Background: Hyperthyroidism is a disorder of thyroid function in which body tissues are exposed to excessive amount of circulating thyroid hormone. It causes the uncontrolable homeostatic. Objectives:This study aims to learn about the results of the treatment by antithyroid and some factors influencing these results in children at National Hospital for Pediatric. Subjects and method:A descriptive, cross sectional in combination with retrospective and prospective study was conducted on 51 patients with hyperthyroidism were treated by antithyroid in the National Hospital for Pediatric from May 1995 to May 2005 and with therapy duration from 12 months upward. Result: Remission rate was 58.8% (30/51) with an average follow - up period after therapy withdrawal of 2.5 \xb1 1.6 years (13 months in minimum) and the relapse rate was 41.2% (21/51) at the age over 10 years old. The antithyroid drug discontinuation, therapy duration <3 years, stress, infection were factors influencing treatment outcome. Relapse was of 90% when therapy duration was under 3 years. Goiter size at diagnosis moment was a significant determinant factor of relapse. Conclusion: Most patients reached remission. The factors affected treatment results were age, antithyroid drug discontinuation, therapy duration, stress, infection, late treatment, goiter size.
Hyperthyroidism/ pathology ; therapy ; Child

A 63-year-old female was admitted to our hospital with a tender abdominal wall mass about 15 cm in diameter, which she had for 1 month. About 1 week earlier, the patient had also perceived a mass in the neck area. Computed tomography revealed huge thyroid and periumbilical masses. The thyroid hormone levels were consistent with a hyperthyroid state. Pathological examination of the thyroid mass was compatible with anaplastic thyroid carcinoma (ATC) and the abdominal cutaneous mass was shown to be metastatic ATC. Despite palliative radiotherapy and chemotherapy, the patient died of respiratory failure on her 63rd day of hospitalization. This case demonstrates that abdominal cutaneous metastasis and hyperthyroidism can occur as initial manifestations of ATC. To our knowledge, this is the first reported case.
Abdomen ; Female ; Humans ; Hyperthyroidism/*etiology ; Middle Aged ; Skin Neoplasms/*secondary ; Thyroid Neoplasms/pathology

Thyroid anomaly are rare embryological condition. The failure of the development of one lobe leading to unilateral agenesis is the rarest of all the thyroid anomalies, The cause of unilateral agenesis is unknown. Thyroid hemiagenes is common in females (3: 1) with the left lobe being absent. The common disease in the remaining lobe is a benign adenoma, a multinodular goiter, hyperthyroidism, chronic thyroiditis, and rarely carcinoma. The most common pathology involved in thyroid hemiagenesis is hyperthyroidism. This report the case of a 57-year-old woman with a right thyroid hemiagenesis.
Adenoma ; Female ; Goiter ; Humans ; Hyperthyroidism ; Middle Aged ; Pathology ; Thyroid Gland* ; Thyroiditis

BACKGROUNDPreparing hyperthyroid patients for thyroid surgery with a combination of antithyroid drugs and thyroxine has long been controversial because this combination usually results in only partial inhibition of thyroid function. We therefore used large doses of antithyroid drugs to completely inhibit the synthesis of thyroxine and render the thyroid gland defunctionalized. We then administered physiologic doses of thyroxine to inhibit thyroid-stimulating hormone secretion. We have named this treatment "sequential thyroid defunctionalization followed by thyroxine supplementation."

METHODSFour hundred and seventy-one hyperthyroid patients seen at our hospital were divided into experimental and control groups. The control group was treated preoperatively with antithyroid drugs and iodine preparation. The experimental group was further divided into four subgroups and treated with "sequential thyroid defunctionalization followed by thyroxine supplementation". Each of the four subgroups received different doses of antithyroid drugs and thyroxine for differing time periods. Thyroid function was assessed at each stage of treatment, as were operative blood loss volumes and postoperative complications.

RESULTSCompared to the control group, the four experimental groups showed less thyroid congestion and surface varices at surgery. Patients in subgroup A also had thyroid glands that were almost histologically normal. The mean operative blood loss volume of the experimental group was less than that of the control group (326 +/- 163) ml in the control group; (196 +/- 57) ml in subgroup A; (230 +/- 71) ml in subgroup B; (240 +/- 80) ml in subgroup C; and (312 +/- 97) ml in subgroup D). The postoperative complication rate of the experimental group was 8.64% (21/243) whereas that of the control group was 17.54% (40/228).

CONCLUSIONSSequential thyroid defunctionalization followed by thyroxine supplementation is effective in reducing the bleeding volume and postoperative complication rate in selected hyperthyroid patients undergoing thyroidectomy.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Hyperthyroidism ; physiopathology ; surgery ; Male ; Middle Aged ; Thyroid Gland ; pathology ; physiopathology ; Thyroidectomy ; Thyroxine ; administration & dosage

OBJECTIVETo study the clinicopathological features of thyrotropin-secreting pituitary adenoma (TSH adenoma).

METHODSClinical and pathological features of 7 TSH adenoma cases were studied by review of patients' medical records, light and electronic microscopy, and immunohistochemistry.

RESULTSAll seven patients presented with clinical hyperthyroidism and high levels of plasma free T3, free T4, total T3 and total T4. The levels of TSH failed to be suppressed by thyroxin administration. MRI showed macro or giant pituitary adenomas in all seven patients with tumor diameters ranging from 2.0 to 5.0 cm. Under light microscope, there were 5 cases of chromophobe cell adenoma, 1 case of acidophil cell adenoma, and 1 case of mixed acidophil and chromophobe cell adenoma. Immunohistochemical stains showed a strong positivity of TSH in all the tumors, PRL positive cells in 1 tumor, GH positive cells in 2 tumors and scattered GH and PRL double positive cells in 3 tumors. Ki-67 proliferation index ranged from 0 approximately 0.4%. P53 immunostain was negative in all tumors. After initial surgery, 2 cases had recurrences. However, the Ki-67 proliferation index was not elevated in these two tumors.

CONCLUSIONSThe histological features of TSH pituitary adenomas are heterogeneous with chromophobe as the most common subtype. Secretion of TSH was detected by immunohistochemistry in all cases. P53 mutation is not a feature of TSH adenoma and the proliferation marker, such as Ki-67, may not predict clinical behavior of the tumor. Recurrence is likely due to incomplete resection.

Adenoma ; pathology ; secretion ; Adult ; Aged ; Female ; Humans ; Hyperthyroidism ; blood ; etiology ; Ki-67 Antigen ; blood ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pituitary Neoplasms ; pathology ; secretion ; Thyrotropin ; secretion

Thyroid hemiagenesis is a development failure of one of the thyroid lobes, predominantly in females with a left lobe. The associated disease in the remaining thyroid lobe include benign adenoma, multinodular goiter, hyperthyroidism, chronic thyroiditis, and carcinoma etc. We report a very rare case of thyroid hemiagesesis with hyperthyroidism, thyroid cancer, and ectopic thymus. A 43-year-old female presented with hyperthyoidism and thyroid nodule. Thyroid scan with 99mTcO4 revealed cold nodule in left lobe with absent right lobe. The patient underwent thyroid exploration. Because nodule in the remaining thyroid lobe proved to be a thyroid cancer on frozen biopsy, total thyroidectomy was performed. There was a thyroid-like tissue at the right side (scan 'absent' side) and removed. Pathology confirmed that the removed tissue from right side was thymus. There has been no report in world literatures of such case; in one patient, thyroid hemiagenesis, hyperthyroidism, thyroid carcinoma, and ectopic thymus coexists. We report the case and review the literature on thyroid hemiagenesis and ectopic thymus.
Adenoma ; Adult ; Biopsy ; Female ; Goiter ; Humans ; Hyperthyroidism* ; Pathology ; Sodium Pertechnetate Tc 99m ; Thymus Gland* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis

We report a case of a 74-year-old woman who was incidentally found to have a single thyroid nodule. Laboratory evaluation showed undetectable serum thyroid stimulating hormone and elevated free thyroxine levels. (99m)Tc thyroid scan showed a hyperfunctioning autonomous nodule in a right lobe of the thyroid. Thyroid ultrasonography showed a 2.2 cm sized nonhomogeneous spiculated nodule with microcalcification, and which was identical with the hyperfunctioning nodule confirmed in thyroid scan by (99m)Tc single photon emission computed tomography/computed tomography. Fine needle aspiration was done, and cytology reported as suspicious of malignancy. The patient underwent total thyroidectomy with central neck dissection, and pathology was consistent with papillary thyroid carcinoma. This case report demonstrates that diagnosis of a hyperfunctioning autonomous thyroid nodule does not preclude the possibility of thyroid cancer. Clinicians should consider further evaluation such as ultrasonography and fine needle aspiration in patients with hyperfunctioning autonomous nodules.
Aged ; Biopsy, Fine-Needle ; Diagnosis ; Female ; Humans ; Hyperthyroidism* ; Neck Dissection ; Pathology ; Radionuclide Imaging ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyroidectomy ; Thyrotropin ; Thyroxine ; Ultrasonography

OBJECTIVE: The aim of our study was to evaluate the clinical, laboratory, and sonographic charac- teristics of struma ovarii. METHODS: Thirty three cases of struma ovarii were reviewed retrospectively over recent 5 years (1997- 2001). The presenting clinical, radiological, and pathological features of patients with consequent struma ovarii were compared, retrospectively. RESULTS: The mean age of the patients was 40.5 years (20-70). Eight women (24.2%) were postmenopausal. The mean tumor diameter was 7.6 cm (1.5-15) and occured more frequently (60.6%) in the right ovary. Ascites was present in 11 cases. The CA-125 level was normal in 30 cases and significantly increased in 3 cases. Fourteen patients had pelvic pressure symptoms such as lower abdominal discomfort or pain, lumbago, and some of these patients were examined because of irregualr vaginal bleeding. In asymptomatic 19 patients, the ovarian tumor was an incidental finding on routine examination. Although one of the patients had cervical thyroid nodule, preoperative and postoperative evidence of hyperthyroidism was not noted and any patients did not complained symptoms of hyperthyroidism. All of the tumors were diagnosed as benign on permanant pathology and only surgical excision was done as a definitive treatment. CONCLUSION: The presented clinical, laboratory and radiological features of patients with consquent struma ovarii were diverse. The diagnosis was only made later by strict pathological criteria and conservative treatment by tumor excision only may be sufficient.
Ascites ; Diagnosis ; Female ; Humans ; Hyperthyroidism ; Incidental Findings ; Low Back Pain ; Ovary ; Pathology ; Retrospective Studies ; Struma Ovarii* ; Thyroid Nodule ; Ultrasonography ; Uterine Hemorrhage

PURPOSE: The diagnosis of Graves' disease can be clinically made by the findings of hyperthyroidism combined with eye signs or a diffusely enlarged goiter. The pathological findings of Graves' disease are hypertrophy and hyperplasia of the thyroid follicles. Surgical treatment for Graves' disease is indicated for patients with a suspicion of cancer, a large goiter, medical failure, patient preference or severe ophthalmopathy. The aim of this study is to determine the diagnostic accuracy of clinically diagnosed Graves' disease on the basis of the postoperative pathologic findings. METHODS: We performed a retrospective analysis of the medical records of the patients who were diagnosed as having Graves' disease since Jan 2000 at St. Mary's Hospital, The Catholic University of Korea. To confirm the pathological findings in this study, the patients who underwent surgical treatment were enrolled, and their preoperative diagnostic tests were also reviewed. RESULTS: A total of 57 patients with Graves' disease underwent surgery due to medical failure in 45 (78.9%), ophthalmopathy in 25 (43.8%), huge goiter in 4 (7%), suspicion of cancer in 4 (7%), and others in 4 (7%). Thirty nine (68.4%) patients were female and total thyroidectomies were performed in 52 (91.2%) patients. The pathological reports of the thyroid specimens showed diffuse hyperplasia in 53 (92.9%), nodular hyperplasia in 2 (3.5%), Lymphocytic thyroiditis in 1 (1.8%) and Hashimoto's thyroiditis in 1 (1.8%). The diagnostic accuracy of preoperative antimicrosomal Ab, anti-TSHR Ab and a technetium 99m thyroid scan was 73.8%, 86.0% and 69.7%, respectively. Papillary carcinoma was identified in 6 patients (10.5%). CONCLUSION: The microscopic findings of 5 patients (7.0%) who were diagnosed clinically as having Graves' disease were not compatible with the criteria for a pathological diagnosis. Surgical treatment and confirmation of the exact pathology should be performed for the appropriate treatment.
Carcinoma, Papillary ; Diagnosis ; Diagnostic Tests, Routine ; Female ; Goiter ; Graves Disease* ; Humans ; Hyperplasia ; Hyperthyroidism ; Hypertrophy ; Korea ; Medical Records ; Pathology ; Patient Preference ; Retrospective Studies ; Technetium ; Thyroid Gland ; Thyroidectomy ; Thyroiditis ; Thyroiditis, Autoimmune

A 12-year-old girl presented with a history of cervical mass, and one week of throat discomfort and dyspnea. Five years ago, the patient was diagnosed as Hashimoto's thyroiditis and hyperthyroidism; she received antithyroid drug treatment, but the result was not satisfactory. B-ultrasonic showed that the size of thyroid gland was 8.1 cm×3.2 cm in the left and 8.2 cm×4.8 cm in the right. After iodine 131 combined with radiofrequency ablation (RFA) treatment, throat discomfort and recumbent breathing difficulties disappeared, and B-ultrasonic showed that the size of thyroid reduced to 2.3 cm×1.7 cm (left) and 2.8 cm×2.0 cm (right). No recurrence was observed during the two and a half years of follow-up.
Ablation Techniques ; methods ; Child ; Dyspnea ; etiology ; therapy ; Female ; Goiter ; complications ; diagnostic imaging ; pathology ; therapy ; Hashimoto Disease ; therapy ; Humans ; Hyperthyroidism ; therapy ; Iodine Radioisotopes ; therapeutic use ; Radio Waves ; therapeutic use ; Ultrasonography