The spectrum of thyroid disorders in iodine deficient community: The Pescopagano Survey

Università di Pisa, Pisa, Tuscany, Italy
Journal of Clinical Endocrinology &amp Metabolism (Impact Factor: 6.21). 03/1999; 84(2):561-6. DOI: 10.1210/jcem.84.2.5508
Source: PubMed


We carefully assessed thyroid status and goiter by ultrasound in 1411 subjects virtually representing the entire resident population of Pescopagano, an iodine-deficient village of Southern Italy. Median urinary iodine excretion was 55 microg/L. The prevalence of goiter was 16.0% in children and 59.8% in adults. Thyroid nodularity was 0.5% in children and progressively increased with age to 28.5% in the 56- to 65-yr-old group. The prevalence of present or past hyperthyroidism was 2.9%, including 9 cases with toxic diffuse goiter and 20 with toxic nodular goiter. Functional autonomy was rare in children, progressively increased with age up to 15.4% in the elderly, and was related to nodular goiter. The prevalences of overt and subclinical hypothyroidism in the adults were 0.2% and 3.8%, respectively. Serum autoantibodies to thyroglobulin and thyroperoxidase were detected in 12.6% of the entire population. The prevalence of diffuse autoimmune thyroiditis was 3.5%, being very low in children. Thyroid cancer was found in only 1 case. In conclusion, in the present survey of an iodine-deficient community, a progressive increase with age of goiter prevalence, thyroid nodularity, and functional autonomy was observed. Hyperthyroidism was twice as high as that reported in iodine-sufficient areas, mainly due to an increased frequency of toxic nodular goiter. Although low titer serum thyroid antibodies were relatively frequent, the prevalences of both overt and subclinical autoimmune hypothyroidism were not different from those observed in iodine-sufficient areas.

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    • "Nodule prevalence in adults has been estimate to range from 2 to 6% by palpation, from 19 to 35% by ultrasonography (US) and from 8 to 65% in postmortem examinations [3]. Although the epidemiological studies in pediatric age are very scanty, nevertheless US prevalences in childhood may be estimated to range from 0.2 to 5.1% [4,5]. However, the cancer risk of a thyroid nodule is significantly greater in children than in adults (22 vs 14%) [6]. "
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    ABSTRACT: Aims of this commentary is to report the most recent views about epidemiology, diagnostic procedures, malignancy risk factors and clinical management of thyroid nodules in children. On the basis of our personal experiences and recent literature evidences, we conclude that: a) if nodule is accompanied by lymphadenopathy and/or other alert findings, fine-needle aspiration biopsy (FNAB) should be recommended; b) if no lymphadenopathy and no other clinical and ultrasonographic alert signs are observed, work-up can progress to FNAB only if nodule persists or grows over time, even under levo-thyroxine therapy.
    Italian Journal of Pediatrics 05/2014; 40(1):48. DOI:10.1186/1824-7288-40-48 · 1.52 Impact Factor
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    • "It reportedly accounts for approximately 0.5–3% of all carcinomas in their age groups (1), and its incidence under the age of 20 is about one in 100,000 in Japan (7). The prevalence of thyroid nodules in children was reported to be lower than that in adults (1, 16, 17). But some reports showed that the cancer risk of thyroid nodules is higher in children than in adults. "
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    ABSTRACT: Here we present the case of a 14-yr-old girl who developed thyroid follicular carcinoma accompanied by Graves' disease. She was diagnosed with Graves' disease at 10 yr of age and soon achieved a euthyroid state after starting treatment. When she was 13 yr of age, her hyperthyroidism and goiter worsened despite medical therapy. Multiple nodules were found in her enlarged thyroid gland by ultrasonography. Her serum Tg level seemed within the normal range. She underwent near-total thyroidectomy for control of thyroid function. Histopathological study demonstrated that multiple oxyphilic follicular neoplasms were surrounded by the thyroid tissue compatible with Graves' disease. Capsular invasion was identified in one of the nodules, and thus the histological diagnosis was minimally invasive follicular carcinoma. She did not have signs suggesting metastasis, and has had no relapse for 18 mo after the operation. Although some previous studies showed a high prevalence of thyroid cancer with an aggressive nature in adult patients with Graves' disease, few reports about thyroid cancer accompanied by Graves' disease are available in children. The present case, however, suggests that careful investigation is needed when we detect thyroid nodules or progressive thyroid enlargement, especially in children with Graves' disease.
    Clinical Pediatric Endocrinology 04/2014; 23(2):59-64. DOI:10.1297/cpe.23.59
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    • "Thyroid nodules are palpable in 5% of subjects [1] [2] but are detectable by thyroid ultrasound (US) in up to 50% of the general population [3]-[5]. Only a minority of thyroid nodules are likely to cause significant health problems. "
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    ABSTRACT: The purpose of this study was to evaluate the predictive value of real-time ultrasound elastogra-phy (RUE) in differentiating benign from malignant thyroid nodules, with fine needle aspiration cytology analysis as the reference standard. A total of 78 consecutive patients with thyroid no-dules who were selected for fine needle aspiration biopsies were examined in this prospective study. 78 nodules in these patients were examined by conventional ultrasound, and ultrasound elastography. The final diagnosis was obtained from cytological findings. Tissue stiffness on ul-trasound elastography was scored from 1 (low stiffness over the entire nodule) to 5 (high stiffness over the entire nodule and surrounding tissue). On real-time ultrasound elastography, 47 of 62 benign nodules (76%) had a score of 1 or 2, whereas 15 of 16 malignant nodules had a score of 3 to 5, with sensitivity of 93.7%, specificity of 90%, a positive predictive value of 71%, and a nega-tive predictive value of 98%. Real-time ultrasound elastography is a promising imaging technique that is useful in the differential diagnosis of thyroid cancer. Utilization of ultrasound elastography could reduce the rate of thyroid biopsies because of its high elasticity being highly associated with benign cytology.
    Open Journal of Medical Imaging 03/2014; 4(4):38-47. DOI:10.4236/ojmi.2014.41006
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