The paper introduces professor SHENG Can-ruo's experience in treatment of goiter with the combination of acupuncture and herbal medication. Professor SHENG believes that this disease is mostly related with emotional injury, improper diet and geographical and climatic factors, as well as body constitution. Qi stagnation, phlegm retention, blood stagnation and interaction of phlegm and stasis are the essential pathogenesis of goiter. Either acupuncture or herbal medication should focus on "phlegm and stasis" in treatment. Besides, the theory of western medicine should also be considered. In western medicine, thyroid enlargement is classified into Ⅰ, Ⅱ and Ⅲ degrees of struma, thus, the pathogenesis and treatment with Chinese medicine should be adjusted accordingly. The created "four throat points", combined with acupuncture at distal points, relieve the local masses. The basic herbal formula is prepared and the couplet medicines are modified based on syndrome differentiation. The integrated acupuncture and herbal medication regulates emotions and provides a comprehensive treatment for goiter.
Acupuncture Therapy ; Combined Modality Therapy ; Goiter/drug therapy* ; Humans ; Medicine, East Asian Traditional ; Neck

OBJECTIVETo compare the effects of three different iodine interventions on the speed of normalization of enlarged thyroid gland.

METHODSSchoolchildren aged 8 - 10 years were randomized divided into one of three groups: group A was given iodized salt by researchers with an iodine concentration of 25 mg/kg; group B used iodized salt purchased from the market; and group C was similar to group B with additional intake of iodized oil capsules containing 400 mg iodine at the beginning of the study. Salt iodine content was measured bimonthly for 18 months and indicators of iodine deficiency were measured at baseline and 6, 9, 12 and 18 months thereafter.

RESULTSThe prevalence of goiter measured by ultrasound, based on the World Health Organization (WHO) body surface area reference > 97(th) percentile, was 18% at baseline and declined to less than 5% by 12 month in groups A and C respectively, and to 9% after 18 months in group B. Rates of goiter were similar by palpation or by ultrasound. The median urinary iodine was 94 micro g/L at baseline and increased in all groups to > 200 micro g/L at the 6-month follow-up.

CONCLUSIONSIn this sample of schoolchildren with initially low or moderate level of iodine deficiency, the group receiving salt with 25 mg/kg (group A) recovered from iodine deficient on all indicators after 18 months of study. However when the iodine content of salt was floating, as seen in group B, the sizes of thyroid did not yet achieve normal status by 18 months.

Child ; Female ; Goiter ; drug therapy ; physiopathology ; Humans ; Iodine ; therapeutic use ; Male ; Outcome Assessment (Health Care)

Adult ; Antiviral Agents ; administration & dosage ; Drug Therapy, Combination ; Female ; Goiter, Nodular ; complications ; drug therapy ; Hepatitis C, Chronic ; complications ; drug therapy ; Humans ; Interferon-alpha ; administration & dosage ; Ribavirin ; administration & dosage

PURPOSE: Anaplastic thyroid cancer (ATC) is a rare but highly aggressive neoplasm with a dismal prognosis. However, a few patients survive for a long time after treatment. We tried to identify prognostic factors of this disease and analyzed treatment outcomes in patients with ATC. METHODS: We reviewed the medical records of 15 patients diagnosed with ATC in our institution between 1988 and 2003. The survival was compared by the Kaplan-Meier logrank test using SPSS program. RESULTS: The female-to-male ratio was 1.5:1 (9 women and 6 men), and the mean age at diagnosis was 63.9 years (range, 44~91). The mean tumor size was 6.3 cm (range, 4~10 cm). Extrathyroidal invasion was present in 12 cases and distant metastasis at diagnosis was present in 6 cases. Surgery was performed in 8 cases. Radiotherapy was used for 10 cases and chemotherapy for 5 cases. The mean overall survival time of the 15 patients was 237 days (range, 28~717 days). The 6~, 12~, 18~ and 24~ month survival rates were 33%, 26%, 13% and 0%. No association was found between survival and presenting symptoms, age, gender, tumor size, previous goiter history, extrathyroidal invasion, distant metastasis, surgery, radiotherapy or chemotherapy. A significantly better outcome was observed in patients received triple modality treatment (surgery, radiotherapy and chemotherapy) than in those received single or dual modality treatment (P=0.05). CONCLUSION: Although most patients with ATC had a poor prognosis, a multimodal approach including surgery, radiotherapy and chemotherapy, might improve survival.
Diagnosis ; Drug Therapy ; Female ; Goiter ; Humans ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Radiotherapy ; Survival Rate ; Thyroid Carcinoma, Anaplastic*

BACKGROUND: Anti-thyroid drug therapy is considered a treatment of choice for Graves' disease; however, treatment response varies among individuals. Although several studies have reported risk factors for relapse after initial treatment, few have assessed responsiveness during the early treatment period. Our study aimed to identify the clinical characteristics for responsiveness to methimazole. METHODS: We included 99 patients diagnosed with Graves' disease for the first time. Drug responsiveness was defined as the correlation coefficients between decreasing rates of free thyroxine level per month and methimazole exposure dose. According to their responsiveness to treatment, the patients were classified into rapid or slow responder groups, and age, sex, free thyroxine level, and thyrotropin binding inhibiting immunoglobulin (TBII) titers were compared between groups. RESULTS: The mean patient age was 44.0±13.5 years and 40 patients were male (40%). The mean TBII titer was 36.6±74.4 IU/L, and the mean free thyroxine concentration was 48.9±21.9 pmol/L. The rapid responder group showed higher TBII titer and free thyroxine level at diagnosis, while age, sex, smoking, and presence of goiter did not differ between the two groups. Logistic regression analyses revealed that high level of serum thyroxine, high titer of TBII, and absence of goiter were significantly associated with a rapid response, while age, sex, and smoking were not significant factors for the prediction of responsiveness. CONCLUSION: In patients with new onset Graves' disease, high level of free thyroxine, high titer of TBII, and absence of goiter were associated with rapid responsiveness to methimazole treatment.
Diagnosis ; Drug Therapy ; Goiter* ; Graves Disease* ; Humans ; Immunoglobulins ; Logistic Models ; Male ; Methimazole* ; Recurrence ; Risk Factors ; Smoke ; Smoking ; Thyrotropin ; Thyroxine*

PURPOSE: This study was carried out to evaluate the age and sex distribution, clinical manifestation, presence of the antithyroid antibody, the clinical outcome following antithyroid drug treatment in children with Graves' disease. METHODS: A total 45 children with Graves' disease were entered into the study. Diagnosis was based on clinical manifestation, elevated thyroid function and increased homogeneous 99mTc thyroid uptake on thyroid scan. All patient were treated with prophylthiouracil or methimazole, and assessed concerning about clinical symptoms and signs, existence of antithyroid antibody and states of thyroid function and outcome following antithyroid drug treatment during 3 years of therapy. Remission was defined as a euthyroid state without clinical manifestation and presence of TRAb, while relapse was defined as the recurrence of hyperthyroidism within 12 months of no medication after antithyroid therapy at least for 3 years. RESULTS: 1) The most prevalent age group was 10 to 15 years(82.8%) and female is more prevalent than male(M : F=1 : 14). 2) Goiter, emotional instability, hyperactivity, palpitation, sweating and exophthalmos are the most common symptoms in orders.3) The detection rate of TRAb, AMA and ATA before treatment were 93.3%, 86.7% and 62.2% respectively. 4) The euthyroid state showed in 36(80.0%) of 45 patients within 8 weeks after treatment. 5) The TRAb values remained positive in 27(60.0%) of 45 patients during the first 1 year of antithyroid therapy. 6) Remission rate was 58.8%(26 cases) and relapse rate of remission cases 73.1%. CONCLUSIONS: The present study suggests that children with Graves' disease will continue to require long term clinical and laboratory assessment after discontinuation of antithyroid drug therapy.
Child* ; Diagnosis ; Drug Therapy ; Exophthalmos ; Female ; Goiter ; Graves Disease* ; Humans ; Hyperthyroidism ; Methimazole ; Recurrence* ; Sex Distribution ; Sweat ; Sweating ; Thyroid Gland

Thyroid anaplastic cancer is one of the most malignant neoplasms encountered in human. These tumors usually present as rapidly enlarging neck mass in old patients who may or may not have had a previously recognized goiter. The distant metastases of anaplastic cancer eventually occur in about 50% patients, mostly in the lung and bone and are an important prognostic factor, substantially reducing survival time.A 66-year old man visited out hospital because of rapidly growing anterior neck mass and hoarseness. He was diagnosed as thyroid anaplastic cancer with lymph node and lung metastasis and received combined chemotherapy and radiation therapy. On the 8th hospital day, severe abdominal pain developed and exploratory laparotomy was conducted. During operation, two intestinal mass were discovered, one of which was perforated. The microscopic examinations showed that undifferentiated malignant cells were infiltrated in the wall of small bowel. We report this case because we first experienced thyroid anaplastic cancer with intestinal metastasis.
Abdominal Pain ; Drug Therapy ; Goiter ; Hoarseness ; Humans ; Intestines ; Laparotomy ; Lung ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Thyroid Gland

Hashimoto's thyroiditis is an autoimmune thyroid disease characterized by a gradual enlargement of the thyroid gland, extensive lymphocytic infiltration and fibrosis of thyroid follicles. Hashimoto's thyroiditis occurs frequently in conjunction with a wide range of organ-specific and systemic autoimmune diseases. The association of chronic lymphocytic leukemia with other autoimmune diseases also has been recognized. Here, we report a case of chronic lymphocytic leukemia diagnosed by abrupt painful swelling of the thyroid gland in a 69-year-old woman with Hashimoto's thyroiditis. The painful enlargement of goiter and elevated levels of antibodies to thyroglobulin were improved after chemotherapy with cyclophosphamide, vicristine and prednisolone.
Aged ; Antibodies ; Autoimmune Diseases ; Cyclophosphamide ; Drug Therapy ; Female ; Fibrosis ; Goiter ; Humans ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Prednisolone ; Thyroglobulin ; Thyroid Diseases ; Thyroid Gland* ; Thyroiditis* ; Thyroiditis, Autoimmune

Since 1949, lithium has been widely used for treatment of manic depressive disorder. It has also been used for agranulocytosis after anticaneer chemotherapy and partially for hyperthyroidism. But it is well known that the long term administration of this drug is associated wih various antithyroid effects such as hypothyroidism, simple goiter, nodules and even thyrotoxicosis. Although the exact mechanism for leading hypothyroidism or goiter is still unknown, the incidence of lithium-induced hypothyroidism is 1-37% during lithium atment. We had an experience of newly developing goiter with or without hypothyroidism during lithium treatment in 4 MDP patients. Among our patients, the duration of lithium administration was from 0.7 months to 11 years, and the development of thyroid abnormality was impossible to predict. They were treated with thyroxine while lithium was discontinued causing favorable outcome. We suggest that routine thyroid function test include thyroid autoimmune antibody screening in patients planning to undergo lithium treatment.
Agranulocytosis ; Antithyroid Agents ; Depressive Disorder ; Drug Therapy ; Goiter* ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Lithium Carbonate* ; Lithium* ; Mass Screening ; Thyroid Function Tests ; Thyroid Gland ; Thyrotoxicosis ; Thyroxine

Medullary carcinoma of the thyroid gland(MTC) constitutes approximatesly 3% to 10% of all malignant thyroid tumors. It appears in both familial and sporadic forms. Metastases are frequently present at diagnosis and are resistant to chemotherapy and radiotherapy. Surgical resection of the primary tumor and the metastases is the mainstay of treatment. Although MTC can be detected by elevated serum calcitonin, localization of residual or metastatic foci may be difficult. Many scintigraphic methods have been used for identification of the residual tumor or metastasis. However, most of them have either low sensitivity or low specificity. MTC frequently secretes somatostatin and may express somatostatin receptors. Recently, somatostatin-receptor imaging has been known to be useful for the detection of residual and recurrent medullary thyroid carcinoma. A 25 year-old woman who was dignosed as medullary carcinoma by biopsy of thyroid mass is presented. Thirteen years ago, she underwent left thyroidectomy due to thyroid cancer(MTC). Laboratory tests revealed an increase in the levels in serum CEA(CEA=557.6 ng/ml) and calcitonin(calcitonin= 720 pg/ml). The second patient, a 30 year-old female, complained of a palpable mass in the left anterior neck. Ten years ago, she underwent a right lobectomy of thyroid gland due to adenomatous goiter. Laboratory tests revealed an increase in the levels in serum CEA(CEA=617 ng/ml) and Calcitonin (Calcitonin=2,300 pg/ml). In both cases, pre- and postoperative In-111 pentetreotide scintigraphy were done and compared with "'I scintigraphy. In-111 pentetreotide scan may be useful for the localization of residual or metastatic medullary thyroid carcinoma. Further study is warranted to define the sensitivity and specificity of the technique.
Biopsy ; Calcitonin ; Carcinoma, Medullary ; Diagnosis ; Drug Therapy ; Female ; Goiter ; Humans ; Neck ; Neoplasm Metastasis ; Neoplasm, Residual ; Radionuclide Imaging ; Radiotherapy ; Receptors, Somatostatin ; Sensitivity and Specificity ; Somatostatin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy