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Related Concept Videos

Goiter01:27

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Goiter refers to an abnormal enlargement of the thyroid gland that may appear as a diffuse goiter (uniform enlargement) or nodular (single or multiple nodules). Functionally, it is classified as nontoxic (normal/low hormone levels) or toxic (excess hormone production).PathophysiologyDiffuse thyroid enlargement typically results from prolonged stimulation by thyroid-stimulating hormone (TSH) or TSH-like agents, commonly seen in hypothyroidism or iodine deficiency. In contrast, in hyperthyroid...
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Hyperthyroidism II: Pathophysiology01:27

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Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH...
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The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
The follicles have a central cavity lined by simple cuboidal to squamous epithelial cells called follicular cells. These cells produce the glycoprotein...
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Hyperthyroidism I: Introduction01:25

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Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
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Graves' Disease I: Introduction01:28

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Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactivity of the thyroid gland. It results from autoantibodies called thyroid-stimulating immunoglobulins (TSIs), which bind to thyroid-stimulating hormone (TSH) receptors, leading to overstimulation of hormone production and a hypermetabolic state.EtiologyAlthough considered idiopathic, Graves’ disease has well-established contributing factors. There is a strong genetic component, with increased prevalence...
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Graves Disease II: Pathophysiology01:24

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Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor,...
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Minimal Invasive Resection of Large Retrosternal Thyroid Goiter
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Incidental cancer in multinodular goitre post thyroidectomy.

I Bombil, A Bentley, D Kruger

    South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
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    A 5.7% risk of undetected thyroid cancer exists in multinodular goitre (MNG) patients. Papillary carcinoma was the most common incidental malignancy found during thyroidectomy for MNG.

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    Area of Science:

    • Endocrinology
    • Surgical Oncology
    • Pathology

    Background:

    • Multinodular goitre (MNG) carries a significant risk of malignancy, estimated at 7.2%.
    • Fine-needle aspiration biopsy (FNAB) is the standard for thyroid cancer diagnosis, but inconclusive or benign results can mask underlying malignancy.
    • The management of MNG with benign FNAB results poses a challenge due to the potential for missed thyroid cancer.

    Purpose of the Study:

    • To investigate the prevalence and histological characteristics of incidental thyroid cancers in patients undergoing thyroidectomy for MNG.
    • To assess the rate of malignancy missed by FNAB in the context of MNG management.

    Main Methods:

    • Retrospective review of 166 thyroidectomies performed between 2005 and 2010 at Chris Hani Baragwanath Academic Hospital.
    • Analysis of patient demographics, thyroid function tests, FNAB cytology, and final histological findings.
    • Focus on cases with pre-operative FNAB results suggestive of benign nodular goitre.

    Main Results:

    • Incidental malignancy was detected in 5.7% (4 out of 70) of MNG cases with benign FNAB results.
    • All incidental cancers identified were papillary carcinomas, with the follicular variant being predominant (75%).
    • Female patients constituted the majority (139/162) of those undergoing thyroidectomy.

    Conclusions:

    • The study highlights a 5.7% risk of occult thyroid malignancy in patients with MNG initially diagnosed as benign by FNAB.
    • Papillary carcinoma, particularly its follicular variant, is the most frequent histological subtype of incidental thyroid cancer found in MNG.
    • These findings underscore the importance of considering surgical intervention in select MNG cases even with benign FNAB results, especially in high-risk populations.