Goitre prevalence and mental performance were determined amongst the Aborigines in Sinderut, a remote rural area in Pahang. A total of 196 subjects aged 4 to 60 years old were selected for study. Goitre status was determined by an experienced endocrinologist using classification suggested by World Health Organization; while mental performance was measured using Raven's test (Oxford Psychologists Press). Blood specimen was also taken for thyroxine (T4) and thyroid stimulating hormone (TSH) measurement. It was found that goitre prevalence was 26.5% (52/196); with visible goitre prevalence of 42.3% (22152). The overall mean of goitre volume was 21.4 ± 19.1 ml (range: 3.0 - 90.8 ml), while the prevalence of mental performance for the percentile value of more than 5.0 was 26.5% (range: 5.0 - 50.0). Mean thyroxine levels was 75.4 ± 19.3 nmol/L (range: 19.9 - 138.1 nmol/ L) while mean levels of thyroid stimulating hormone was 4.9 ± 3.2 mU/L (range: 0.4 - 18.9 mU/L). There was no significant correlation between hormone levels and mental performance score (Pearson Correlation; T4 : r=-0.002, p=0.9736; TSH : r=0.10, p=0.1843). goitre volume and mental performance score (Pearson Correlation; r=-0.02, p=0.8395). Goitre prevalence of more than 20% in this area indicates a moderate endemia, while mental performance showed a low thinking level in the Aborigines particularly those who lived in remote areas.
The c.2268dup mutation in thyroid peroxidase (TPO) gene was reported to be a founder mutation in Taiwanese patients with dyshormonogenetic congenital hypothyroidism (CH). The functional impact of the mutation is not well documented. In this study, homozygous c.2268dup mutation was detected in two Malaysian-Chinese sisters with goitrous CH. Normal and alternatively spliced TPO mRNA transcripts were present in thyroid tissues of the two sisters. The abnormal transcript contained 34 nucleotides originating from intron 12. The c.2268dup is predicted to generate a premature termination codon (PTC) at position 757 (p.Glu757X). Instead of restoring the normal reading frame, the alternatively spliced transcript has led to another stop codon at position 740 (p.Asp739ValfsX740). The two PTCs are located at 116 and 201 nucleotides upstream of the exons 13/14 junction fulfilling the requirement for a nonsense-mediated mRNA decay (NMD). Quantitative RT-PCR revealed an abundance of unidentified transcripts believed to be associated with the NMD. TPO enzyme activity was not detected in both patients, even though a faint TPO band of about 80 kD was present. In conclusion, the c.2268dup mutation leads to the formation of normal and alternatively spliced TPO mRNA transcripts with a consequential loss of TPO enzymatic activity in Malaysian-Chinese patients with goitrous CH.
A massive goiter may constrict the trachea resulting in shortness of breath. Recurrent laryngeal nerve compression may cause vocal cord paralysis. We highlight a case of a 62- year-old female with a 30 year history of an anterior neck swelling gradually increasing in size. She presented with acute symptoms of upper airway obstruction and voice changes. Emergency thyroidectomy was performed by dividing the middle part of the gland using ultrasonic scissors. The recovery was uneventful and the patient regained normal vocal cord function post operatively.
A significant difference in the levels of thyroxine (T4), thyroid stimulating hormone (TSH) and thyroid volume among settlements at various selected Orang Asli locations is reported. The levels improved according to the level of socio-economic development. No significant difference was found in mental performance by location.
Massive goiter with retrosternal extension may impose additional risk such as difficult intubation, tracheomalacia, and possibility of different incision and approach including sternotomy. We would like to report a case of massive goiter encasing major neck structures and how it was managed.
BACKGROUND: Acute life threatening presentations of thyroid disease are uncommon. The aim of this study was to review our experience of emergency thyroid surgery with regard to the incidence, management and outcome to this approach.
METHODS: Forty patients who underwent emergency thyroid surgery from December 1998 to December 2007 were prospectively accrued in this study. There were 30 female and 10 male patients. The mean age was 63.8 years (range, 33-83 years). All patients had total thyroidectomy, except one patient who only had a right hemithyroidectomy for a dominant right multinodular goiter. Eight of the patients had been intubated before referring to our centre.
RESULTS: The mean weight of specimen was 219 g (range, 32-800 g). A histopathology report confirmed 16 patients had multinodular goiters, eight patients had papillary thyroid carcinomas, seven patients had anaplastic cancers, four patients had follicular thyroid carcinomas, two patients had thyroid lymphoma, one patient had medullary carcinoma, one patient had sarcoma and one patient had thyroid abscess. A total of 28 patients were discharged well postoperatively.
CONCLUSION: Acute life threatening presentations of thyroid disease are uncommon. However, early recognition of these problems is crucial and may life saving. Emergency thyroidectomy is important to release the critically obstructed airways. Nonetheless it is associated with higher risk of surgery and complication rate then any elective thyroid surgery.
Large goitres are common in the developing world, particularly in Asia and Africa. Nonetheless, large fungating goitres are extremely rare and represent a unique challenge to surgeons. Surgery should always be considered, when the general condition of the patient permits, to provide a better quality of life as it offers the only hope of long-term survival. The potential gain with surgery is that it allows maximum benefit for more effective radioactive iodine ablation and radiotherapy treatment. We report two cases of large fungating thyroid cancers complicated by anaemia and foul-smelling discharge.
Iodine deficiency endemia is defined by the goitre prevalence and the median urinary iodine concentration in a population. Lack of local thyroid volume reference data may bring many health workers to use the European-based WHO/International Council for Control of Iodine Deficiency Disorders (ICCIDD)-recommended reference for the assessment of goitre prevalence in children in different developing countries. The present study was conducted in non-iodine-deficient areas in Malaysia to obtain local children's normative thyroid volume reference data, and to compare their usefulness with those of the WHO/ICCIDD-recommended reference for the assessment of iodine-deficiency disorders (IDD) in Malaysia.
A total of 2,034 subjects aged 15 years and above from different parts of the State of Kelantan were studied to determine goiter size and urinary iodine excretion. The State was divided into 2 areas - area 1 consisting of localities in the districts near the coast and area 2 consisting of localities in the inland districts. There were 1,050 subjects in area 1 and 984 subjects in areas 2. The mean age (+/- SE) of subjects in areas 1 and 2 were 38.2 + 0.5 and 37.1 +/- 0.5 years, respectively. The prevalence of goiter was 31.4% in area 1 and 45.0% in area 2; the difference was statistically significant (p < 0.05). However, the prevalence of large and visible goiters (grades II and III) was only 2.0% in area 1 and 3.3% in area 2; the difference was not statistically significant. The mean (+/- SD) urinary iodine excretion in areas 1 and 2 was 57.1 +/- 2.1 and 56.8 +/- 2.1 micrograms I/g Cr, respectively. The values were below those recommended by WHO. There was no significant difference in urinary iodine excretion between those with and without goiters in both areas and also between the grades of goiters. There were significantly more females with goiters than males in both areas but there was no significant difference in the urinary iodine excretion between the 2 sexes. Thus based on urinary iodine excretion, the iodine intake of the population in this area, was suboptimal and this was associated with a high prevalence of goiter.
The study was conducted to compare the prevalence of goitre among Malays and Aborigines in remote inland rural areas to those in coastal areas. All subjects were examined thoroughly by an experienced endocrinologist for the presence of goitre. The overall goitre prevalence in coastal areas was 6.3%; 6.0% (4/67) of Aborigines and 6.7% (4/60) of Malays were affected. However, in remote inland areas, the prevalence of goitre was almost 5 times higher compared to coastal areas. The prevalence of goitre was 30.7% in Baling; 30.2% (19/63) Aborigines and 30.8% (92/299) Malays were affected. Iodine deficiency is the most likely cause for the high prevalence of goitre in the remote inland areas.
Four areas of differing remoteness were studied to determine the prevalence of goitre in the Keningau Division of Sabah. These areas were Keningau town, the Biah Resettlement Scheme, the Dalit subdistrict and the Pagalunggan subdistrict. The predominant ethnic group in these areas is the Murut. The overall endemicity of goitre for the study population was 76.5% for females aged 15 years and above. There was a significant correlation between the incidence of goitre and the remoteness of an area. The Dalit subdistrict has the highest incidence of goitre (82.6%) followed by the Pagalunggan subdistrict (77.8%), the majority of these goitre cases being classified as grade 2 (visible goitres). These were the two most remote areas in the study. In contrast, Keningau town, the least remote area has the lowest incidence of goitre (62.5%) with most of the goitres being relatively small. With regards to salt usage in the Dalit subdistrict, only 3.0% used iodised salt; 28.0% used fine salt; 3.6% used coarse salt and 65.5% used both fine and coarse salt. In the Pagalunggan subdistrict, all females used uniodised salt with 17.6% using fine salt, 20% using coarse salt and the remainder using both fine and coarse salt. As yet, there is no legislation for the iodisation of salt in Sabah. It is clear that all types of salt need to be iodised and adequately distributed to deprived areas, particularly inland areas.
A retrospective review of 107 patients operated on for multinodular goitre was carried out to determine the incidence of carcinoma. Of the group 7.5 per cent harboured incidental carcinomas with papillary carcinoma being the most common variety. The indications for removal of multinodular goitre should be compressive symptoms, suspicion of malignancy and cosmesis.
Acute airway obstruction in pregnancy remains a challenge to manage. Failure of appropriate and timely airway management may lead to maternal morbidity and mortality such as aspiration pneumonitis or worst hypoxaemic cardiopulmonary arrest. 1 As pregnancy may exacerbate asthma attacks, parturient presenting with wheezing or shortness of breath will commonly be treated as suffering from an asthmatic attack. 2 However, it is important to note other possible differential diagnoses. Thyroid disease is relatively common in women of childbearing age. The thyroid gland undergoes several changes during pregnancy, which may lead to altered function as well as gland enlargement and cause upper airway obstruction and symptoms similar to a bronchial asthma attack. 3 4 With that in mind, we report a case of a parturient with long-standing goitre in her second trimester who presented to our institution with acute respiratory symptoms and cardiopulmonary arrest.
Thyroid cancer is the most common among all endocrine malignancies. The worldwide prevalence of goitre in the general population is estimated at 4-7 percent and the incidence of malignancy in goitrous thyroid is about ten percent. It is postulated that goitrous thyroid is a precursor lesion to the development of malignant thyroid diseases. As Sarawak is a state well known for endemic goitre, this study focused on establishing the incidence of thyroid malignancy among goitrous thyroid swellings.
The effect of consuming large amounts of cassava leaves on thyroid function and urinary iodine was studied. Twenty volunteers were given 200 gm of boiled cassava leaves twice a day for 12 consecutive days. Thyroid hormones triiodothyronine and thyroxine were significantly lower by 9 days. Urinary iodine excretion was also significantly decreased. Cassava leaves, consumed in large amounts by aborigines, probably caused goitres by decreasing iodine absorption.
Mask ventilation is one of the most important skills in airway management. Difficulty in mask ventilation can become life threatening if it is associated with difficulty in intubation during general anesthesia. We report a potential impossible ventilation condition which was safely and easily overcome with appropriate innovative modification of an Opsite adhesive film.
Endemic goitre is a major concern in many parts of the world, including Southeast Asia. Goitrous thyroid lesion is postulated as a precursor lesion to thyroid cancer (TC). This paper reviews the prevalence rates and characteristics of TC among cases of goitrous thyroid-swelling in different parts of Malaysia and Myanmar. Recorded data from hospital-based retrospective studies of thyroid cases, whose study periods ranged from three to 11 years, were analysed. These included research findings from the author's publications as well as other published review articles of retrospective analyses. The incidence of TC varies among gender, age, race/ethnicity and histological type. There appears to be a higher rate of occurrence among females aged 21-60 years. Papillary thyroid carcinoma is the more common histological type compared to follicular cancer. This review also presents a descriptive analysis and discussion on studies conducted in other countries. Further exploration is warranted in order to uncover the possible risk factors for the rising incidence of TC.