高于对照地中相应成分.主成分分析表明,影响鹅喉羚采食地选择的主要环境因子是蛇麻黄、木地肤、扁果木蓼盖度和植物种数.

地方性甲状腺肿致病危险因素的调查分析

目的探索地方性甲状腺肿的致病危险因素，为科学防治提供理论依据。方法在黑龙江大庆地区随机抽取９９７８名居民，进行问卷、体检和采集静脉血样。结果大庆地区人群地方性甲状腺肿的患病率为５．６％；拟定的１０种致病危险因子，经Ｌｏｇｉｓｔｉｃ回归分析有统计学意义的只有４个，依次为低碘盐、高碘盐、地区性、含碘药品。结论机体摄碘不足和过高均是地方性甲状腺肿的主要危险因素。

甲状腺常见病变CT诊断及与ECT对照分析

目的通过对甲状腺常见病变(甲状腺腺瘤、甲状腺癌和结节性甲状腺肿)的CT表现及ECT表现的分析,探讨甲状腺病变的影像学诊断特点。方法根据手术病理结果,对42例甲状腺病变的CT及其中1 9例ECT表现进行观察分析。结果甲状腺腺瘤15例,CT主要表现为形态规则,边缘光整的结节,呈岛状强化。ECT多为"凉"或"温"结节。甲状腺癌13例,CT表现为形态不规则,边缘模糊,密度不均匀,可见细沙粒状钙化,呈不均匀强化,ECT多为"冷"结节。结节性甲状腺肿14例,CT表现为多发结节,边缘不清,密度均匀,增强呈中等度强化,ECT为"温"结节。结论CT对甲状腺肿瘤的诊断有一定的价值,结合ECT对核素的摄取能力能更好地提高甲状腺肿瘤的定性诊断定性。

甲状腺腺瘤和结节性甲状腺肿的彩色多普勒超声诊断

目的探讨彩色多普勒超声对甲状腺腺瘤和结节性甲状腺肿的鉴别诊断价值。方法回顾性分析经手术或细针抽吸活检病理证实的58例甲状腺腺瘤患者和47例结节性甲状腺肿患者的声像图资料,对这两组的二维声图像与彩色多普勒血流(CDFI)图像特点进行比较分析,并将声像图诊断与病理结果相对照。结果上述两组疾病在甲状腺大小,结节数目、大小、内部回声、周边包膜及结节内部血流参数等方面,均无显著性差异(P>0.05);在结节边缘晕环、结节内部血流信号、结节周边血流信号及其血流参数等方面,差异均有显著性(P<0.05)。结论彩色多普勒超声可对甲状腺腺瘤和结节性甲状腺肿做出较准确的诊断。

离子色谱法测定碘在地甲病环境地质调研中的应用

收集了安徽省某地区地甲病流行患者的血、尿、发样，病区的饮水样、谷物、蔬菜样和环境地质样共计６９９个，同时收集了该地非病区水样和环境地质样２８２个。水样直接进样，其它样品经湿法分解后，用离子色谱法测定其中的碘和溴的含量。统计分析表明，病区地甲病患病率与饮水中碘的含量密切相关，也与环境地质如地貌、地质构造及水文地球化学等条件密切相关。碘含量低的石灰岩地区，地甲病患病率高。

我国某核电站运行前儿童甲状腺肿大调查

目的提供核电正常运行或核电事故对儿童健康影响相应的基础资料。方法对我国某核电站周围30km范围内4003名7～14岁儿童采用临床触诊方法进行检查,然后从触诊受检者中随机抽取30%儿童进行专用B超仪检查;使用半定量法测定全部触诊儿童家中食盐碘的含量,用酸消化砷铈接触法测定216名触诊儿童尿碘含量。结果甲状腺触诊检查人数为4003人,甲状腺肿大率平均为8.34%,其中距核电站5km的A镇甲状腺肿大率大于10%,食盐碘盐的合格率以A镇最低;甲状腺专用B超仪检查人数为1590人,甲状腺肿大率平均为9.69%,其中距核电站5km的A镇及15km的D镇甲状腺肿大率均大于10%,尿碘测定低于100μg/L的以D镇人数最多;B超检查甲状腺肿大检出率高于触诊检出率。结论我国某核电站周围部分地区可能存在地方性甲状腺肿大流行区。